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Flashcards in Endocrinology Deck (43):
1

Addisons:
Presentation

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

2

Addisons:
Bloods

⬇️Na
⬆️K
⬆️Ca
Uraemia
Anaemia

3

Synacthen test

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

4

Addisons:
Treatment

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

5

Addison's disease:
Causes

TB
Autoimmune
Adrenal metastases

6

DKA:
Sx

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

7

DKA:
Diagonsis

8

DKA:
Management

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

9

DKA:
Investigations

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

10

SIADH:
Diagnosis

Concentrated urine ie Na+ >20, osmolality >500
In presence of hypo atresia

11

SIADH:
Causes

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

12

SIADH:
Tx

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

13

Diabetes insipidus

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

14

Diabetes insipidus:
Symptoms

Polyuria, polydypsia, dehydration - uncontrollable thirst

15

Diabetes insipidus:
Causes

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

Diagnosis with water deprivation test

16

What fasting blood level confirms diabetes?

>7

17

What level of blood glucose after glucose load confirms diabetes?

>11

18

Subacute (De Quervains) thyroiditis

Hyperthyroidism following viral illness
Painful goiter

Self limiting, steroids if severe or hypothyroid develops

⬇️ TSH
⬆️ T4
⬆️ESR

19

HONK

Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria

Tx: slowly replace fluid, insulin sliding scale

20

Causes of hypothyroidism

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

21

HONK

Triad of:
hyperglycaemia + dehydration + Mild/absent ketonuria

Tx: slowly replace fluid, insulin sliding scale

22

Causes of hypothyroidism
(most to least common)

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

23

Side effects of Gliptins

Weight neutral
No hypos

24

When to add GLP1?

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

25

When do you treat subclinical hypothyroidism?

TSH >10
Thyroid antibody +ve
Autoimmune disorder
Previous tx of Graves

otherwise risks leading to overt hypothyroid

26

Side effects of radioiodine tx of hyperthyroid

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

27

MODY

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

28

Unwell Addisons pt

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

29

CI to glitazones

Heart failure

30

Addisons features

hypoglycaemia
hyponatraemia
hyperkalaemia
acidosis

31

De Quervains

Hyperthyroid
Tender goitre
Reduced iodine uptake
Self limiting

32

Primary Hyperparathyroidism

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

33

Secondary hyperparathyroidism

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

34

Normal/high PTH
Raised Calcium
Low Phosphate

Primary Hyperparathyroidism

35

Normal/high PTH
Low Calcium
High Phosphate

Secondary hyperaparthyroidism

36

Tertiary Hyperparathyroidism

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

37

Multiple Endocrine Neoplasia II

thyroid carcinoma
parathyroid adenoma
phaeochromocytoma

38

TFTs Thyrotoxicosis/Graves

TSH - Low
T4 - High

39

TFTs
Primary Hypothyroid

TSH - high
T4 - Low

40

TFTs
Secondary Hypothyroidism

TSH - low
T4 - low

41

TFTs
Sick Euthyroid

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

42

TFTs
Subclinical hypothyroidism

TSH - high
T4 - normal

43

Cushings metabollic affect

hypokalaemic metabollic alkalosis