1. transphenoidal surgery 2. medical rx (if inoperable or unsuccessful surgery) - somatostatin analogue e.g. octreotide - GH receptor antagonist e.g. pegvisomant - dopamine agonists e.g. bromocriptine

endocrine Flashcards by S K

1st line for pain in diabetic neuropathy

duloxetine

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Addisons electrolyte derangement

hyponatraemia
hyperkalaemia

+ hypoglycaemia

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what would cause LOWER than expected levels of HbA1c

conditions with reduced RBC lifespan

sickle cell
G6PD deficiency
hereditary spherocytosis
haemodialysis

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what would cause HIGHER than expected levels of HbA1c

conditions causing increased RBC lifespan

B12/ folic acid deficiency
iron deficiency anaemia
splenectomy

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drug causes of raised prolactin (galactorrhoea) (4)

metoclopramide, domperidone
phenothiazines (e.g. prochlorperazine)
haloperidol
very rare: SSRIs, opioids

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levothyroxine interactions (2)

what happens?

how to prevent this?

iron
calcium carbonate

levothyroxine absorption is reduced

give at least 4hrs apart

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which T2DM medication is CI in heart failure?

why?

pioglitazone

causes fluid retention

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Cushing’s syndrome blood gas results

hypokalaemic metabolic alkalosis

excess cortisol –> Na and water retention

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ix for Addisons

short Synacthen test

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drug causes of gynaecomastia (6)

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

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which class of medications reduces hypoglycaemic awareness?

Beta blockers

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sick euthyroid syndrome blood results

low T3/T4
normal TSH

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levothyroxine starting dose

25mcg in elderly or IHD
otherwise 50mcg

1.6 microgram per kilo

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how long after changing levothyroxine dose should thyroid bloods be re-checked?

8-12 weeks

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how much should levothyroxine be changed in pregnancy?

25-50mcg increase

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SE of levothyroxine: (4)

hyperthyroidism (due to over-rx)
reduced bone mineral density
worsening of angina
AF

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acromegaly mgt:

transphenoidal surgery
medical rx (if inoperable or unsuccessful surgery)

somatostatin analogue e.g. octreotide
GH receptor antagonist e.g. pegvisomant
dopamine agonists e.g. bromocriptine

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acromegaly cx (4)

HTN
DM
cardiomyopathy
colorectal cancer

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C-petide levels in T1DM
high or low?

LOW

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T2DM dx if pt sx:

fasting glc > or equal to 7
random glc >11 (or after OGTT)

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T2DM dx in asx pt:

on 2 separate occasions:
fasting glc > or equal to 7
random glc >11 (or after OGTT)

or HbA1c 48 or more on 2 occasions

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HbA1c cut off for dx of diabetes

(on 2 occasions if asx)

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HbA1c suggestive of pre-diabetes

42-47

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HbA1c target in:

i. diabetes
ii. diabetic on 1 drug which lowers glc
iii. diabetic already on 1 drug but HbA1c risen to 58

i. 48
ii. 53
iii. 53

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HbA1c level at which to add further drug:

impaired fasting glc definition:

6.1- 7.0 mmol/l if impaired fasting glc offer OGTT to rule out DM

impaired glc tolerance definition

fasting plasma glucose < 7.0 mmol/l & OGTT 2-hour value 7.8 - 11.1 mmol/l

T2DM mgt 1st line

T2DM 2nd and 3rd line mgt

metformin how does it work? (2)

increases insulin sensitivity decreases hepatic gluconeogenesis

metformin SE (2)

lactic acidosis GI upset

sulphonylureas example

gliclazide

sulphonylureas how do they work?

stimulate pancreatic B cells to secrete insulin

sulphonylureas side effects (4)

hypoglycaemia increased appetite & weight gain (most common) SIADH cholestasis and liver dysfunction

pioglitazone (a thiazodinedione - the only thiazodinedione) how does it work?

activates PPAR - gamma receptors in adipocytes to promote adipogenesis and increase fatty acid uptake

pioglitazone (a thiazodinedione - the only thiazodinedione) side effects: (4)

oedema/ fluid retention weight gain liver dysfunction fractures

DPP-4 inhibitors examples?

drugs ending in ________gliptin

DPP-4 inhibitors how do they work?

increase incretin levels to inhibit glucagon secretion

DPP-4 inhibitors SE (1)

pancreatitis

SGLT-2 inhibitors examples:

drugs ending in _______glifozin

SGLT-2 inhibitors how do they work?

inhibit glucose reabsorption by the kidneys

SGLT-2 inhibitors SE: (3)

normoglycaemic DKA weight loss glucosuria (and therefore thrush/ balanitis)

GLP-1 agonists examples

drugs ending in _________tide

GLP-1 agonists how do they work?

incretin mimetic

GLP-1 agonists SE (3)

weight loss N&V pancreatitis

thyroid storm mgt: (4)

1. beta-blockers: typically IV propranolol 2. anti-thyroid drugs: e.g. methimazole or propylthiouracil 3. Lugol's iodine (delay 1-4 hrs from administration of anti-thyroid drugs) 4. dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3

primary hyperparathyroidism: i. PTH ii. calcium iii. phosphate

i. normal or raised ii. raised iii. low

acromegaly ix (3)

1. IGF -1 if raised: 3. 2. OGTT & 3.serial GH measurements to confirm dx

prolactinoma presentation in women (4)

amenorrhoea infertility galactorrhoea osteoporosis

prolactinoma presentation in men (3)

impotence loss of libido galactorrhoea

macroadenoma (big prolactinoma) presentation (3)

headache. visual disturbances (classically, a bitemporal hemianopia (lateral visual fields) or upper temporal quadrantanopia) symptoms and signs of hypopituitarism

prolactinoma mgt:

benign pituitrary mass 1. dopamine agonists e.g. cabergoline, bromocriptine 2. surgery if fail to respond to medical rx

Cushing's most common cause

pituitary adenoma (80%)

pheochromocytoma what is it?

catecholamine secreting tumour of adrenal medulla 10% rule: - bilateral in 10% malignant in 10% extra-adrenal in 10%

pheochromocytoma features: (5)

TRIAD 1. HTN (but postural hypotension) 2. headache 3. fever Also: weight loss fatigue, flushing

pheochromocytoma ix: (3)

1. plasma metanephrines followed by urinary metanephrines 2. adrenal imaging (CT/MRI) 3. PET scan/ MIBG for extra-adrenal

pheochromocytoma mgt:

1. alpha blocker (e.g. phenoxybenzamine) then beta blocker (e.g. propranolol) 2. surgery (definitive)

primary hyperaldosteronism causes: (5)

1. idiopathic bilateral adrenal hyperplasia (more common, 60-70% of cases) 2. Conn's syndrome (adrenal adenoma) others: unilateral hyperplasia familial hyperaldosteronism adrenal carcinoma

primary hyperaldosteronism features:

HTN hypokalaemia (e.g. muscle weakness) metabolic alkalosis

primary hyperaldosteronism ix:

aldosterone/ renin ratio CT abdomen and AVS (adrenal venous sampling) - to distinguish between unilateral and bilateral hyperplasia

primary hyperaldosteronism mgt:

if: - adrenal adenoma: surgery (laparoscopic adrenalectomy) - bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

endocrine Flashcards

(61 cards)