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Endocrine Flashcards

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1
Q

What are incretins?

A

Hormones produced by the GI tract which are secreted in response to a big meal and reduce blood glucose levels. They;
- Increase insulin secretion
- Inhibit glucagon production
- Slow glucose absorption by the GI tract

Main incretin = GLP-1

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2
Q

Which enzyme inhibits incretins?

A

DPP-4 (dipeptidyl peptidase - 4)

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3
Q

Metformin

A

MOA = increases insulin sensitivity + decreases hepatic gluconeogenesis
SE = GI upset / Lactic acidosis
Contraindications = eGFR < 30

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4
Q

Sitagliptin

A

Type = DPP-4 Inhibitor (Increases levels of GLP-1)
SE = GI upset / URTI symptoms / Headaches / Inc risk of pancreatitis

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5
Q

SLGT-2 Inhibitors

A

Dapagliflozin / empagliflozin
MOA = Inhibit SGT in the PCT which increases glucose excretion.
SE = Increased UTIs/Thrust / Fourniers gangrene / Can cause DKA!
Pros = causes weight loss

*NOTE - dapagliflozin is also licensed in the management of HF.

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6
Q

Liraglutide / Exanatide

A

GLP-1 Agonists
SC Injection + also licensed for weight loss
SE = Hypoglycemia!!! N&V / GI upset / Dizziness
May increase risk of pancreatitis

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7
Q

Piaglitazone

A

Thiazolidinedione
MOA = Activates PPAR-gamma receptors in adiopcytes which increases insulin sensitivity + decreases hepatic gluconeogenesis
SE = Fluid retention / HF / CKD / Anemia / Liver dysfunction / Inc risk of bone fractures / WEIGHT GAIN / can inc risk of bladder cancer

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8
Q

Sulfonylureas

A

Gliclazide
MOA = Inhibits K+ channels on beta cells leading to insulin secretion
SE = HYPOGLYCEMIA / weight gain / Hyponatremia / bone marrow toxicity
Contraindications: avoid post MI or Renal failure

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9
Q

Which diabetic agents cause weight gain

A

Pioglitazone + sulfonylureas (gliclazide)

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10
Q

Which diabetic agents can cause DKA

A

SGLT-2 inhibitors

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11
Q

Which diabetic agents are most likely to cause Hypoglycemia

A

GLP-1 Agonists
Sulfonylureas

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12
Q

Which diabetic agents can aid weight loss

A

GLP 1 agonists + SLGT-2 inhibitors

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13
Q

Central diabetes insipidus

A

Decreased secretion of ADH from posterior pituitary

Causes = Idiopathic or secondary to pituitary surgery, head injury, haemochromatosis, CNS infection, Craniopharyngiomas .

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14
Q

Nephrogenic diabetes insipidus

A

A failure of the Collecting ducts to respond to ADH

Causes = tubulo-interstitial nephritis / Lithium therapy / avpr2 mutation / hypercalcemia / hypokalemia / Sjogren’s syndrome

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15
Q

Which cancer is hashimoto’s thyroiditis associated with?

A

MALT lymphoma

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16
Q

Hashimoto’s thyroiditis autoantibodies

A

Anti-TPO + Anti-thyroglobulin (Anti-Tg)

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17
Q

Which drug most commonly exacerbates hyperthyroidism

A

Amiodarone

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18
Q

Functions of cortisol

A

Increases alertness
Increases blood glucose
Increases metabolism
Inhibits the immune system
Inhibits bone formation

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19
Q

ABG/VBG findings in Cushing’s disease

A

Hypokalemic metabolic alkalosis + Hypernatremia

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20
Q

Blood findings in Addison’s disease

A

Hyponatremia + Hyperkalemia

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21
Q

Management of acromegaly in a patient who cannot undergo surgery

A

GH antagonists (pegvisomant)
Somatostatin analogue (Ocreotide) - inhibit GH release
Dopamine agonists (Bromocriptine)

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22
Q

Advice for pregnant women with hypothyroidism

A

Increase levothyroxine dose by 50%

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23
Q

Digoxin causes gynaecomastia, true or false?

