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Year 2 Revision > Endocrinology Investigation and Management > Flashcards

Endocrinology Investigation and Management Flashcards

(58 cards)

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1
Q

Investigations for hypothyroid disease

A

Thyroid function tests

Anti-TPO antibody

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2
Q

Hypothyroid management

A

Start levothyroxine at 25-50 micrograms daily.
Adjust dose every 4 weeks according to response.
Check TSH 2 months after any dose change.

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3
Q

Myxoedema coma management

A 
ABCDE
Passively rewarm
Cardiac monitoring for arrhythmias
Monitor UO, fluid balance, CVP, blood sugar, oxygenation. 
Broad spectrum antibiotics.
Thyroxine and hydrocortisone.
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4
Q

Hyperthyroid investigations

A

Thyroid function tests
TRAb
Scintigraphy if antibody negative or suspected nodular disease.
Potentially thyroid ultrasound for nodule.

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5
Q

Thyroid storm management

A 
Lugol's iodine
Glucocorticoids
PTU
B-blockers
Fluids
Monitoring
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6
Q

Hyperthyroid management

A
  1. Medication: carbimazole (propylthiouracil in 1st trimester) and beta blockers for symptomatic relief.
  2. Radioiodine.
  3. Thyroidectomy.
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7
Q

Thyroid cancer investigations.

A

Ultrasound guided FNA

Maybe excision biopsy of lymph node

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8
Q

Management for papillary microcarcinoma, minimally invasive follicular carcinoma with capsular invasion only or AMES low risk?

A

Thyroid lobectomy with isthmusectomy.

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9
Q

Management for thyroid cancer with extra-thyroidal spread, mets, nodal involement or AMES high risk.

A

Sub-total or total thyroidectomy.

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10
Q

Investigation after sub-total or total thyroidectomy

A

Whole body iodine scanning.

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11
Q

Thyroid mets management

A

Thyroid remnant ablation (given radioactive iodine).

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12
Q

Investigations for hypercalcaemia of malignancy

A

Raised calcium and ALP
X-ray, CT, MRI
Isotope bone scan

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13
Q

Hypercalcaemia acute management

A

Rehydration with saline
Consider loop diuretics once rehydrated
Bisphosponates
Steroids occasionally used.

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14
Q

Investigation after diagnosis of primary hyperparathyroidism

A

Setamibi scan

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15
Q

Primary hyperparathyroidism management

A

Surgery

Cinacalcet (calcium mimetic, useful if unfit for surgery)

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16
Q

Indications for parathyroidectomy

A

End organ damage (bones, gastric ulcers, renal stones, osteoporosis)
Very high calcium
Under 50
eGFR <60ml/min

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17
Q

Familial hypocalciuric hypercalcaemia management

A

Nothing, it will not cause any problems

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18
Q

Acute hypocalcaemia management

A

Emergency: IV calcium gluconate

Calcium gluconate infusion.

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19
Q

Hypoparathyroidism long term management

A

Calcium supplement

Vit D supplement (alphacalcidol)

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20
Q

Pseudohypoparathyroidism biochemical findings

A

Low calcium

PTH elevated

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21
Q

Pseudohypoparathyroidism management

A

Same as primary hypoparathyroidism

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22
Q

Chronic rickets/osteomalacia treatment

A

Vitamin D3 tablet (calcitriol, alfacalcidol)

Combined calcium and vit D.

