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Flashcards in Endocrinology Deck (94):
1

Over what time period do insulin levels decrease from low->none in DM1?

Over a year or 2

2

What is MODY?

Maturity Onset Diabetes of the Young - like DM2 but presenting in kids, needs less insulin than expected
Autosomal dominant insulin defect of mitochondria

3

4 Ts of diabetes presentation? 2 extra Sx?

Tired
Thirsty
Toilet
Thin (not necessarily for 2)
+ xerostomia and hunger

4

Biochemical diagnosis of DM?

Random glucose > 11.1
Fasting glucose > 7.0 (2 hours post prandial >11.1)
If symptomatic, diagnostic. Otherwise repeat tests

5

Biochemical requirements for impaired glucose tolerance?

Fasting glucose

6

Biochemical requirements for impaired fasting glucose?

Fasting glucose 6.1-7
2 hour post prandial

7

What 2 conditions constitute prediabetes?

Impaired glucose tolerance
Impaired fasting glucose

8

What is used for the oral glucose tolerance test?

75mg glucose

9

HbA1c criteria for diagnosing DM2?

HbA1c >48

10

Name some contraindications to HbA1c use in diagnosing DM?

Increased red cell turnover - pernicious anaemia, acute blood loss, haemolytic anaemia, malaria, haemaglobinopathies e.g. Thalassaemia
Pregnancy, liver disease, renal disease

11

Underlying problem in DM2?

Peripheral insulin resistance so relative deficiency, eventually leading to B cell failure

12

4 causes of secondary DM?

Chronic pancreatitis
Cushing's syndrome
Acromegaly
Haemachromatosis

13

3 macrovascular complications of DM?

CVA
IHD
PVD

14

3 microvascular complications of DM?

Retinopathy
Nephropathy
Peripheral neuropathy

15

What basic abnormality in DM causes microvascular complications?

High glucose

16

What basic abnormalities cause macrovascular complications in DM?

High BP and lipids

17

Initial management of prediabetes?

Lifestyle - exercise, weight loss
6 monthly or annual checks
Aim for 5-10% body fat drop over year

18

Initial management of DM2?

Reassess lifestyle factors
Metformin

19

2 major contradictions to metformin?

Renal disease - creatinine > 150
Contrast scans (stop before)

20

Major side effects of metformin?

GI upset - MR preparations for this
Lactic acidosis risk

21

Major benefits of metformin?

Weight loss
Low risk of hypos
Cardioprotective

22

Major side effects of sulfonylureas e.g. Gliclazide, glibenclamide?

Weight gain
Risk of hypos

23

3rd line drug for DM management?

Thiazolidinediones e.g. Pioglitazone

24

How does Pioglitazone work?

Bit like biguanides/metformin
Treats underlying peripheral insulin resistance, delaying decline in B cell function

25

Major SEs of pioglitazone?

Risk of oedema (contraindicated in heart failure)
Weight gain + dilutional anaemia
Distal limb fractures

26

Advantage of Pioglitazone over metformin?

Can be used in renal failure

27

How do DDP4 inhibitors (gliptins) work?

Gliptin effect - increase endogenous GLP1

28

Benefits of gliptins?

Weight neutral
Safe in renal impairment
CV benefit

29

What is exenatide?

GLP1 agonist - suppresses appetite so induces weight loss, promotes insulin secretion, preserves B cell function

30

What is the gliptin effect?

Insulin secretion via GLP1 agonist action, caused by GLP agonists e.g. Exenatide and gliptins (DD4 inhibitors)

31

Side effects of GLP1 agonists (exenatide)?

Nausea, GI upset
Risk pancreatitis

32

3 SEs of insulin therapy?

Hypoglycaemia
Weight gain
Lipohypertrophy

33

What constitutes a hypoglycaemia?

BM 4 or less (4 is the floor)

34

Causes of hypoglycaemia?

Missed or late meals
Too much insulin
Increased physical activity, high temperature
Alcohol (delayed onset)

35

Symptoms of hypoglycaemia?

Sympathetic response - sweat, tachy, palps, paraesthesia, cold, pale, dilated pupils, anxiety
Nausea, vomiting, headache
Neuro change - decreased consciousness, confusion, irritability, fatigue, lethargy, visual and speech changes

36

Management of hypo?

