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Endocrinology Flashcards

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1
Q

Define acromegaly?

A

An insidious multi-systemic disorder resulting from GH overproduction by a pituitary somatotroph adenoma.

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2
Q

What are the (weak) RFs for acromegaly?

A

gpR101 over expression, MEN1, carney’s complex

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3
Q

What are the signs / symptoms of acromegaly?

A

Face - prognathism, macroglossia, spaces between teeth, increased nose and jaw size, frontal bossing
Skin - inc thickness, inc sweating, inc skin tags
Carpal tunnel syndrome
Arthropathies, OSA
sex - Dec libido, ED, infertility, amenorrhoea
Fatigue, HTN, inc appetite, amenorrhoea, headaches, polyuria

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4
Q

What investigations confirm acromegaly?

A

Serum IGF1 - inc
serum GH - >0.4ug/l
Oral glue tolerance - gh nadir <0.4
Pit MRI/CT - assessment of size and for pre surg
GHRH - may be high if ectopic/hypothalamic
Cortisol/TSH - check other pit functions
Prolactin - inc in 30%

Visual field - bitemporal hemianopia

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5
Q

What are the RXs for acromegaly?

A

Transphenoidal surgery
Somatostatin analogue - octeotride/lanreotride 10/20IM3month
Dopamine antagonist - cabergoline / bromocriptine 0.25mg orally
GHreceptor antagonist - pegvisomat
Radiotherapy

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6
Q

Define addisons?

A

Addisons is a disorder affecting the adrenal glands, characterised by decreased production of all adrenal hormones: cortisol, aldosterone and DHEAs. Insidious or acute. 90% destruction required. Most = a/I

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7
Q

What are the RFs for addisons?

A

Female, TB (WW), (80% autoimmune), coeliacs, sarcoidosis, adrenal haemorrhage, HIV, adrenocortical antibodies,

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8
Q

What are the signs and symptoms of addisons?

A

Fatigue, anorexia, WL, N+V, hypotension, peripheral hypotension, loss of hair, arthralgia,
Hyperpigmentation of sun exposed skin, folds in skin, mucous membranes,

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9
Q

What is the treatment for an Addisonian crises?

A

Treatment is with hydrocortisone sodium succinated 50-100mg IV 8hrly 1-3 days. Will become stable
+- glucose/Saline

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10
Q

What is the Rx for addisons (once stable)?

A

Oral GC and oral MC
Hydrocortisone 15-30mg orally divided dose
Fludrocortisone 0.1-0.2orally OD.

X dose by 3 if stress event
Replace DHEA if lady with no libido

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11
Q

What is carcinoid syndrome?

A

The release of serotonin and other vasoactive peptides into the systemic circulation from a carcinoid tumour.

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12
Q

What are the RFs for carcinoid tumour? (1)

A

MEN1

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13
Q

What are the signs and symptoms of carcinoid syndrome?

A

Flushing, diarrhoea, palpitations, acute abdo pain, telangectasias, Rsided HF, murmurs and hepatomegaly

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14
Q

Investigations for carcinoid

A

Serum chromogranin A/B - increased (60-90% sens)
24hr urine hydroxyindolacetic acid - increased
Met panel - possible low k, inc urea and creat from diarrhoea
Pet/CT/endoscopy - tumour location
MIBG/somatostatin receptor scintigraphy

Histology

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15
Q

Define cushings syndrome?

A

Clinical manifestation of hypercorticolismfrom any cause. Causes include pituitary ACTH adenomas, autonomous adrenal cortisol over production, ectopic ACTH secreting carcinomas and exogenous steroid overuse.

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16
Q

What are the signs and symptoms of cushings?

A

Interscapular fat pad, straie, proximal myopathy, central adiposity, dec glucose tolerance, DM, menstrual irregularities, dec libido, bruisability, HTN, osteoporosis, absent preg, acne, hirsituism, dec linear growth in kids, round face, absence of malnutrition, alcoholism and stress

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17
Q

What are the investigations for cushings?