A
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24
Q

MEN type 1

A

Parathyroid
Pituitary
Pancreas

+ Adrenal + Thyroid

Often presents as hypercalcemia (hyperparathyroidism) or recurrent hypoglycemia (insulinoma) or recurrent gastric ulcers (gastrinoma)
Mutation = MEN1 gene

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25
MEN type 2
Parathyroid Phaeochromocytoma Medullary thyroid cancer RET oncogene mutation
26
MEN type 3
Medullary thyroid cancer Pheochromocytoma Marfinoid Neuromas
27
Main side effects of carbimazole
Agranulocytosis (infections) Acute pancreatitis
28
Visual field defects seen in prolactinoma's
Bitemporal hemianopia Bitemporal superior quandrantopia
29
Hashimoto's thyroiditis antibodies
Anti-TPO
30
Grave's disease antibodies
TSH antibodies
31
First line treatment for cerebral mets
Dexamethasone
32
Hyperthyroidism management in pregnant ladies
First trimester = propylthiouracil 2nd + 3rd trimester = carbimazole
33
Diagnostic glucose measurements for diabetes
Fasting glucose >7mmol/L Random glucose >11.1 (or after OGTT)
34
Pre-diabetes glucose measurements
Fasting glucose 6.1 - 6.9 Glucose tolerance / random plasm glucose 7.8 - 11.1
35
Features unique to T1DM (not seen in T2DM)
Low C peptide Weight loss Autoantibodies Ketonuria
36
Primary Hypothyroisim
Low T4/T3 High TSH Causes; - Hashimoto's - Iodine deficiency - Lithium - Amiodarone - Overtreatment of hyperthyroidism
37
Secondary hypothyroidism
Low T4/T4 Low TSH Causes; - Pituitary adenoma - Pituitary surgery / trauma / radiotherapy - Sheehan's syndrome
38
Myxoedema coma
Severe hypothyroidism leading to decreased conciousness + coma
39
Management of myxoedema coma
IV fluids IV levothyroixine IV hydrocortisone
40
Sick Euthyroidism
T3/T4 low TSH = innapropriately low / normal Pt will typically have pneumonia / other illness at the same time
41
Grave's disease Features
Autoimmune hyperthyroidism - Bilateral expothalmus - Opthalmoplegia - Pretibial myxoedema - Acropacy (clubbing) May have a gotire Scintigraphy shows increased uptake
42
Gotire with firm nodules and scintigraphy reveals patchy uptake
Multinodular goitre
43
Painful gotire with reduced, patch iodine uptake on scintigraphy
De quervain's thyroiditis
44
De quervain's thyroiditis
Initially causes a transient hyperthyroidism and then hypothyroidism. Usually caused by a viral infection.
45
Medical management of hyperthyroidism
1st line = Carbimazole 2nd line = Propylthiouracil Symptomatic relief with beta-blockers Radioactive iodine if multinodular goitre
46
Thyrotoxic storm
Acute severe form of hyperthyroidism Sx = hyperpyrexia + tachycardia + agitation Tx = propylthiouracil + hydrocortisone + propanolol ECG may show lateral T wave inversion
47
Most common type of thyroid cancer
Papillary
48
Management of papillary / Follicular thyroid cancers
Total thyroidectomy + radioiodine Yearly TFTs/Calcitonin levels (as thats how a medullary one would present)
49
Causes of Hypoparathyroidism
Primary = usually due to thyroidectomy (Hypocalcemia + Low PTH + high phosphate) Pseudo-hypoparathyroidism = resistance to PTH (would cause a hypocalcemia + raised PTH)
50
Symptoms of hypocalcemia
Tetany Peri-oral parasthesia Trousseau's sign - BP cuff Chvostek's sign - parotid gland
51
Causes of cushing's syndrome
1. Exogenous steroid use (primary adrenal excess) 2. Cushing's disease (pituitary adenoma - secondary adrenal excess) 3. Adrenal adenoma (primary) 4. Paraneoplastic syndrome (ectopic ACTH release)
52
Clinical Features of cushings
Round moon face Central obesity Proximal limb muscle wasting Buffalo hump Abdominal striae HTN + Cardiac hypertrophy + Hyperglycemia can all occur from high cortisol
53
Investigations & Findings in Cushing's.
