Endocrinology

Question 1

Side effects of levothyroxine

Answer 1

Osteoporosis
Hyperthyroidism
AF

Question 2

HbA1C Targets

Answer 2

Lifestyle +/- Metformin - 48
Lifestyle + hypoglycaemics - 53 (eg gliclazide)

Question 3

T2DM Mx

Answer 3

Assess CVD risk (eg QRISK >10%)
- if no risk = metformin
- if risk = metformin first then + SGLT2 inhib (eg Dapagliflozin)

Question 4

T2DM Mx when Metformin is contraindicated

Answer 4

No CVD risk = DPP‑4 inhibitor or pioglitazone or a sulfonylurea

CVD risk = SGLT2 inhib monotherapy (eg Dapagliflozin)

Obesity = add GLP-1 (Semaglutide)

CKD (eGFR <30) = DPP4-i (Linagliptin)

Question 5

DVLA Diabetes rules

Answer 5

Can NOT drive unless:
- NOT been severe hypoglycaemia event in past 12 months
- 2 episodes hypoglycaemia in group 1 = no drive.
- 1 episode hypoglycaemia in group 2 = no drive
- has full hypoglycaemia awareness
- adequate blood sugar control (twice daily checks)

If Group 2 (HGV) - need to complete form for DVLA

All drivers must inform DVLA of diabetes on insulin

Question 6

Blood pressure Mx for Diabetics

Answer 6

1st - ACEi or ARB
In Black patients choose ARB

Question 7

Causes of raised prolactin

Answer 7

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

Question 8

Diabetes Diagnosis

Answer 8

If symptomatic:
- fasting Glucose >7.0
- random glucose >11.1 (or post glucose tolerance test)

HbA1C
- HbA1C >48 (6.5mmol) - check every 6 months once stable
- if asymptomatic test must be repeated

Question 9

Prediabetes Ix

Answer 9

HbA1C 42-47 (6.0-6.4%) - checked once per year

Impaired fasting glucose
- fasting glucose 6.0-6.9

Impaired glucose tolerance
- fasting glucose <7.0
- and OGTT >7.8 but <11.1 (if above then diabetes)

Question 10

Type 1 diabetes Mx

Answer 10

1st - basal–bolus using twice‑daily insulin detemir
2nd - basal-bolus using once-daily insulin determir or glargine

If BMI >25 add Metformin

Check HbA1c 3-6 monthly
HbA1c target <48

Question 11

Thiazolidinediones (eg Pioglitazone) side effects

Answer 11

weight gain
liver impairment - monitor LFTs
fluid retention - contraindicated in CHF
fracture risk
bladder Ca

Question 12

Metabolic syndrome Fx

Answer 12

> 3 of the following:

waist circumference: men > 102 cm, women > 88 cm

elevated triglycerides: > 1.7 mmol/L

reduced HDL: < 1.03 mmol/L in males, < 1.29 mmol/L in females

raised blood pressure: > 130/85 mmHg, or known HTN

raised fasting plasma glucose > 5.6 mmol/L, or known T2DM

Question 13

Metabolic syndrome associated conditions

Answer 13

raised uric acid levels
non-alcoholic fatty liver disease
polycystic ovarian syndrome

Question 14

Klinefelter’s syndrome biochemisty

Answer 14

Low Testosterone
High LH

Question 15

Primary hyperparathyroidism biochemistry

Answer 15

High calcium
low phosphate
PTH can be high or normal

caused by parathyroid adenoma or hyperplasia

Question 16

Secondary hyperparathyroidism biochemistry

Answer 16

Low or normal calcium
PTH very high

caused by chronic hypocalcaemia eg CKD

Question 17

SGLT2 inhib (eg dapagliflozin) side effects

Answer 17

UTI + Fourniers gangrene
Normoglycaemia ketoacidosis
Ulcers - risk of amputation, feet need to be checked
weight loss - this can be of benefit

Question 18

Carbimazole (for hyperthyroid) side effects

Answer 18

Agranulocytosis (need to check FBC)

Question 19

T2DM insulin Mx

Answer 19

1st - Neutral Protamine Hagedorn (NPH) insulin [aka isophane insulin] OD or BD
2nd - NPH plus short acting insulin if HbA1C >75 (9.0)
3rd - Glargine or Detemir (if NPH contraindicated)

Question 20

Over 60, new onset T2DM, weight loss ??

Answer 20

CT Abdo - ?pancreatic ca

Question 21

Addisons crisis Mx

Answer 21

IM Hydrocortisone

Question 22

Conditions where HbA1c may not be used for diagnosis:

Answer 22

haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected gestational diabetes
children
HIV
chronic kidney disease
people taking medication that may cause hyperglycaemia (for example corticosteroids)

Question 23

Bloods to differentiate T1DM and T2DM

Answer 23

C peptide
Anti-GAD

Question 24

Primary hyperaldosteronism (Conns) Fx

Answer 24

Hypertension
HypoKal

Question 25

Primary hyperaldosteronism (Conns) Ix

Answer 25

Aldosterone: Renin ratio

Question 26

Phaechromocytoma Ix

Answer 26

24hour urinary metanephrines

Question 27

Hypothyroidism in pregnancy Mx

Answer 27

Increase Levothyroxine dose once pregnancy confirmed (by 25-50mcg)

Question 28

Addisons disease Ix

Answer 28

Short Synachten test

Question 29

Addisons disease biochemisty

Answer 29

HypoNa HyperKal

Question 30

Pioglitazone SE

Answer 30

peripheral oedema (fluid retention) - therefore not suitable for heart failure patients

Question 31

Exenatide (GLP-1 agonist) side effect

Answer 31

pancreatitis renal impairment

Question 32

Thiazolidinediones Fx

Answer 32

Eg Pioglitazone PPAR-gamma receptor agonists - reduce peripheral insulin resistance SE/ weight gain liver impairment - monitor LFTs Fluid retention - cautioned with heart failure risk of fractures risk of bladder Ca

Question 33

Addison's patient with intercurrent illness Mx of steroids

Answer 33

double the glucocorticoids (hydrocortisone), keep fludrocortisone dose the same

Question 34

Kallmans biochemisty

Answer 34

LH + FSH low/ normal Testosterone low

Question 35

When is Metformin contraindicated or needs to be stopped

Answer 35

eGFR <30 creatinine >150

Question 36

MODY (mature onset diabetes in young) Mx

Answer 36

Asymptomatic - no treatment Symptoms - Sulphonylurea (Gliclazide)

Question 37

Addisons Ix

Answer 37

9am Cortisol <150 = refer endocrine

Question 38

Addisons Fx

Answer 38

Low BP HypoNa HyperK Low blood Glu