A

Deg suppression - low dose = no suppression of cortisol (>50nmol/l). If high dose = suppression = pituitary. No sup = ectopic

PREG TEST -VE
Serum ACTH - >4pmol/L - ectopic/pituitary

Late night salivary cortisol = high.
24hr urinary cortisol (<50ugs)

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18
Q

Rx for cushings syndrome?

A

Transphenoidal pituitary adenomectomy
Must have PRE-Rx ablation - mifepristone/pascreatride/ketoconazole
Then REPLACEMENT post surg (only cortisol most important) 0 hydrocortisone 10-25mg per m^2 body surface area

Replacement once recovered with 
Levothyroxine 1.8ug/kg/day
Testosterone transdermal 2.5-7.5mg
Desmopressin - titrated until adequate UO 
Oestradiol 2mg if lady

Adrenalectomy / bilateral for carcinomas

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19
Q

What is Diabetes Insipidus?

A

A metabolic disorder characterised by the inability to concentrate urine. Results with an increased production of dilute urine.

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20
Q

What are the (many) RFs for DI?

A

Pit surf, craniopharygiomas, stalk compression, brain trauma, phenytoin, congenital malformations, CNS infection, CVA, pregnancy,

Weak - lithium, rifampicin, sickle cell, gentamicin, poor DM control, FHx,

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21
Q

What are the signs and symptoms of DI?

A

Polyuria, Nocturia, Polydispia
Hypernatraemic signs - irritability, restlessness, spasticity, hypereflexia, hyperthermia, lethargy, delerium, seizure, coma

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22
Q

What are the investigations that confirm DI?

A 
Urine osmolarity <300 consistently 
24 urine production >3000mls
Ca, Na, Urea, creatinine all raised markedly 
Urine dip - -ve for gluc
Gluc tolerance - N

Can do water deprivation test with ADH (desmopressin)
After giving desmopressin cranial DI = concentrates urine
Nephrogenic DI cannot.
-

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23
Q

What is the Rx for central DI?

A

Desmopressin 0.1-1mg IV/sc + fluids if dehydrated (dextrose 5%)
Check electrolytes regularly and correct over several days - dec cerebral oedema/seizure

Desmopressin available as spray

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24
Q

Acute nephrogenic DI Rx?

A

Allowed to drink as much as possible
In severe - may be hard to hydrate - dextrose IV used
Can reduce sodium consumption to <500mg/day
If not use hydrochlorthiazide (RENAL CONSULTANT ONLY)