1st line = dexamethasone suppression test. Low dose = no supression of cortisol High dose = allows you to determine the cause of the cushing's - Cortisol + ACTH are suppressed = Cushing's disease - Just ACTH suppressed = Adrenal adenoma - Neither suppressed = Ectopic cause (SCLC)
54
Causes of Adrenal Insufficiency
Primary = Addison's disease Secondary = Pituitary surgery/inf/radiation/sheehan's Tertiary = Long term steroid use (can suppress the hypothalamus)
55
Presence of what clinical feature indicates a primary adrenal insufficiency rather than secondary/tertiary
Hyperpigmentation - as this suggests raised ACTH
56
1st line investigation for adrenal insufficiency
Short syncathen test (ACTH stimulation test) = Failure for cortisol to rise
57
Which antibodies are seen in Addison's disease
Adrenal cortex antibodies + 21-hydrozylase antibodies
58
Management of addison's disease
Hydrocortisone Fludrocortisone
59
Addisonian crisis presentation + management
Reduced consciousness severe hypotension Hyponatremia + Hyperkalemia Hypoglycemia Management = IV hydrocortisone + IV fluids + IV dextrose - monitor + treat hyperkalemia as required
60
Medical Management of acromegaly
Pegvisomant (GH antagonist) Octreotide (Somatostatin analogue)
61
Causes of Hyperaldosteronism
Primary; - Bilateral adrenal hyperplasia - Conn's syndrome (adrenal adenoma) - Familial hyperaldosteronism Secondary; - Renal artery stenosis /obstruction - HF
62
How to differentiate between causes of hyperaldosteronism
Renin:Aldosterone ratio in primary there is a Low renin + high aldosterone In secondary there is a high renin + high aldosterone
63
Blood/ABG/VBG findings in Hyperaldosteronism
pH = Alkalosis Hypokalemia
64
Symptomatic relief of hyperaldosteronism
Spirinolactone
65
Causes of SIADH
Ectopic production - paraneoplastic syndrome (SCLC, Pancreatic + prostate cancer) Meds - thiazides, NSAIDs etc Neurological - stroke, head injury etc Infection Post op
66
Diagnostic findings of SIADH
High urine sodium + High urine osmolality + Hyponatremia + Euvolemia
67
Tolvaptan
ADH receptor blocker
68
Histology of papillary thyroid cancer
Cells with empty nuclei Orphan annie eyes Psammoma bodies (ca deposits in papillary cells)
69
Waterhouse Friedreichsen syndrome
Severe adrenal failure due to severe infection (often neisseria meningitis) Essentially causes severe addisonian crisis + DIC + Shock
70
Increased uptake on scintigraphy in a well defined sphere shape
Most likely a thyroid adenoma - grave would cause a more diffuse increased uptake and a multinodule goitre causes patchy uptake
71
Which insulin is used in an insulin pump
Insulin lispro
72
What would an ECG of hypocalcemia show
Isolated QTc elongation *can occasionaly cause torsades de pointes but not as common as QT elongation.
73
Causes of hypophosphatemia
DKA Alcohol excess Acute liver failure Refeeding syndrome Primary hyperparathyroidism Osteomalacia Consequences = Haemolysis + WBC dysfunction + Muscle weakness + Rhabdomylosis + CNS dysfunction.
74
Management of hypophosphatemia in DKA
Hypophosphatemia is a common complication of insulin therapy in DKA (as it causes an intracellular shift of phosphate). You should never stop the insulin infusion because of this, just transfuse some phosphate if its severe (i.e levels < 0.3)
75
What type of malignancy is associated with Hashmimoto's thyroiditis
MALT lymphoma
76
Treatment of acute severe symptomatic hyponatemia
Hypertonic saline solution (e.g 3% Sodium chloride)
77
Treatment of acute severe symptomatic hyponatemia
Hypertonic saline solution (e.g 3% Sodium chloride)
78
Central pontine myelinolysis
Occurs from rapid correction of hyponatemia (too fast) leading to brainstem damage. Features = spastic quadriparesis, Pseudobulbar palsy and emotional lability. If severe can lead to confusion, coma and even locked in syndrome.

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