Endocrinology Flashcards
(125 cards)
1
Q
What is T1DM
A
autoimmune destruction of pancreatic islet cells –> reduced insulin
2
Q
What is T2DM
A
- hypersecretion of insulin by depleted beta cell mass
- increased insulin resistance
3
Q
comps of DM
A
- retinopathy
- neuropathy
- nephropathy
- infections
4
Q
pancreatic alpha cells produce?
A
glucagon
5
Q
insulins action on cells?
A
allows glucose to enter cell
6
Q
pres of t1DM
A
polyuria, pokydipsia, wt loss, lethargy +/- DKA
7
Q
Ix of DM
A
-urine, dip, FPG, RPG, GTT, HbA1c
8
Q
Screening in DM
A
- urine (protein)
- BP
- fasting lipid
- eyes
9
Q
Neuropathy seen in DM
A
glove and stocking
10
Q
mx of nephropathy in DM
A
ACEi/ARB
11
Q
Minimise CVSRFs in DM
A
- control BP
- lifestyle
- basically lower QRISK
12
Q
Reduced chest infections in DM
A
- pneumococcal vaccine
- annual influenza vaccine
13
Q
what causes diabetic foot?
A
- Periph artery disease
- neuropathy
- infection
14
Q
pres of diabetic foot?
A
- ulcers (neuropathic = painless, arterial = loss of pulse, painful)
- charcot foot
15
Q
2 signs in diabetic eye?
A
- microaneurysm
- hard exudate
- haemorrhages
16
Q
pres of diabetic retinopathy?
A
- painless
- patch loss of vision
17
Q
mx of diabetic retinopathy?
A
- optimise DM control
- BP control
- laser photocoagulation
18
Q
General mx of DM
A
-education (DAFNE), lifestyle,
19
Q
HbA1c
in DM?
in pre-DM?
A
> 48mmol
42-47mmol
20
Q
Pharma mx of T2DM?
A
- Metformin (if HbA1c>58)
- +gliptin/sulfonylurea/pioglitazone (if HbA1c remains > 58)
- triple therapy
- insulin
21
Q
Metformin
- mechanism
- CI
- SE
A
- increase insulin sensitivity (GLUT4), decrease gluconeogen
- eGFR<30
- GI upset
22
Q
Gliptin
- mechanism
- CI
- SE
A
- DPP-4 inhibitor (destroys incretin)
- 3.
23
Q
Sulfonylurea
- mech
- CI
- SE
A
- increase pancreatic insulin secretion
- pregnancy
- hypos, wt gain
24
Q
Pioglitazone
- mech
- CI
- SE
A
- increase insulin sensitivity
- HF, osteoporosis
- wt gain, fluid retention, osteoporosis
25
Hypo mx
1. conscious
2. unconscious
1. glucogel/glucose tablets
| 2. IM glucagon
26
Why does being unwell increases risk of DKA?
- Stress response to illness --> increased cortisol
| - cortisol increases blood sugar, decreases insulin
27
Triggers of DKA (5Is)
- insulin (missed)
- infection
- intoxication
- ischaemia
- infarction
28
Pres of DKA
- N+V
- abdo pain
- dehydration
- Kussmaul breathing
29
What is kussmaul breathing?
```
deep hyperventilation
(to correct metabolic acidosis)
```
30
hypokalaemia ECG
- PR prolomged
- ST depression
- flat/invert T wave
- prominent U wave
31
3 ix in DKA
- Plasma glucose > 11
- plasma ketones >3
- ABG --> metabol acidosis (pH < 7.3)
- urine dip: ketones ++, glucose ++
32
mx of DKA
- ABCDE + catheterise
- IV NaCl
- IV insulin (FIXED RATE) 0.1U/kg/h
- Correct hypokalaemia
- if acidaemic --> IV bicarbonate
33
Hyperosmolar hyperglycaemic state
1. who in
2. features
1. T2DM
| 2. v. high blood glucose > 40, v.high serum osmolality
34
Triggers of HOHG
infection, infarction, dehydration, not taking meds, thiazides, loops
35
Pres of HOHG
dehydration, altered mental stae +/- seizures, delirium
36
ix in HOHG
- urinalysis
- cap glucose > 30
- serum osmolarity > 320
- U+Es = AKI
- Blood cultures r/o sepsis
37
Mx of HOHG
- ABCDE
- treat cause
- replace fluids + electrolytes
- IV insulin
38
Hypothyroid
1. most common cause
2. other
3. presentation
1. hashimotos
2. Iodine def, lithium, De Quervians, amiodarone
3. Bradycardia, constipation, menorrhagia, cold intol, depressed, TATT, decreased appetite, wt gain
39
complication of hypothyroid?
| how does it present??