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25
Define T1DM?
A metabolic disorder characterised by an absolute deficiency of insulin due to a/I destruction of pancreatic B cells. Idiopathic = non autoimmune.
26
What are the RFs for t1DM?
HLADR/Q, european, infectious enteroviruses
27
What are the signs and symptoms of DM?
Polyuria, polydipsia, nocturia, YOUNG, WL, blurred vision | Ketoacidosis symps - Tachypnoea, N+V, lethargy, coma
28
What investigations confirm T1DM?
Random plasma glue - >11.1 Fasting - >6.9 HBA1c - >48mmol PLasma / urine ketones - N/H
29
What is the Rx for T1DM?
Basal bolus insulin - glaring/determine/NPH Pre-meal insulin - lispro/as part/regular Poor control - can give amylin - pramlintide Even poorer - fixed dose biphasic insulin
30
Define T2DM
A progressive metabolic disorder caused by insulin resistance and decreased production, resulting in abnormal glucose metabolism and adverse effects.
31
What are the RFs for T2 DM?
Increased central adiposity, dyslipidaemia, HTN, inactivity, CVD, inc age, gestational DM, acromegaly, PCOS, FHx, prediabetes
32
What are the signs and symptoms of T2DM?
Often asymptomatic Retinopathy, fatigue Uncom- nocturia, polyuria Inc skin infections, candida, UTIs, Polydipsia - req hba1c >95 (want<48) Acanthosis nigricans
33
What arête investigations that confirm DMT2?
``` RPG - >11.1 FPG >6.9 Urinary ketones -ve Fasting lipid profile - H LDL, L HDL Retinal check Urinary albumin - good marker of organ damage Serum creatinine and GFR - LLL ABI >0.9 (peripheral arterial disease) ```
34
What is the treatment for T2DM?
BP control - ACEi/ARB/CCB/Thiazides (Last two 1st line if black) - Never combine ACEi and ARB - Use 1 of ACEi and ARB if CKD Lifestyle control and smoking cessation Antiplatelet therapy - aspirin ``` <16.6mmol / hba1c <86mmol 1st line = metformin If HbA1c still not improved then add -insulin secretagogue - sulphonylurea -Basal insulin at bedtime glargine/determir -DPP4 siragliptin/litagliptin -GLP1 (sc) - liraglutide / exemetibe -SGLT2 orally ``` 2nd line - a-glucosidase inhibitor (acarbose) - thiazolidinidione (pioglitzone) STILL BAD = individually augment the regimen IF MARKED HYPER AFTER ATTEMPT TO PREVENT >16.6mol or hba1c >86mol - Basal bolus insulin required = s/c glargine/determir +/- metformin
35
What is graves disease?
An autoimmune thyroid disorder characterised by hyperthyroidism and orbitopathy as a result of TSH receptor antibodies.
36
What are the RFs for graves?
FHx a/i thyroid, a/I disease, women, stress
37
What are the signs and symptoms?
HT - palpitations, diarrhoea, sweating, WL, inc appetite, sensitivity to heat, tremor, diffuse goitre Irritability, wide pulse pressure, upper lid retraction (90%), moist velvety skin, scalp hair loss Thyroid acropachy, pretibial myxoedema, onchylosis, vitiligo
38
What investigations confirm graves?
``` Serum TSH - LLL Serum t3.4 - HHH TSH-R-abs - +ve Thryroid isotope scan - diffuse uptake Tech 99 thyroid scan - diffuse uptake Thyroid USS - increased vascularity (may hear bruit) ```
39
Define primary HPTism?
An endocrine disorder characterised by autonomous production of PTH, resulting in deranged calcium metabolism. 80% due to a solitary PT adenoma
40
What are the RFs for primary HTPism?
Female, 50-60, MEN1,2a,4, Hx/current lithium Rx, irradiation of the head and neck
41
What are the signs and symptoms of HPTism?
STONEs - kidney stones (12%) BONEs - Bone pain, muscle cramping, myalgia GROANs - Abdo pain THRONES - Constipation PSYCHIATRIC OVERTONES - depression, anxiety, mood changes, memory loss
42
What investigations confirm HPTism?
``` Serum Ca - high Serum PTH - high 25hydroxyVITD - LOW - converted to 1,25hydroxyvitd Serum ALP - H DXA - likely low ```
43