Dextrose/sugar if oral available
IV dextrose
Glucagon IM
Follow with complex carb meal e.g. Sandwich
Don't miss out insulin subsequently!

37

Causes of DKA?

Illness and infection
Pregnancy
Missed insulin
MI
First presentation

38

Mechanism for DKA?

Low insulin -> mega high glucose -> osmotic diuresis
Lipolysis -> fatty acids -> ketone conversion in liver -> metabolic acidosis

39

Hyperglycaemic symptoms of DM?

Thirst
Polyuria
Dehydration -> hypovolaemic shock

40

Ketoacidotic symptoms of DKA?

Nausea and vomiting
Abdo pain -> acute abdomen
Anorexia
SOB, deep laboured Kussmaul breathing (ketotic breath)
-> LoC, coma, cerebral oedema, DIC

41

Investigations for DKA?

Glucose and ketones (dip)
BM > 15 but lower than in HHS
ABG - metabolic acidosis +/- respiratory compensation

42

Management of DKA?

Insulin!
Fluid replacement - bolus if shocked
Monitor potassium as insulin can induce hypokalaemia

43

What is HHS/HONK?

Hyperosmolar hyperglycaemic state
Hyperosmolar non-ketotic state
Typical of DM2 as small amount of insulin inhibits lipolysis

44

Causes of HHS?

Infection
Poor glycaemic control
Medications - diuretics (low blood volume), steroids, B blockers/Ca channel blockers

45

Glucose levels in DKA vs HONK?

DKA > 15
HHS > 33 but often well over 40 or 50

46

What is LADA?

Latent Autoimmune Disease of Adulthood - like DM1 but presents as adult

47

3 common causes of hyperthyroidism?

Graves' disease
Toxic multinodular goitre
Toxic adenoma

48

2 medications that can induce hyperthyroidism?

Amiodarone
Lithium

49

Symptoms of hyperthyroidism?

Weight loss
Diarrhoea
Heat intolerance
Palpitations
Tremor

50

Signs of hyperthyroidism?

Fast, irregular pulse
Warm sweaty skin
Fine tremor
Palmar erythema
Goitre
Lid lag
Hyperreflexia
Bruits

51

4 graves-specific signs of hyperthyroidism?

Exophthalmos
Ophthalmoplegia
Pretibial myxoedema
Thyroid acropachy

52

Blood tests to investigate hyperthyroidism?

Thyroid function - low TSH, high T4 and T3
Thyroid antibodies

53

Imaging that might be useful in thyroid disease?

USS thyroid/neck

54

Medical management of hyperthyroidism?

Carbimazole
Radio-iodine
Symptomatic relief via B blockers

-> surgical removal

55

Alternatives to carbimazole for hyperthyroidism? Under what circumstances?

Propiothiouracil (PTU)
Doesn't cross placenta so safer in pregnancy

56

Rare side effects of carbimazole?

Bone marrow suppression - neutropenia, agranulocytosis

57

Complications of hyperthyroidism?

Heart disease - AF, heart failure, cardiomyopathy, angina
Pregnancy related complications
Thyroid storm
Osteoporosis

58

Common causes of hypothyroidism?

Hashimoto's thyroiditis
Iodine deficiency atrophic hypothyroidism
Iatrogenic (thyroidectomy or radio-iodine)
Congenital

59

Symptoms of hypothyroidism?

Lethargy
Depression
Cold intolerance
Weight gain
Constipation

60

Signs of hypothyroidism?

Bradycardia
Cold peripheries
Ankle jerks
Dry skin, thin hair
Round puffy face
Goitre in Hashimotos
Pretibial myxoedema

61

Medical management of hypothyroidism?

Titrated dose levothyroxine

62

Complications of hypothyroidism?

Heart disease via hypercholesterolaemia
Pregnancy complications
Myxoedema coma
Carpal tunnel syndrome

63

MSK complication of hypothyroidism?

Carpal tunnel syndrome

64

2 substances that parathyroid glands control?

Calcium
Phosphate

65

What does PTH do and how?

Increases Ca levels in blood via increased osteoclast activity, active Ca resorption in kidneys and intestinal absorption via vit D

66

What does calcitonin do?

