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Flashcards in Endocrine Deck (43):
1

Management of hypocalcaemia

Acute:
Calcium gluconate

Maintenance:
Calcitriol + calcium carbonate/citrate

2

Management of hyperkalaemia

Calcium gluconate
Sodium bicarbonate (used in metabolic acidosis)
Insulin + glucose (used in CKD)
Sodium/calcium polystyrene sulfonate (to remove from bowel lumen)

3

Management of hyperphosphataemia

Calcium carbonate

4

Management of hypercalcaemia

Sodium chloride (for rehydration)
Bisphosphonates
Prednisolone (in vitamin D toxicity)

5

Management of hypokalaemia

Oral potassium supplements
IV potassium chloride
Potassium-sparing diuretics – spironolactone, amiloride (for maintenance)

6

Management of hyponatraemia

Fluid restriction
Sodium chloride

7

Management of hypernatraemia

Oral fluid replacement
5% dextrose infusion

8

Management of Addisonian crisis

Hydrocortisone + IV fluids

9

What is Addison's disease?

Primary adrenal insufficiency

10

What is Conn's disease?

Primary hyperaldosteronism

11

Causes of Conn's disease

Adrenal adenoma (80%)
Bilateral adrenal hyperplasia (10%)
Adrenal carcinoma
Unilateral adrenal hyperplasia

12

What is Cushing's syndrome?

Hypercortisolism

13

Causes of Cushing's syndrome

Iatrogenic
ACTH-secreting pituitary adenoma (Cushing's disease)
Cortisol-secreting adrenal adenoma/hyperplasia/carcinoma
ACTH-secreting ectopic tumour (e.g. SCLC)

14

Signs of Cushing's syndrome

CUSHINGOID:
Cataracts
Ulcers
Skin – striae, thinning, bruising, acne
Hirsutism, hypertrichosis, buffalo hump
Increased blood pressure
Necrosis
Glucose intolerance
Osteoporosis, central obesity
Immunosuppression
Different face (moon-like facies, plethora)

15

Dexamethasone suppression test

Low dose:
Suppression = normal
No suppression = Cushing's syndrome

High dose:
Suppression = Cushing's disease
No suppression = other cause

16

Causes of hypercalcaemia

Metabolic:
-Hyperparathyroidism (primary - parathyroid adenoma, secondary - response to hypercalcaemia in CKD)
-Vitamin D intoxication
-Hyperthyroidism
-Sarcoidosis
-Milk-alkali syndrome

Malignant:
-Breast cancer
-SCC of lung
-Multiple myeloma
-Bone metastases

Congenital:
-Familial hypocalciuric hypercalcaemia

Drugs:
-Lithium
-Thiazides

17

Clinical features of hypercalcaemia

-Stones - polyuria, polydipsia, nephrolithiasis
-Bones - bone pain, osteoporosis, arthritis
-Abdominal moans - constipation, N/V, peptic ulcers, abdominal pain, anorexia, pancreatitis
-Psychic groans - depression, lethargy, weakness, confusion, coma, impaired memory

18

Clinical features of hyperthyroidism

GTFO THYROIDISM:
-Goitre
-Tremor
-Fine, brittle hair
-Ophthalmoplegia - NO SPECS:
*No signs
*Only signs - lid lag, lid retraction
*Soft tissue - periorbital swelling, conjunctival infection, chemosis
*Proptosis
*Extraocular (diplopia)
*Corneal abrasions
*Sight loss
-Thirst
-Heart - tachycardia, AF, palpitations, hypertension
-Yawning (fatigue)
-Reduced weight with increased appetite
-Oligo/amenorrhoea
-Intolerance to heat
-Diarrhoea
-Irritability, restlessness
-Sweating
-Muscle weakness

19

Signs of thyroid malignancy on U/S

Hypoechogenicity
Microcalcifications
Increased vascular flow
Irregular borders
Absence of halo

20

Causes of hypocalcaemia

Metabolic:
-Vitamin D deficiency
-Hypoparathyroidism (iatrogenic, congenital, autoimmune, infiltrative)
-Hypomagnesaemia (malnutrition, PPI/thiazides/loop diuretics, alcohol, IBD, coeliac disease, DKA)
-Hypermagnesaemia (renal failure)
-Hyperphosphataemia (renal failure, hypoparathyroidism)

Systemic:
-Sepsis
-Burns
-Renal failure
-Acute pancreatitis
-Rhabdomyolysis
-Tumour lysis syndrome
-Hyperventilation
-Blood transfusions