Define MALE hypogonadism?
Endocrine disorder whereby there is a deficiency in the production of testosterone by leydig cells or sperm by sertoli cells in the seminiferous tubules resulting from a dysfunction in the HPG axis.
44
What are the RFs?
Primary causes - kleinfelters, noonans, varicocele, trauma, torsion,HIV, irradiation, Secondary - DM, COPD, exogenous steroids, hyperprolactinaemia, pit tumours, super seller tumours, craniopharyngiomas.
45
What are the signs and symptoms of male hypogonadism?
Dec - libido, morning glory, muscle bulk, sperm production, height, linear growth as a child, penis size, Fatigue, night flushes/sweats, inc BMI, gal actor Rhona, loss of axillary hair, fine facial wrinkles
46
Hypogonadism in women. Define it.
Also known as premature ovarian failure/premature menopause. Defined as the cessation of menses for 1 year before the age of 40.
47
What are the RFs?
Hysterectomy(have4+yrs earlier), chemo, radiation, FHx of POF, smoking, autoimmune, embolisation.
48
What rate the signs and symptoms of prem ov failure?
Hot flushes, <40, dry vagina, vaginal atrophy, infertility, sleep disturbance, low socio econ, irritability, small uterus and non palpable ovaries
49
What investigations confirm prem ov failure?
``` Pregnancy test - -ve Serum oestradiol - LOW Serum FSH >40units = menopausal Serum LH - H Serum antimullerian hormone - L Check TFTs - increased TSH , low T4 (increased risk if autoimmune) Trans vag USS - no follicular activity + small Serum prolactin - N ``` DXA scan - often osteoporosis
50
Define hypopituitarism?
Partial or complete deficiency of one or more pituitary hormones. Can be caused by congenital or acquired diseases of the pituitary, hypothalamus or supersella structures.
51
What are the causes of hypopituitarism?
Neoplastic - pit adenomas (most common), cranopharyngiomas, metastasis Infectious - TB, abscess, Inflammation - sarcoidosis Vascular - pituitary apoplexy, Sheehans (infarction after bloodloss in preg)
52
What are the signs and symptoms of hypopituitarism?
Hypothyroid symptoms Hypogonad symptoms Hypoadrenal symptoms GH deficiency related symptoms
53
What investigations confirm hypopituitarism?
``` 8am cortisol - <83mmols 8am testosterone/oestradiol/FSH/LH - LLL Prolactin - MAY be high if prolactinoma IGF1 - L Consider water dep test - DI DXA scan - possible L MRI/CT - lesion searching ```
54
What is the Rx for hypopituitarism?
Replace ACTH def with hydrocortisone 10mg morning, 5 lunch, 5 dinner Replace thyroid def with levothyroxine - 25ugs - titrate to t4 levels GnRH def - replace with conj oestrogen 1mhg orally 25days, medroxyprogesterone 5-10mg orally days 16-25 of cycle Men - testosterone transdermal patch 5mg OD If fertility desired consult specialist GH define - somatotropin 0.3mg s/c and titration to IGF1 ADH do - desmopressin spray 10ugs @ night
55
Define primary hypothyroidism?
A clinical state resulting from the underproduction of T3/4, resulting in increased levels of TSH.
56
What are the causes of hypothyroidism, and which is the 1* cause in the Uk?
UK- hashimotos thyroiditis Other - lymphocytic thyroiditis (occurs in 6% postpartum) Transient hypothyroidism in de quervains thyroiditis Iodine deficiency RFs- women, middle aged, FHx, autoimmune disorders
57
What are the symptoms of hypothyroidism?
Fatigue, weight gain, dec appetite, coarse hair, loss of eyebrows, depression, oligomenorrhea, dry/coarse skin. Bradycardia, deep voice, slow reflexes, goitre, cold insensitivity, myalgia, facial oedema, constipation
58
What investigations confirm primary hypothyroidism?
Serum TSH - H in primary, L in secondary T3/4 - LLL Anti-TPO antibodies - hashimotos Serum cholesterol - often H FPG - may be H FBC - normocytic anaemia (MILD) may be seen