myxoedema coma
hypoventilation + seizures + hypothermia + decreased consciousness
40
mx of myxoedema coma
- IV levothyroxine
- IV hydrocortisone
- resp support
41
mx of hypothyroid
- lifelong levothyroxine
| - screen for osteroporosis, arhhythmias
42
antibody in graves
-anti-TSHr
43
ix in hyperthyroid
- TFT
- Anti-TSHr
- imaging
44
mx of hyperthyroid
- BB
- Carbimazole/propylthiouracil
- levothyroxine
45
which antithyroid is CI in preg?
carbimazole
| use propylthiouracil
46
thyroid storm pres
- Hyperpyrexia > 41
- HR > 140
- Hypotension
- N+V, jaundice, diarrhoea
- Confusion, agitatino
47
Ix in thyroid storm
- septic screen
- TFT
- ECG
- ABG
48
Mx of thyroid storm
- ABCDE
- Resus
- carbimazole/propylthiouracil
- IV propanolol
- IV hydrocortisone
- keep cool with sponge
49
What causes PTH release?
low Ca
50
PTH effects?
Bone --> increase osteoclast activity
Kidney --> increase reabs Ca, decrease reabs PO4
--> vit d metabolism --> acts on gut to increase Ca absorp
51
who gets primary hyperparathyroid?
post menopausal women (benign adenoma of parathyroids)
52
secondary hyperparathyroid causes?
low Ca --> PT hyperplasia
CKD
53
what hormone inhibits osteoclasts?
(opposes PTH)
where is it produced?
- calcitonin
| - produced by para-follicular C cells of thyroid
54
sx of hypercalcaemia?
```
Bones (pain, fractures)
Stones (renal colic)
Abdo moans (diarrhoea, pain, vom)
Thrones (polyuria, poldipsia)
Psych overtones (depression, altered consciousness)
+ muscle weakness
```
55
mx of primary hyperparathyroid?
Treat hypercalcaemia with:
- Vitamin D
- Fluids
- Bisphosphonates
+/- surgical resection of parathyroids
56
mx of secondary hyperparathyroid?
- Vitamin D
- Calcium supplements
- phosphate binders
- calcimimetics
57
Tertiary hyperparathyroid?
after longstanding secondary
58
ddx for Hypercalcaemia
- Hyperparathyroid
- malignancy [PTHrP, osteolysis]
- endocrine
- drugs [thiazide, vit D]
59
ix in hypercalcamia
- corrected calcium
- alk phos
- XR
60
mx of hypercalcaemia
0.9% saline
loop diuretic
IV bisphosphonates
61
causes of hypocalcamia
low PTH
Vit D deficiency
CKD
acute pancreatitis
62
sx of hypocalcamiea
paraesthesia
tetany
carpopedal spasm
cramps
63
ix in hypocalcamiea
correct calcium
U+Es
ECG - long QT
64
signs in hypocalcaemia
Chvosteks [tap facial nerve --> spasm]
| Trousseaus [
65
mx of hypocalcaemia
- 10ml 10% calcium gluconate infusion [stabilises cardiac memb]
- oral calcium
- correct hypoMg if present
- LT [Ca + Vit D]
66
Anterior pituitary hormones
- GH
- Prolactin
- FSH
- LH
- ACTH
- TSH
67
Posterior pituitary hormones
- ADH
| - oxytocin
68
2 local effects of pituitary tumours
- cavernous sinus = CN 3, 4, 5, 6
- optic chiasm =bitemp hemianopia
- headaches
69
ddx of pituitary adenoma local effects
craniopharyngioma
70
mx of pituitary adenoma
transsphenoidal surgery
71
pharma mx of prolactinoma
bromocriptine
72
pharma mx of GH adenoma
somatostatin
73
which drugs raise prolactin?
antipsychotics
| antidepressants
74
SEs of bromocriptine
- somnolence
- hypotension
- fibrosis (pulm., cardiac, retroperitoneal)
75
2 hormones in acromegaly
GH
| IGF-1
76
3 features of acromegaly
- local --> headache, visual field defect
- big hands/feet
- frontal bossing, macroglossia
- skin pigmentation
- carpal tunnel
- T2DM
77
3 ix in acromegaly
- IGF-1 raised
- OGTT
- GH
- Pituitary MRI
- Visual fields
78
mx of acromegaly
- Surgical [transsphenoidal surgery]
| - Medical [somatostatin, bromocriptine]
79
layers of adrenals (from outside to inside)
- Glomerulosa (mineralocorticoids - aldosterone)
- Fasciculata (glucocorticoids - cortisol)
- Reticularis (androgens - DHEA)
"the deeper you get the sweeter it gets"
GFR - salt sugar sex
80
Cortisol effects
RIDGE
- suppression or Reproduction
- suppression of Immunity
- suppression of Digestion
- suppression of Growth
- mobilisation of Energy (increase glucose, decrease insulin_
81
High cortisol syndrome
Cushing's
82
classification of Cushing's syndrome?