Decreases Ca in blood via inhibition of osteoclast/increased osteoblast activity, decreased intestinal absorption and decreased resorption in kidneys

67

What is the main purpose of calcitonin?

To prevent bone loss in hypocalcaemia, pregnancy, lactation etc. and to prevent postprandial hypercalcaemia

68

Symptoms of hyperparathyroidism?

Bone pain, tenderness due to breakdown
Weakness, fatigue, myalgias
Dehydration

69

Common cause of hyperparathyroidism?

Chronic renal disease
Vitamin D deficiency
Essentially Ca deficiency -> increased PTH

70

Symptoms of hypoparathyroidism?

Paraesthesia around hands, feet, mouth
Muscle spasms, tetany, cramps
Fatigue, bone pain, headaches, abdo pain

71

CATS Go numb of hypocalcaemia?

Convulsions
Arrhythmia
Tetany and hyperreflexia
Go numb - numbness and paraesthesia in hands, feet, mouth

72

4 causes of Cushing's syndrome?

Cushing's disease (pituitary ACTH secreting tumour)
Iatrogenic - exogenous steroids
Adrenal adenoma - increased cortisol
Ectopic ACTH secreting tumour e.g. Small cell lung cancer

73

Symptoms of Cushing's syndrome?

Weight gain
Acne
Lethargy
Mood change - depression, psychosis
Proximal muscle weakness
Gonadal dysfunction - hirsutism, ED, irregular menses

74

Signs of Cushing's syndrome?

Central obesity + abdominal striae
Moon face and buffalo hump
Thin skin (plethoric) and easy bruising
Muscular atrophy
Hirsutism, gynaecomastia

75

2 steps of investigations for Cushing's syndrome?

Confirm Cushing's syndrome
Identify cause

76

How do you confirm Cushing's syndrome?

Dexamethasone suppression test overnight
For Cushing's ACTH will be high in the morning

77

How to determine the cause of Cushing's syndrome once confirmed?

Measure ACTH - if high, Cushing's disease or ectopic tumour
If low, adrenal adenoma

78

Next line of investigation when Cushing's confirmed and ACTH measured?

MRI pituitary +/- adrenal CT +/- whole body CT

79

Management of Cushing's disease?

Trans-sphenoidal surgical removal

80

5 major complications of Cushing's syndrome?

DM
Weight gain
Immunosuppression
Hypertension
Osteoporosis

81

Major causes of Addison's disease?

Primary disease of adrenals (autoimmune)
Rapid cessation of exogenous steroids

82

Signs and symptoms of Addison's disease?

Weight loss, anorexia
Tiredness
Mood change
Tanning (increased MSH), pigmented palmar creases, vitiligo
Weakness
Dizziness, postural hypotension

83

Symptoms of addisonian crisis?

Hypotension
Tachycardia
Coma

84

What electrolyte disturbances may be visible in Addison's disease? What happens to blood glucose?

Hyponatraemia
Hyperkalaemia
Low BM

85

Gold standard test for Addison's disease?

Synacthen test - measure cortisol, give synacthen then measure at 30 mins
Cortisol > 550 excludes diagnosis
Then measure ACTH - will be high in primary Addison's, low in pituitary causes

86

Management of Addison's disease?

Corticosteroids (hydrocortisone) for life
Consider mineralocortoids e.g. Fludrocortisone

87

What needs to be adjusted if an Addisonian patient becomes unwell, increase exercise or is stressed?

Increase steroid dose

88

Hormones secreted by the anterior pituitary?

ACTH/MSH
LH/FSH
TSH
Prolactin
GH

89

Hormones secreted by the posterior pituitary?

ADH
Oxytocin

90

Differentials for polyuria and polydipsia?

DM
DI
Hypercalcaemia
CKD
Psychogenic

91

2 blood tests that can be used in investigating DM 1?

GAD - glutamic acid decarboxylase
Islet cell autoantibodies

92

What endocrine disease yields ankle jerks?

Hypothyroidism

93

What do ankle jerks in terms of thyroid disease?

Hypothyroid

94

Why is there an increased risk of CVD in hypothyroidism?

Causes hypercholesterolaemia