59
What is the Rx for hypothyroidism?
<50-60/healthy Levothyroxine - 1.6ug/day and titrate to TSH by 12.5ug increases >50-60/CAD - 25-50ug per day and adjust 6-8weekly
60
What is MEN?
An inherited tumour syndrome of variable neoplastic patterns, characterised by the formation of multiple endocrine tumours.
61
What mutation occurs in MEN1 + 2?
Men 1 - Men 1 | RET protooncogene = MEN 2
62
What are the RFs for MEN?
FHx, MEN1/RET protooncogene mutations
63
What causes the symptoms in MEN?
Predominantly due to endocrine hormone oversecretion
64
What is obesity?
A chronic adverse condition due to the presence of excess adipose tissue. BMI>30 = obese
65
What are the RFs for obesity?
Redundant cause = excess calorific intake > calorific spending Behaviour - large portions/plates/eating disorders/mental illness Hormonal - hypothyroid, insulinaemia, hypercortisolism, lepton def. X. Yea ah
66
Define osteoporosis?
A complex skeletal disorder characterised by a reduction in BMD and microarchitecture that result in increased fragility which predisposes to fracture
67
What are the RFs for osteoporosis?
Female, short, low BMI, inc age, hypogonadism (prim), menopause, GC excess, exogenous steroid use, cushings, smoking, FHx hip fractures, heparin, dec calcium intake, HYPERTHYROIDISM - increases osteoclast activity.
68
What are the signs/symptoms of osteoporosis?
Can be asymptomatic | Back pain, kyphosis,
69
What investigations are performed for those diagnosed with osteoporosis?
DXA scan - Osteoporosis =
70
Define pagets disease of the bone?
A chronic bone disorder characterised by areas of increased bone remodelling that results in the formation of poorly organised bone. This imbalance results in osseous deformities, abnormal biomechanics and nerve compression.
71
What are the RFs for pagets?
FHx (5-40% genetic), age 50
72
What are the signs / symptoms of pagets?
Most cases - asymptomatic Back pain, long bone pain, typically pelvis/femor/skull, nerve compression symptoms, frontal bossing/prognathism/bone bowing CN8 = hearing loss, increased temperature, loosening teeth
73
What are the investigations for Pagets?
Plain X rays - early = areas of lyric changes (mainly skull), later stage = sclerotic Bone scan - areas of increased uptake in pagetoid bone ALP - raised or normal. Bone spec ALP >40i/u Ca = Normal LFTS - N Serum procollagen 1 N terminal peptide/c terminal peptide for collagen 1 = INCREASED IN EARLY STAGES Vit d = N Can do MRI / Bone biopsy
74
What is a phaeochromocytoma?
A tumour arising from chromaffin cells in the adrenal medulla that oversecretes catecholamines and metaphrines, resulting in the cardinal symptoms of palpitations, headache and sweating.
75
What are the RFs for phaeos?
MEN 2a/2B, VHL, NFT, Prior phaeo, succinct dehydrogenase mutations
76
What are the signs and symptoms of phaeos?
Sweating, palpitations, headache, paroxysmal HTN, pallor, impaired glucose tolerance, MI, panic attaches, sense of doom. Av age=42 Abdo mass, papilloedema, fever, tremors
77
What are the relevant investigations for a phaeo?
24hr urine collection - increased catecholamines and metaphrines and normetaphrines Increased serum metaphrines, NMs and catecholamines Consider genetic testing MEN2a/b, succinctness etc MIBG scintigraphy - increased uptake in catecholamine producing tissues Chromogranin A - increased with other neuroendocrine tumours
78
What is a non functioning pituitary adenoma?
A pituitary adenoma that does not cause acharacteristic hypersecretion of hormones
79
What are the RFs for NFPA?
MEN1
80
What are the signs and symptoms of a NFPA?