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23
Q

Vit D resistant rickets treatment

A

Phosphate and vit D supplements

Maybe surgery

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24
Q

Adrenal insufficiency investigations

Study These Flashcards
A 
Biochemisty
Short synacthen test!!!
ACTH levels
Renin/aldosterone levels
Adrenal autoantibodies
Imaging
25
Primary adrenal insufficiency management
Hydrocortisone as cortisol replacement Fludrocortisone as aldosterone replacement Remember sick day rules
26
Secondary adrenal insufficiency management
Hydrocortisone replacement | fludrocortisone unnecessary
27
Cushings screening tests
Overnight dexamethasone suppression test 24 hour urinary free cortisol Late night salivary cortisol
28
Gold standard cushings test
Low dose dexamethasone suppression test | Repeat to confirm
29
Primary aldosteronism investigation
``` Biochemical testing (high sodium, low potassium) Plasma aldosterone renin ratio Saline suppression test (2 litres of saline normally suppresses aldosterone by over 50%) Adrenal CT (adenoma) Sometimes adrenal vein sampling to determine whether adenoma or bilateral adrenal hyperplasia ```
30
Management of Conn's adenoma (primary aldosteronism).
Unilateral laparoscopic adrenalectomy.
31
Management of bilateral adrenal hyperplasia.
Mineralocorticoid receptor antagonists (spironolactone, eplerenone).
32
Congenital adrenal hyperplasia investigation.
Basal or stimulated 17-OH progesterone (raised) | Can do genetic mutation analysis
33
CAH management
``` Glucocorticoid replacement Mineralocorticoid replacement in some Surgical correction Achieve maximal growth potential Control androgen excess Restore fertility ```
34
Phaeochromocytoma investigation
Urine - 24 hours catecholamines/metanephrines Plasma - catecholamines/metanephrins ideally at time of symptoms MRI scan MIBG scan PET scan
35
Phaeochromocytoma management
Alpha blocker (phenoxybenzamine), then beta blocker. Fluid and/or blood replacement Careful anaesthetic assessment Laparscopic excision (or de-bulking) Chemotherapy if malignant (radio-labelled MIBG).
36
Prolactinoma investigations
Raised serum prolactin MRI pituitary Pituitary function tests Visual fields
37
Prolactinoma management
Dopamine agonists (cabergoline, bromocriptine)
38
Acromegaly investigations
``` IGF-1 (age+sex matched) Glucose tolerance test (measure GH after glucose) MRI pituitary Visual fields Pituitary function testing ```
39
Acromegaly management
1. Pituitary surgery then retest GTT. 2. Somatostatin analogues (lanreotide, octreotide). 3. Dopamine agonists (cabergoline) 4. GH antagonist (pegvisomant, last line, expensive)
40
Cushings disease (pituitary disease) specific investigation.
CRH test (stimulation test).
41
Cushings disease (pituitary disease) management.
1. Hypophysectomy 2. External radiotherapy if recurs. 3. Bilateral adrenalectomy.
42
Cushings syndrome adrenal cause management.
Adrenalectomy
43
Cushings syndrome ectopic source management.
1. Remove source. | 2. Bilateral adrenalectomy.
44
Cushings medical treatment.
1. Metyrapone. 2. Ketoconazole (hepatotoxic) 3. Pasireotide
45
Pan hypopituitarism investigations.
Pituitary function tests.
46
Osteoporosis investigation
DEXA scan looking for bone mineral density.
47
Who is referred for osteoporosis investigation
Patients over 50 with low trauma fracture Patients at increased risk of fracture based on risk factors calculated using risk assessment tool Anyone with a 10 year risk assessment for any OP fracture of at least 10%
48
Osteoporosis lifestyle management
``` High intensity strength training Low-impact weight-bearing exercise Avoidance of excess alcohol Avoidance of smoking Fall prevention ```
49
Osteoporosis management
Vit D and Ca supplements Bisphosphonates (alendronate, risedronate) Zoledronic acid (once yearly IV infusion) Denosumab (6 monthly SC injection) Teriparatide
50
When to treat in osteoporosis
Consider antiresorptive therapy when T-score < -2.5 | If ongoing steroid use (3 months or more) or vertebral fracture, then when T score
51
Paget's disease management
Bisphosphonates if pain not responding to analgesia.
52
Osteogenesis imperfecta management
Fracture fixation Surgery to correct deformities Bisphosphonates
53
T1 and T2 diabetes in pregnancy management
Pre-pregnancy counselling (good sugar control) Folic acid 5mg Consider change from tablets to insulin Regular eye checks (due to accelerated retinopathy) Use b-blocker, calcium channel blocker or methyldopa for blood pressure (avoid ACEI and statin)
54
Hypothyroidism in pregnancy management
Increase thyroxine by 25mcg as soon as pregnancy suspected Check TFTs months for first 20 weeks then every 2 months Aim for TSH <3
55
Investigation for hyperemesis gravidarum (to distinguish from hyperthyroid)
hCG (increased) TSH (decreased) TRab (negative) Improves by 20 weeks gestation
56
Hyperthyroidism in pregnancy management
B-blockers if needed Low dose anti-thyroid drugs (PTU 1st trimester, carbimazole 2/3rd) Wait as late as possible before starting anti-thyroid drugs
57
Post-partum thyroiditis
Don't treat in hyperthyroid stage | Do treat in hypothyroid stage
58
Thyroid nodule initial investigation and second line investigation
Thyroid function tests | US guided FNA

Year 2 Revision (45 decks)

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