Endocrine Flashcards
Causes of OP
Drugs-steroids, heparin, thyroxine, Li, phenytoin, cyclosporine
GI- malabsorption, PBC
Malnutrition
Malignancy - MM, metastatic ca, lymphoma, leukaemia
CTD- Mefans, Ehlers-danlos, OI, RA
Endo- hyperthyroid, hyperPTH, Cushings, Gh deficiency, hyperprolactin, hypogonadism
Causes of osteomalacia
- VitD deficiency - malabsorption in fat, metabolism (CKD, pseudo hypoPTH), decreased bioavailability (sunlight, nephrotic syndrome, peritoneal dialysis)
- Low Phosphate availability - antacids, hereditary, Fanconi
- NAGMA with hypokalaemia (Type 1 RTA, SS, SLE)
DEXA scan indications
Minimal trauma fracture Female >65y, male >70y Monitoring at 1 year with low BMD Prolonged steroid (10mg 3 months) Hypogonadism 1' HyperPTH, cirrhosis, CKD, Crohns, malabsorption, RA
Ix for OP
DEXA scan
Ca, PO4, vitD, ALP
Secondary causes - FBC, ESR, EUC, LFT, EPG
Endo - TFT, cortisol, testosterone in male
Xrays - loss of trabecular bone, codfish deformity, wedging
Iliac crest biopsy if Ddx OP vs osteomalacia
Mx of OP
Ca 1200-1500mg in diet
VitD for severe >25nM give 3000-5000IU 2-3 months
Cease smoking, alcohol
Bisphosphonates (>70y with BMD
Causes of hypercalcaemia
HyperPTH (adenoma, MEN) Malignancy Increased vit D (diet, sarcoidosis) High bone turnover (hyperthyroid, thiazides, vitA) CKD -> 2' hyper PTH FHH Li
Features of Pagets
Bone turnover -high ALP, bone pain, 2’ OA, height/hat size change, pathological #, bone deformity
Neuro - hearing loss, gait (cerebellar, SCC, basilar long tract), cranial n, headache
CCF
Renal Ca stones
Gout
HyperCa
Osteosarcoma (rare)
Pagets examination
Short stature, bony deformity
Skull diameter >55cm, prominent skull veins, bony warmth, bruit
Fundi -angioid streaks, papilloedema, optic atrophy, acuity, fields
CN VIII
Neck - basilar invagination (short neck, extended)
CCF
Back, hips, legs, knees *hip abd
Sarcomas (tender swelling)
UA for blood (renal stones), height
Pagets Ix
Ca
Disease activity - ALP, urinary hydroxyproline
Bone scan for eary lytic phase, bony enlargement, increased density, irregular widened cortex, cortical infarcts on convex side
CT/MRI for suspicious lesions ?sarcoma
Pagets Mx
NSAIDs for pain bisphosphonates, C, vitD Calcitonin for bony pain and neuro Sx Mithramycin IV for emergency ex. SCC Surgery ex. bowed femur/difficult mobility Sarcoma - neoadjuvant chemo then surgery
Acromegaly features
Frontal bossing, prognathism, large hands/feet Diabetes OSA CCF Hypogonadism, impotence Sweating, headache, carpal tunnel, peripheral neuropathy, paraesthesiae Myopathy Skin tags, colonic polyps Organomegaly
Acromegaly Mx
Goal is normal IGF-1 and appropriate GH suppression <1.2mIU/L by glucose suppression test
1. Long-acting somatostatin analogues - octreotide LAR 20mg SC monthly, lanreotide autogel 60mg SC monthly
Cabergoline 2nd line - usually post-surgery
2. Transsphenoidal resection of adenoma - 50-80% success, only 10% postop hypopituitarism
3. RTx 2nd line if surgery incomplete
Screening:
Cardio - TTE q5years
GI - colonoscopy
Thyroid
Metabolic syndrome - BP, lipids, BSL
MSK
T1DM antibodies
IAA
IA-2
ZnT8
GAD
Diabetes diet
Exchanges 15g carbs = 60 Cal : usually 3x per meal, 2x for snack
Carbs 50%
Protein 20%
Fat <30% (Polyunsaturated fat 10%, saturated fat <10%, cholesterol <300mg)
Fibre 30g
Diabetes history
Dx - age, Sx, Ix
Mx - Meds, insulin and admin technique
Glucose control - hyperglycaemia, hypos, admissions, monitoring, infections
Microvascular - eyes, kidneys, neuropathy, autonomic
Macrovascular - cardiac, stroke, claudication
Diet, exercise, weight
