Diabetic/ endocrine Flashcards
Diabetic med to not cause hypos?
Pioglitazone
SE: Hf, Weight gain, fractures, bladder cancer
Gliclazide is a ?
Sulfonylurea (surlf and glide):
SE: weight gain, hypoglycaemias, decrease warfarin effect (PCBRAS), caution in renal impairment for sulfonylureas. Gliclazide is metabolised in liver.
Pioglitazone is a?
no hypos, has heart failure, weight gain, fractures,thiazolidinedione, works by increasing insulin sensitivity
Sitagliptin is a?
sit on 4 legs
DPP4inhibitor. small risk pancreatitis. linagliptin is renal safe. reduce the peripheral breakdown of incretins such as GLP-1
What is SGLT2?
dapagliflozin - flows through urine. hypos. used for heart failure after metformin established or as monotherapy if CI to metformin. recurrent UTIs, fournier’s gangrene
Dx of diabetes
FBG 7+ or random 11.1+ x2 in asymptomatic
Sx- Hba1c 48+
Dx of IFG?
FBG 7.1 - 7 do OGTT
OGTT <7 then post glucose 7.8-11.1
Pernicious anaemia, DM, High TSH, low t4?
Hashimotos (common), painless goitre
DM2 - 2nd line/ dual therapy?
metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)
DM2 tripple therapy options?
metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment
Normal T3/T4 TSH is 5.7. Mx?
Subclinical hypothyroidism.
if TSH 5.5-10 (x2 3 months apart, with sx, <65YO) then trial 6 months levo
If TSH 10+ then consider levothyroxine (if x2 3 months apart)
When to consider GLP1 mimetic?
BMI 35+, psyhcosocial issues related to obesity. BMI < 35 and occupational related. Only keep on if WL 3% in 6 months and if Hba1c reduces by 11.
Works by increase insulin secretion and inhibit glucagon secretion
Aldosterone: renin test:
High aldosterone, low renin meaning? HTN, low K, alkalosis?
main causes?
Primary hyperaldosterone. Adrenal gland makes too much, suppressed renin bc high BP.
Bilateral adrenal hyperplasia (most common)
Adrenal adenoma secreting aldosterone (Conn’s syndrome)
Familial hyperaldosteronism (rare)
HTN, low K+, alkalosis?
Aldosterone: renin test: High aldosterone, High renin meaning?
TX?
Secondary hyperaldosteronism.
Excessive renin is released due to disproportionately lower blood pressure in the kidneys, usually due to:
Renal artery stenosis -doppler USS, Ct angio, MRA
Heart failure
Liver cirrhosis and ascites
TX: percutaneous renal artery angiogrplasty
Sx of HTN, low K, alkalosis? other IX?
Hyperaldosteronism - do aldosterone:renin ratio.
Do CT adrenals, renal artery imaging, adrenal venous sampling
Short synacthen test - Cortisol does not double after synacthen given (ACTH). ACTH is high
primary adrenal insufficiency.
Pituitary is producing lots of ACTH, cortisol is not released for neg feedback. destruction to adrenal cells - addisons
Short synacthen test - cortisol is low and ACTH is also low
ACTH level is low in secondary adrenal failure. Low ACTH release due to pituitary gland damage - trauma, sheehan’s, tumour.
What is tertiary adrenal insufficiency cx?
Failure of adrenals due to low CRT from hypothalamus due to long term suppression from exogenous steroids.
headache, sweating and palpitations HTN IX? TX?
Do urinary metanephrines
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers
Pre DM values?
HBa1c 42-47
FBG 6-7
Impaired glucose intolerance values?
OgTT <7 then 7.8-11.1
FBG 6.1-7
What is glimerperide
sulfonylurea
Kallman’s syndrome/ klinfelter’s syndrome levels of hormones?
Kallman - low FSH/LH and low testosterone
Kleinfelter’s - high FSH and LH, low test (small testes, tall, gynacomastia)
Confusion, hypothermia, non pitting oedema, dry skin, course hair?
Myxoedema coma
Why does hypercalcaemia cause peptic ulcers ad HTN?
increased gastrin production and vasoconstrion. Also AF: pancreatitis, MEN 1 and 2
Raised calcium, low phosphate, Normal/ raised PTH?
when would you conservatively manage?
Primary hyperparathyroidism. caused by pituitary tumour
conservative mx: if Ca is less than 0.25, patient 50YO+ , no evidence of organ damage trial calcimimetic (cinacalcet)
Acromegaly: if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms, then treatment is?
Octreotide
Secondary hyperparathyroidism presents?
High PTH, Low/ normal Ca.
Low Ca caused by CKD, vitamin D deficiency, positive feedback.
Tertiary parathryoidism presents as?
Chronic CKD, low vit D, increased PTH production to compensate, leads to hyperplasia of parathyroid gland. (Secondary to tertiary) hyperplasia remains
Causes of SIADH mnuemonic?
IX:
Explain SIADH?
post pit releases ADH (and ectopic) so collecting ducts, H20 retention, Na dilutional low in blood. urine more concentrated.
SCEPTICS - for P its the cancers and for T its the lung pathology starting with TB. I’ve done lung cancer SCC twice as its a big one
SSRI/TCA
Carbamaz
Encephalitis/Meningitis
Prostate/Panc/Lung
TB/Pneumonia/SCC Lung
Intracranial - Stroke/SAH/Subdural
Cyclophosphamide/Vincristine
Sulphonureas
IX- exclude other cx of hyponatraemaia. do short synacthen to exlude adrenal insufficiency. CXR
Sulfonylureas profile?
increase insulin secretion from pancreas.
risk -hypos, SIADH CI breastfeed and pregnancy, bone marrow suppression
Hypercalcaemia causes?
main cause in hospitalised and non-hospitalised?
Hyperparathyroidism
malignancy in hospitalised patients
Other: sarcoid, thyrotoxicosis, acromegaly, thiazide, pagets, addisions, vit D intoxication, milk-alkali syndrome, thiazides, dehydration
Confusion, post CT contrast/ trauma/ with jaundice, fever, N+V, heart failure, Graves disease Hx? DX?
TX?
Thyrotoxic storm - TX
treatment of underlying precipitating event
beta-blockers: typically IV propranolol
anti-thyroid drugs: e.g. methimazole or propylthiouracil
Lugol’s iodine
dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
What tablet reduces the absoption of levothyroxine?
Ferrous sulphfate/ calcium carbonate. should be given 4 hrs apart.