Endocrine Flashcards
(41 cards)
Does Hashimoto’s cause hyper or hypothyroidism?
What type of goitre?
Autoimmune. Hypothyroidism (although RARELY may be 6-12 months of thyrotoxicosis in acute phase)
Firm, non-tender goitre.
What antibodies would you expect in Hashimoto’s?
Anti-thyroid peroxidase and anti-Tg antibodies.
What would a viral infection followed by hyperthyroidism suggest>?
Subacute (De Quervain’s) thyroiditis.
What are the 4 typical phases of De Quervain’s thyroiditis?
1: (3-6 weeks): Hyperthyroidism, painful goitre, raised ESR
2: (1-3 weeks) Euthyroid
3: (weeks-months) Hypothyroidism
4: Structure and function -> normal.
What is the Mx of De Quervain’s thyroiditis?
Usually self-limiting. Most patients do not require treatment.
Thyroid pain may respond to NSAIDs
Steroids used in more severe cases.
What glucose results are needed to diagnose T2 DM?
If symptomatic:
- Fasting 7+
- Random/after OGTT: 11.1 +
If asymptomatic: same criteria, on two occasions.
What is impaired fasting glucose?
Fasting glucose: 6.1-6.9
Offer OGTT
What is impaired glucose tolerance?
Fasting plasma glucose: <7 and OGTT 2-hour value 7.8-11
What HbA1c value would be diagnostic of diabetes?
48+mmol/mol (6.5%)
NB. Value below this doesnt exclude, its not as sensitive as fasting samples.
When would you not be able to use HbA1c in diabetes diagnosis?
Increased RBC turnover:
- Haemoglobinopathies
- Haemolytic anaemia
- Untreated iron deficiency anaemia
- Suspected gestational diabetes
- Children
- HIV
- CKD
- Meds that may cause hyperglycaemia, ie. steroids.
How do you adjust steroid dosage in Addison’s patient with acute illness?
Double hydrocortisone dose, same fludrocortisone dose
What is the typical drug mx of Addison’s disease?
Hydrocortisone (= glucocorticoid) (in 2/3 doses, majority in morning dose)
Fludrocortisone (=mineralocorticoid)
In the context of acute illness, what would low T3/4 and normal TSH suggest?
Sick euthyroid syndrome.
May also get rise in cortisol as normal stress response to infection
What important advice would you give a patient statin carbimazole?
Attend for medical review if develop any infection symptoms - check neutrophil count on FBC.
- Rare SE of drug is agranulocytosis.
What are the ‘sick day rules’ in DM?
- Increase frequency of glucose and ketones readings to at least 4 hourly
- Increase fluid intake, aim for >3L in 24hrs
- If unable to eat, may need sugary drinks to maintain carb intake
- Take medications as normal, except metformin if becoming dehydrated (renal function)
Which DM drug is CI if hx of bladder ca?
Pioglitazone
What are the criteria for starting a GLP1 mimetic (e.g. exenatide)?
BMI >35 and specific health problems associated with obesity
BMI <35 if insulin therapy would have significant occupational implications/ weight loss would benefit other obesity related comorb.
Give 4 drugs that can lead to raised (P)rolactin?
Phenothiazines (-azine)
MetocloPramide
DomPeridone
HaloPeridol
What is the first-line mx of cerebral metastases?
High-dose dex
Release of which 3 hormones is reduced in the stress response?
- Insulin
- Testosterone
- Oestrogen
What are the features of MEN 2B?
- Mucosal neuroma
- Medullary thyroid carcinoma
- Phaeochromocytoma
- Marfanoid appearance
What are the features of primary hyperaldosteronism?
- HTN (refractory)
- Hypokalaemia
- Alkalosis
What is the mx of prolactinomas?
1: Medical - dopamine agonists e.g. bromocriptine
2: Surgery - trans-sphenoidal
What DM drugs would you use in end-stage renal failure?
Metformin is CI
Use a Glicazide