Drugs:
-Bisphosphonates
-Calcitonin

21

Order of pituitary hormone loss

GH, LH, FSH, TSH, ACTH, prolactin

22

Myxoedema coma

-Decompensated hypothyroidism, usually in older women with long-standing, undiagnosed or undertreated hypothyroidism
-Precipitated by infection, cold, disease or drugs
-Causes altered mental state and hypothermia
-Treated with T3 and active warming

23

Stages of diabetic retinopathy

Early - microaneurysms, blot haemorrhages, hard exudates
Diabetic maculopathy - macular involvement
Background retinopathy - macular sparing
Pre-proliferative retinopathy - cotton-wool spots, venous loops and beading
Proliferative retinopathy - neovascularisation

24

Frequency of eye monitoring in DM

If normal - every 2 years
Identified retinopathy, long duration DM or high HbA1c - every year

25

Frequency of foot monitoring in DM

If normal - every year
Identified abnormalities - every 3-6 months

26

Screening of diabetic nephropathy

Every year:
-Albumin/creatinine ratio (spot random urine sample)
-eGFR

27

Osteoporosis vs. osteomalacia

Osteomalacia: painful; risk factors include limited sun exposure and renal failure; low vitamin D, phosphate and calcium, and high ALP and PTH

Osteoporosis: painless until fracture; risk factors include age and glucocorticoid use; normal metabolic levels

28

Risk factors for osteoporosis

Age, female, FHx
SHATTERED:
-Steroid use
-Hyperthyroidism, hyperparathyroidism, hypercalcaemia
-Alcohol, smoking, sedentary lifestyle, caffeine
-Thin (BMI

29

DXA scan interpretation

Normal: T ≥ -1
Osteopenia: -2.5

30

Management of osteoporosis

Lifestyle:
-Dietary calcium
-Exercise
-Smoking cessation
-Sunlight exposure

Falls prevention:
-Exercise
-Well-fitting, slip-resistant shoes
-Vision
-Blood pressure
-Sensory loss
-Medication review
-Chronic diseases - Parkinson's, OA, DM
-Cognitive status
-Environment - lighting, clutter, grab rails, shower chair

Medications:
-Calcium + vitamin D
-Bisphosphonates (alendronate) (PO)
-Denosumab (SC)
-Teriparatide (SC)
-Strontium ranelate (PO)
-Raloxifene (PO)

31

Pathophysiology of Paget's disease

Intense focal bone resorption and cavity formation
Deposition of structurally abnormal bone in cavities
Chronic sclerosis

32

Blood results in Paget's disease

Elevated ALP and ESR/CRP
Normal calcium and vitamin D

33

MEN-1 syndrome

3Ps (1 letter):
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell tumour

34

MEN-2 syndrome

PMP (2 letters):
Parathyroid hyperplasia
Medullary thyroid cancer
Phaeochromocytoma

35

Features of papillary thyroid cancer

Orphan Annie analogies:
-Slow-growing
-Good prognosis (well behaved)
-Orphan Annie nuclei (cleared out appearance)
-Psammoma bodies (Greek psammos = sand; Annie's dog is Sandy)

36

Diagnosis of DM

FBG ≥7.0 mmol/L
RBG ≥11.1 mmol/L
OGTT 2-hr ≥11.1 mmol/L
HbA1c ≥6.5%

37

Glycaemic targets

HbA1c ≤7%
Fasting/preprandial BSL 6-8 mmol/L
Postprandial BSL 6-10 mmol/L

38

Management of DKA

BLS
SPIDEER:
-Saline
-Potassium
-Insulin
-Dextrose
-Embolism (heparin)
-Eat nothing (NPO)
-Reason (treat cause)

39

Clinical features of hypoglycaemia

TIREDD:
-Tachycardia, palpitations
-Irritability, anxiety
-Restlessness
-Excessive hunger
-Depressed conscious state
-Diaphoresis, pallor

40

Management of hypoglycaemia

Conscious, alert - sweetened fluids or glucose tablets
Conscious, drowsy - IV dextrose
Unconscious - IM glucagon

41

Hypoglycaemic unawareness

Absence of symptoms

Contributing factors:
-Autonomic neuropathy (reduced adrenaline secretion)
-Brain desensitisation (after frequent episodes)
-Beta blockers (blunted effect of adrenaline)

42

Blood pressure target in T2DM

≤130/80 mmHg with ACEIs

43

Secondary prevention of T2DM

Glycaemic targets
Lipid targets
Blood pressure target