Endocrinology

Question 1

What viruses can trigger T1D?

Answer 1

Coxsackie B and enterovirus

Question 2

What is a normal glucose range?

Answer 2

4.4-6.1

Question 3

How does hyperglycaemia present?

Answer 3

Polyuria
Polydipsia
Weight loss

(bedwetting and recurrent infections)

Question 4

What tests should be done for T1DM?

Answer 4

FBC, U+E, Lab glucose
HbA1C
Thyroid function
Anti-TTG (Coeliac)
Insulin/islet/Anti-GAD Abs (pancreatic destruction)

Question 5

Name a type of long acting insulin

Answer 5

Lantus

Question 6

Name a short acting insulin

Answer 6

Actrapid

Question 7

How does hypoglycaemia present?

Answer 7

hunger, tremor, sweating, confusion, pale, dizziness

Question 8

In hospital setting how does you treat hypoglycaemia?

Answer 8

IV dextrose and IM glucagon

Question 9

How do you treat DKA?

Answer 9

Fluid resus followed by fixed rate insulin

Question 10

What do you need to be aware of in DKA treatment?

Answer 10

Potassium levels, hypokalaemia

Cerebral oedema

Question 11

How does cerebral oedema present?

Answer 11

Headache, confusion, altered behaviour, bradycardia

Question 12

What is primary adrenal insufficiency?

Answer 12

Addison’s - damaged adrenal gland with decreased cortisol and decreased aldosterone

Question 13

What is secondary adrenal insufficiency?

Answer 13

Damaged pituitary (caused by infection, congenital, radiotherapy, etc)
Not enough ACTH released
Adrenal glands aren’t stimulated enough
Not enough cortisol produced in adrenal glands

Question 14

What causes tertiary adrenal insufficiency?

Answer 14

Inadequate CRH from hypothalamus as a result of long term steroid use suppressing the hypothalamus

Question 15

What are the symptoms and signs of adrenal insufficiency?

Answer 15

Lethargy, vomiting, hypoglycaemia, jaundice, failure to thrive.
Bronze pigmentation (in Addison's only as there's an increase in ACTH which then stimulates melanocytes).

Question 16

What is a test for Addison’s?

Answer 16

Short Synacthen Test (ACTH stimulation test - if cortisol doesn’t rise less than double the baseline then positive test)

Question 17

What investigation results are expected in Addison’s?

Answer 17

Low cortisol
Low aldosterone
High ACTH
High Renin

Question 18

What results are expected in 2’ Adrenal Insufficiency tests?

Answer 18

Low cortisol
Normal aldosterone
Low ACTH
Normal renin

Question 19

How are adrenal insuff treated?

Answer 19

Hydrocortisone - cortisol

Fludrocortisone - aldosterone

Question 20

How does Addisonian Crisis present?

Answer 20

Reduced consciousness + hypotension

Hypoglycaemia, hyponatraemia, hyperkalaemia.

Question 21

How do you manage a Addisonian Crisis?

Answer 21

IV hydrocortisone
IV fluid resus
Correct hypoglycaemia

Question 22

What is Congenital Adrenal Hyperplasia?

Answer 22

Congenital deficiency of 21-hydroxylase enzyme

This causes a decrease in the production of cortisol and aldosterone from progesterone and an overproduction of testosterone from progesterone.

Question 23

What signs + symptoms in CAH?

Answer 23

Female: ambiguous genitalia

After birth: Hypoglycaemia, hyponatraemia and hyperkalaemia.

Could see bronzing from increased ACTH due to cortisol decrease.

Question 24

What is the pathophysiology of Growth Hormone Deficiency?

Answer 24

Damage to anterior pituitary which stimulates the release of ILGF-1 by the liver.

Question 25

What are congenital causes of GHD?

Answer 25

Mutations - GH1 and GHRHR genes

Empty Sella Syndrome (damanged pituitary)

Question 26

How does GHD present?

Answer 26

micropenis, hypoglycaemia + severe jaundice

Question 27

How do you test for GHD?

Answer 27

Growth hormone stimulation test using glucagon, insulin, arginine and clonidine.

Question 28

How do you treat GHD?

Answer 28

Daily injections of somatropin.

Question 29

What investigations should be done in suspected GHD?

Answer 29

Thryoid
MRI brain
Genetic testing
DEXA Scan