Endocrinology

Question 1

what increases when glucose is low

Answer 1

glucagon, adrenaline, GH, cortisol

Question 2

criteria for diagnosis of diabetes

Answer 2

symptoms + 1 chemical
or no symptoms + 2 seperate chemical

> 6.9 fasting
11 random
48/ 6.5% HbA1c
11 2 hour OGTT

Question 3

diagnosis of pre diabetes

Answer 3

5.5-7 fasting
7.8 - 11.1 random
42 -47 HbA1c

Question 4

diagnosis for gestational diabetes

Answer 4

> 5.6 fasting

>7.8 2h OGTT

Question 5

management of gestational diabetes

Answer 5

metformin or insulin

Question 6

what monitoring should diabetics have

Answer 6

HbA1c 3 monthly

BP, cholesterol, eyes, kidney, neuropthy anually

Question 7

first line management of T2DM

Answer 7

weight loss - 5-10% for 3 months

Question 8

first line drug used in T2DM (side effects, contraindications, mechanism)

Answer 8

metformin

• lactic acidosis and GI upset
• C/I kidney disease
• increases sensitivity to insulin

Question 9

3 drugs that may be added second line to metformin

side effects, contraindications, mechanism

Answer 9

1. sulfonyureas (glicazide)
   - hypoglycaemia and weight gain
   - stimulates insulin secretion
2. DPP4I’s (gliptins)
   - pancreatitis, weight loss
   - increases incretin = increase insulin
3. pioglitizone
   - weight gain, liver failure, bladder ca
   - C/I Heart failure
   - increases insulin sensitivity

Question 10

drugs added into metformin + second line to make triple therapy for T2DM
(side effects, contraindications, mechanism)

Answer 10

1. SGLT2 i’s (flozins)
   - weight loss, hypos, DKA, UTIs
   - glucose lost via kidney
2. GLP1 antagonists (exenotide)
   - weight loss
   - mimicks incretin = increase insulin

Question 11

which daibetes drugs cause hypos and what is target HbA1c?

Answer 11

sulfonylureas (gliclazide)
flozins (SGLT2 i’s)
aim for <58

Question 12

management of diabetic with proteinuria

Answer 12

ACEi

Question 13

BP aim in diabetes

Answer 13

130/80

Question 14

causes of hypothyroidism

Answer 14

hashimoto's thyroiditis
iodine deficiency
pituitary tumour
subclinical/ de quervain's
drugs: lithium, amioderone, radioiodine
thyroidectomy

Question 15

causes of hyperthyroidism

Answer 15

graves disease
toxic nodules
drugs: overtreatment with levothyroxine, amioderone, IFN alpha, iodine

Question 16

DDx for high TSH and low T4

Answer 16

primary hypothyroidism

• TPO Abs = hashimotos
• iodine deficiency
• subclinical

Question 17

DDx for low/normal TSH and low T4

Answer 17

secondary hypothyroidism

- pituitary tumour

Question 18

investigation findings in graves disease

Answer 18

TSH r Abs
low TSH and high T4
increased uptake of radioactive iodine
USS - enlarged vascular thyroid (bruits)

Question 19

management of graves disease

Answer 19

radioactive iodine/ surgery
carbimazole
propanolol

Question 20

management of toxic thyroid nodules

Answer 20

radioactive iodine

Question 21

what do you need for diagnosis of diabetes insipidus (and other findings)

Answer 21

> 3 L DILUTE urine a day

high sodium, high plasma osmolality, low urine osmolality, polydipsia, polyuria

Question 22

how to tell apart nephrogenic and cranial diabetes insipidus

Answer 22

desmopressin:
cranial = urine becomes concentrated
nephrogenic = no response to desmopressin, remains dilute

Question 23

diagnosis of SIADHS

Answer 23

concentrated urine
hyponatremia
euvolemic
absence of oedema and diuretics

Question 24

causes of SIADHS

Answer 24

malignancy - SCLC, pancreatic, lymphoma

CNS disorders - stroke, subdural, vasculitis

Question 25

management of SIADHS

Answer 25

fluid restriction hypertonic saline furosemide

Question 26

what does the anterior pituitary secrete

Answer 26

GH, TSH, ACTH, FSH, LH, prolactin

Question 27

what does the posterior pituitary secrete

Answer 27

ADH, oxytocin

Question 28

explain pathophysiology and symptoms of acromegaly

Answer 28

pituitary tumour secretes GH which increases ILGF1 ILGF1 binds to insulin receptors so causes DM (OGTT) large hands and feet, sweating, coarse facial features, gap between teeth, paresthesia and muscle weakness

Question 29

investigations in acromegaly

Answer 29

ILGF1 and GH measurement OGTT (measure GH) MRI pituitary

Question 30

management of acromegaly

Answer 30

transsphenoidal surgery | octreotide

Question 31

explain pathophysiology of cushing's disease

Answer 31

high ACTH from pituitary causes high cortisol from zona fasciculata in adrenal cortex (ACTH can be from ectopics: SCLC)

Question 32

what investigations can you do in cushing's

Answer 32

24 hour urinary cortisol: high dexamethasone suppression test: high cortisol = pituitary adenoma or ectopic (SCLC) suppressed cortisol = adrenal adenoma/carcinoma CT abdomen for adrenal cause, CT chest for SCLC low potassium

Question 33

describe pathophysiology of addisons

Answer 33

``` hypocortisolism adrenal cortex cannot produce steroids due to; autoimmunity malignancy sarcoid amyloid TB surgery stopping steroids abruptly (crisis) ```

Question 34

what investigations can you do in addisons

Answer 34

``` short ACTH test (cortisol does not increase) 21 hydroxylase adrenal antibodies high renin low aldosterone high potassium ```

Question 35

how does addisons present

Answer 35

thin, tanned, tired, low BP, depression, GI problems, abdo pain

Question 36

describe the pathophysiology of Conns

Answer 36

hyperaldosteronism increased aldosterone from zona glomerulosa due to adrenal tumour or increase in aldosterone due to kidney disease (increased renin)

Question 37

what investigations can you do in Conn's

Answer 37

renin and aldosterone levels CT adrenals low potassium HTN

Question 38

investigations in pheochromocytoma

Answer 38

24 hour urinary catecholamines

Question 39

diagnosis of DKA

Answer 39

high glucose (>11) acidosis (pH <7.35) bicarbonate <15 urine or blood positive for ketones

Question 40

management of DKA

Answer 40

saline, insulin and potassium | measure BMs