All related to compression of nearby structures, or active gland which ensures hypoproduction IE - hypothyroid - increased weight, dec appetite, bradycardia, constipation, fatigue, oligomenorrheoa, hair loss, dry skin etc Hypo gonad - breast/gonad atrophy, dec libido, dec muscle mass, infertility, amerorrhoea, hot flushes, diaphoresis Eye compression - diplopia, dec acuity, bitemporat
81
What investigations confirm a NFPA?
Prolactin, testosterone, IGF, estradiol, t3/4 all low Morning cortisol <83nmols ACTH stim <18/dl GH stim <3mg/dl Visual field testing
82
What is PCOS?
Defined as the triad of the symptoms of hyperandrogenism, hyperandrogenaemia, and >12 follicles on USS.
83
What are the RFs for PCOS?
Early adrenarche (growth of pubes + apocrine sweat glands), obesity, LBW
84
What are the signs and symptoms of PCOS?
Hirsituism, obese/overweight, acne, oily skin, amenorrheoa/oligo, HTN, scalp hair loss, infertility, ACANTHOSIS NIGRICANS
85
What investigations confirm PCOS?
Serum/free testosterone - H DHEAs - H Oral Glucose tolerance test - prediabetic values USS - >12 follicles, thick endometrium LH/FSH ratio >3 - only in 2/3rds Fasting lipids - Low HDL, high LDL TGs Cholesterol Rule out Prolactin (inc suggest hyperprolactinoma) TSH (hypothyroidism) 17 hydroxyprogesterone - rules out 21Ahydroxylase adrenal hyperplasia
86
What is primary hyperaldosteronism? (CONNS)
Excessive aldosterone production that exceeds the bodies requirements and operates autonomously with regards to its normal regulator RAAS. It culminates with increased sodium reabsorption in the distal nephron and ensues HTN, hypokalaemia and metabolic alkalosis. 66% due to adrenomegaly, 33% due to adrenal adenomas
87
What are the RFs for hyperaldosteronism?
Fhx, Fhx early stroke. 16% of scotland.
88
What are the signs and symptoms of PHyperaldo?
Nocturia, polyuria, lethargy, mood disturbance, inability to concentrate, 20-70 Hypokalaemia symptoms - weakness, parasthesias, cramps, palpitations
89
What investigations confirm Prim Hyper Aldo?
Plasma k+, N/L Aldosterone to renin ratio - aldosterone >100pmol Fludrocortisone sup test - failur to suppress aldosterone to <6ngms Testing for familial gene
90
What are the Rxs for primary hyperaldosteronism?
Unilateral/bilateral - unilateral adrenalectomy/adenomectomy with pre and post op sprionolactone 12.5-50mgOD Familial type 1 = Dex 0.5mgOD + spironolactone Adrenalectomy = 60% cure
91
Which hormone does prolactin suppress?
GnRH
92
What is a prolactinoma?
Benign lactotroph adenoma that overproduces and secretes prolactin.
93
What are the RFs for a prolactinoma?
Female 20-50s, oestrogen therapy, MEN1/FIPA
94
What are the signs and symptoms for a prolactinoma?
Galactorrhoea, infertility, dec libido, ED men, bitemporal hemianopia, osteoporosis, headaches, opthalmoplegia
95
What are the investigations for prolactinoma?
Serum prolactin - H Pit MRI - features of adenoma Visual fields Serum GnRH - L
96
What are the Rxs for prolactinomas?
If asyptomatic/tiny -> observe If symptomatic, HUGE or seeking pregnancy: ``` - dopamine agonist - bromocriptine / cabergoline THEN - transphenoidal surgery If fails (rarely used) pituitary radiation ``` COCs used to normalise menorrhagia
97
Define SIADH
Syndrome of inappropriate ADH release characterised by hypotonic hypotonic hyponatraemia, concentrated urine and a euvolaemic (ie normal blood volume) state.
98
What are the RFs for SIADH?
Pulmonary conditions, age over 50, nursing home residence, malignancy, CNS infections Medicines - NSAIDs, SSRIs, carbamazepine, amytriptyline, chemo
99
Symptoms of SIADH?
Hyponatraemic symptoms - nausea, vomiting, headache, seizure, comas Absence hypervolaemia - ie HF/cirrhosis Absence hypovolaemia - dry MM, blood loss, tachycardia, low skin turgor etc.
100
What investigations confirm SIADH?