| egs of cause of each
- ACTH dependent [ACTH prod pituitary tumour = Cushing's disease; ectopic ACTH prod tumours (SCLC)}
- ACTH independent [adrenal adenoma/carcinoma]
- most common is IATROGENIC from excess glucocorticoids
83
signs of Cushing's syndrome
- Buffalo hump
- Moon face
- Weight gain
- Proximal muscles wasting
- DM, HTN
84
ix for Cushing's
- glucose
- dexamethasone suppression test (low dose, high dose)
- 24h urinary free cortisol
85
Addison's
- adrenal insufficiency autoimmune
| - primary hypoaldosteronism
86
Causes of adrenal insufficiency
- Primary [addisons, surgical, metabolic failure]
| - Secondary [steroids, TB]
87
signs of addisons
pigmentation of skin
88
Antibody in addisons
anti-21 hydroxylase
89
sx of chroinc addisons (5Ts)
thin, tanned, tired, tearful and tumbling
- GI: N+V, wt loss
- hyperpigmented skin
- fatigue + weakness
- depression, personality change
- muscle cramps
90
signs of addisons
- pigmental palmar crease and buccal mucosa
| - hypotension
91
What test to differentiate between primary vs secondary addisons?
-ACTH levels
High = primary
low = secondary
92
ix in addisons
- ACTH
- U+Es [hyponatraemia, hypokalaemia]
- renin (high), aldosterone (low)
- CT adrenals
- short synacthen test
93
mx of addisons
- education
- steroid card
- REPLACE STEROIDS
- glucocorticoid --> hydrocortisone
- mineralocorticoid --? fludrocortisone
94
Addisonian crisis pres
malaise, fatigue, N+V, low grade fever, muscle cramps, confusion
-DEHYDRATION: hypotension + hypovolaemic shock
95
mx of addisonian crisi
- IV hydrocortisone
- rehydration
- Glucose
96
Conn's syndrome
primary hyperaldosteronism
97
Pathophys of Conn's
hypernatraemia, water retention, hypokalaemia
98
pres of Conns
- oedema
- HTN
- hypokalaemia --> weakness, cramps, paraesthesia
- metabol alkalosis
- polyuria
99
ix in conns
- U+Es
- BP
- aldosterone:renin ratio
- ECG
- CT/MRI of adrenals
100
mx of conns
- Spironolactone
| - adrenalectomy (if u/l)
101
causes of hyperkalaemia
- Renal [AKI, CKD, addisons, RTA]
- Drugs [spiro, ACEi, ARB, NSAID]
- DKA
- Other [rhabdomyolysis, burns, trauma. blood transfusion]
102
pres of hyperkalaemia
weakness, fatigue, flaccid paralysis, palpitations, chest pain
103
ix in hyperK
- med r/v
- U+Es
- ABG
- ECG
104
ECG in hyperK
loss of P
PR prolonged
QRS widened
T - peaked
can progress to VF
105
mx of hyperK
- stop drugs
- IV fluids
- cardiac protection [calcium gluconate IV]
- Insulin + glucose
- Neb salbutamol
106
cause of hypoK
- non-K sparing diuretics
| - N+V
107
pres of hypoK
-weakness, constipation, hypotonia
108
ix of hypoK
- U+Es.
- ABG
- Glucose
- ECG
- Mg (also usually low)
109
mx of hypoK
-give potassium
110
sx of phaeochromocytoma
headache, sweating, HTN, tremor, flushing, tachycardia
111
ix of phaeochromocytoma
- 24h urinary catecholamines
| - abdo CT/MRI
112
what is phaeochromocytoma
catecholamine producing adrenal tumour
113
mx for phaeochromocytoma
Surgical resection of tumour
a-blockade with phenoxybenzamine, followed by -
b-blockade with propanolol --> prevents a hypertensive crisis
114
what is carcinoid syndrome
tumour of enterochromaffin cell --> prod serotonin
115
pres of carcinoid syndrome
flushing and diarrhoea
116
ix in carcinoid
```
urinary 5HT
CT CAP (find tumour!)
```
117
mx of carcinoid
surgical resection
| medical - octreotide
118
what is diabetes inspidus
large amounts of dilute urine, inability to concentrate urine (ADH hyposecretion or resistance)
119
2 causes of diabetes insipidus
cranial
nephrogenic
120
mx of diabetes insipidus
ADH replacement (desmopressin)
121
mx of SIADH
IV hypertonic saline
Treat cause
Furosemide
122
what is dex suppression test?
Give steroids --> should lower cortisol
if it doest = +ve test
therefore pituitary adenoma or ectopic prod of ACTH
123
low dose dexamethasone suppression test
1mg --> no suppression of cortisol = Cushing's syndrome
124
high dose dexamethasone suppression test
8mg --> suppression = Cushing's disease
| no suppression = ectopic ACTH or adrenal cause
125
mx of Cushing's
- Surgery --> treat cause [remove tumour!]
| - Medical --> metyrapone (inhibits cortisol synthesis) / ketoconazole / mifepristone
