Endocrinology

Question 1

Addisons:

Presentation

Answer 1

Tired
Tearful
Lethargic
Nausea
Vomiting/diarrhoea
Pigmented buccal area or palmar creases
Weight loss
Pain

Question 2

Addisons:

Bloods

Answer 2

⬇️Na
⬆️K
⬆️Ca
Uraemia
Anaemia

Question 3

Synacthen test

Answer 3

Give 250mg of syncathen (synthetic cortisol) measure after 30 mins. If >550ml then not addisons

Question 4

Addisons:

Treatment

Answer 4

Hydrocortisone replacement, 10mg in the morn then 5mg lunch 5mg evening. If come in actually unwell immediately x4 their normal dose stat.

Question 5

Addison’s disease:

Causes

Answer 5

TB
Autoimmune
Adrenal metastases

Question 6

DKA:

Sx

Answer 6

Drowsiness, vomiting, dehydration, abdo pain, polyuria, polydypsia, anorexia, deep breathing in type 1 (rarely type2)
Triggered by chemo, new drug, UTI/infection , surgery, MI, pancreatitis

Question 7

DKA:

Diagonsis

Question 8

DKA:

Management

Answer 8

If plasma glucose >20 give 4-8u soluble insulin
Fluid and K+ replacement
LMWH until mobile, - immobile + high plasma osmolality

Question 9

DKA:

Investigations

Answer 9

Glucose
U+E (potassium)
ABG ( for ph and bicarbonate) 
Amylase
Osmolality 
FBC
Cultures (underlying inf)

Question 10

SIADH:

Diagnosis

Answer 10

Concentrated urine ie Na+ >20, osmolality >500

In presence of hypo atresia

Question 11

SIADH:

Causes

Answer 11

Malignancy - SCLC, pancreas, prostate, thymus, lymphoma
CNS - meningitis, access, stroke, SAH/SDH, injury
Chest - TB, pneumonia, abscess, aspergillosis
Endocrine - hypothyroid ( not true SIADH)
Drugs - opiates, psychotropics, SSRIs
HIV

Question 12

SIADH:

Tx

Answer 12

Treat cause
Restrict fluid
If severe, salt +- loop diuretic

Question 13

Diabetes insipidus

Answer 13

Loads of dilute urine due to either not enough ADH from posterior pituitary or impaired response of the kidney to ADH

Question 14

Diabetes insipidus:

Symptoms

Answer 14

Polyuria, polydypsia, dehydration - uncontrollable thirst

Question 15

Diabetes insipidus:

Causes

Answer 15

Congenital, tumour (craniopharyngoma, pituitary) 
Trauma
Haemorrhage
Infection (meningitis) 
Lithium
Chronic renal disease

Diagnosis with water deprivation test

Question 16

What fasting blood level confirms diabetes?

Answer 16

> 7

Question 17

What level of blood glucose after glucose load confirms diabetes?

Answer 17

> 11

Question 18

Subacute (De Quervains) thyroiditis

Answer 18

Hyperthyroidism following viral illness
Painful goiter

Self limiting, steroids if severe or hypothyroid develops

⬇️ TSH
⬆️ T4
⬆️ESR

Question 19

HONK

Answer 19

Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria

Tx: slowly replace fluid, insulin sliding scale

Question 20

Causes of hypothyroidism

Answer 20

Iodine deficiency (developing world)
Hashimotos
De Quervains (painful)
Thyroid adenomas

Question 21

HONK

Answer 21

Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria

Tx: slowly replace fluid, insulin sliding scale

Question 22

Causes of hypothyroidism

most to least common

Answer 22

Iodine deficiency (developing world)
Hashimotos
De Quervains (painful)
Thyroid adenomas

Question 23

Side effects of Gliptins

Answer 23

Weight neutral

No hypos

Question 24

When to add GLP1?

Answer 24

e.g exenatide
if already on triple therapy ( e/g metformin+gliptin+sulfonylurea)
Or BMI more than 35

Question 25

When do you treat subclinical hypothyroidism?

Answer 25

TSH >10 Thyroid antibody +ve Autoimmune disorder Previous tx of Graves otherwise risks leading to overt hypothyroid

Question 26

Side effects of radioiodine tx of hyperthyroid

Answer 26

Pregnancy (up to 6m after tx) Thyroid eye disease may worsen V likely to be hypothryoid in future

Question 27

MODY

Answer 27

``` TD2M before 25 yr old Autosomal dominant HNF alpha mutation V sensitive to sulfonylureas, shouldnt need insulin No ketosis ```

Question 28

Unwell Addisons pt

Answer 28

``` Double glucocorticoids (hydrocortisone) Keep mineralcorticoid (fludrocortisone) the same ```

Question 29

CI to glitazones

Answer 29

Heart failure

Question 30

Addisons features

Answer 30

hypoglycaemia hyponatraemia hyperkalaemia acidosis

Question 31

De Quervains

Answer 31

Hyperthyroid Tender goitre Reduced iodine uptake Self limiting

Question 32

Primary Hyperparathyroidism

Answer 32

``` elderly females unquenchable thirst - bones, moans, groans Raised calcium Low phosphate normal/ high PTH level usually from solitary adenoma ```

Question 33

Secondary hyperparathyroidism

Answer 33

``` High PTH Low calcium High phosphate High vit D ax w CKD Parathyroid gland hyperplasia from low calcium ```

Question 34

Normal/high PTH Raised Calcium Low Phosphate

Answer 34

Primary Hyperparathyroidism

Question 35

Normal/high PTH Low Calcium High Phosphate

Answer 35

Secondary hyperaparthyroidism

Question 36

Tertiary Hyperparathyroidism

Answer 36

``` High PTH Normal/high calcium Low Phosphate ALP High Vit D normal or low Ongoing hyperplasia after corrected CKD ```

Question 37

Multiple Endocrine Neoplasia II

Answer 37

thyroid carcinoma parathyroid adenoma phaeochromocytoma

Question 38

TFTs Thyrotoxicosis/Graves

Answer 38

TSH - Low | T4 - High

Question 39

TFTs | Primary Hypothyroid

Answer 39

TSH - high | T4 - Low

Question 40

TFTs | Secondary Hypothyroidism

Answer 40

TSH - low | T4 - low

Question 41

TFTs | Sick Euthyroid

Answer 41

TSH - low T4 - low T3 - low hx of illness

Question 42

TFTs | Subclinical hypothyroidism

Answer 42

TSH - high | T4 - normal

Question 43

Cushings metabollic affect

Answer 43

hypokalaemic metabollic alkalosis