``` Serum sodium <135 Serum osmolality <280 Serum urea - increased due to volume expansion Urine osmolality - >100mosm Urine sodium >40 ``` Need to rule out Addisons - therefore cortisol >138nmol rules out Can do diagnostic trial of saline infusion TSH normal
101
What problem occurs if sodium is corrected too quickly in SIADH
Central pontine myelinolysis | Overcorrection causes cerebral cell lysis. To treat overcorrection get pt to drink water
102
What is the Rx for SIADH?
IV hypertonic saline and fluid restriction. Check sodium 2 hrly. Treat underlying cause, ie infection, pain, stress, trauma Add furosemide 20mg IV according to response (IF AT RISK OF FLUID OVERLOAD) If severe, patient requires vaptans (VP receptor antagonist) ie tolvaptan 15mg orally OD If not severe - fluid restriction and treat cause.
103
Define thyroid cancer
Neoplasms of the thyroid of which 4 types make up 98% of malignancies Papillary - Braf mutation Follicular - PPAR chromosomal translocation Medullary - RET protooncogene Anaplastic
104
What are the RFs for thyroid carcinomas?
H+N irradiation, female, FHx
105
What are the S+S of thyroid cancers?
Hoarseness, dysphonia, dyshagia, deviation, cervical lymphadenopathy, If RAPID neck involvement, thick anaplastic, thyroid lymphoma or haemorrhage from a nodule Palpable nodule - hard consistency, fixation, LNs,
106
What investigations confirm thyroid carcinomas?
TSH - N FN biopsy - cytology shows histological features - inc Ñuc:cyto ratio USS neck - nodular, hypervascular T3/4 NORMAL NORMAL NORMAL Serum calcitonin - increased in medullary CT neck Iodine 123 scan + uptake - hot nodule ruled in/out
107
What is nontoxic multinodular goitre?
Multiple adenomas / colloid nodules. No overproduction
108
What is a toxic adenoma (Thyroid)
Autonomously functioning benign nodules (INC UPTAKE)
109
Define subacute granulomatous thyroiditis (DE QUERV)?
A self limited inflammation of the thyroid associated with a triphasic clinical course of transient thyrotoxicosis, hypothyroidism and a return to normal thyroid function.
110
What are the RFs for de quervains?
HLABW35, preceding URT viral infection (30-40%)
111
What are the signs and symptoms?
Initial phase - fever, myalgia, malaise, palpitations, tremor, heat intolerance Hypothyroid phase - hypothyroid symptoms
112
What investigations suggest de quervains?
``` Initial: T3/4 H (ratio 15:1) TSH suppressed <0.01mu Radioiodine uptake - LOW 1-3% CRP and ESR - HH AntiTPO antibodies - mildly raised FNA - giant multinucleated cells and follicular epithelium degeneration USS - poor irregular margins and hyperechoic areas ```
113
What is the Rx for de quervains?
Hyperthyroid phase: Pain control ibuprofen-naproxen-codeine-pred Tachycardia - use propranolol 20-40mg SEVERE - potassium iodide 250mg TDS + Prednisolone 40mg OD 3 weeks Can use levothyroxine in the hypothyroid phase and titrate
114
Define osteomalacia?
Metabolic bone disease characterised by incomplete mineralisation of the underlying bone matrix following growth plate closure in adults. (Rickets = before closure = defective mineralisation of epiphysial growth plates)
115
What are the RFs for osteomalacia?
Primary RF = vit d deficiency, | Suboptimal UVB exposure, CKD, malabsorption, CF, bisphosphonate use, mesenchymal tumours, Franconi's syndrome
116
What are the signs/symptoms of osteomalacia?
Increased age, bone pain (diffuse), fractures, waddling gait,
117
What are the investigations for osteomalacia?
Serum ca - N/L Serum 25HvitD - L Serum phosphate - L PTH + ALP - H Urea and creatinine ratio elevation - CKD
118
What is the Rx for osteomalacia?
Ergocholecalciferol/cholecalciferol 50k units 1 per week + calcium carbonate / calcium citrate 2g / day Add sodium phosphate if phosphate wasting

Sdpeh (50 decks)

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