MRSA - Diabetes and Endocrinology

Diabetes and Endocrinology

Name some sulfonylureas

Glyburide, Glipizide, Glimepiride, Gliclazide

What is the MOA of sulfonylureas?

Bind to ATP-dependent K+ channels on the cell membrane of the pancreatic beta cells to stimulate insulin secretion.

Name 2 common side of effects of sulfonylureas such as gliclazide

Hypoglycemia and weight gain.

What anti-hyperglycaemic group of drugs is associated with hyponatraemia secondary to SIADH

Sulfonylureas

Hyponatraemia, bone marrow suppression, hepatotoxicity and peripheral neuropathy are 4 rare side effectsof what group of diabetic medications?

Sulfonylureas

What two groups of people should sulfonylureas be avoided in?

Breastfeeding and pregnancy

When does the HbA1c target change from 48?

If patient is on second medication or takes medication with risk of hypoglycaemia eg sulfonylureas

What’s the first-line drug for TIIDM

Metformin

What medication should be added to metformin FIRST LINE in people who either have a high risk of CVD (QRISK>10%), has established CVD, or has CHF

SGLT-2 inhibitors eg empagliflozin

Name some SGLT-2 inhibitors

Canagliflozin, Dapagliflozin, Empagliflozin

What should you start someone on SGLT-2 monotherapy

If metformin contraindicatedor not tolerated, initiate SGLT-2 inhibitors as first-line treatment and they have CVD, risk of CVD or CHF..

Name some DPP-4 inhibitors

Sitagliptin, Saxagliptin, Linagliptin

Name some pioglitazones

Rosiglitazone, Troglitazone

When should GLP-1 mimetics be used

If triple therapy doesnt work in patients with - BMI > 35 or they have a condition related to obesity

Example of GLP-1 mimetics

Liraglutide, Exenatide

Name 9 causes of gynaecomastia

Physiological, androgen deficiency eg Kallman’s, mumps (testicular failure), liver disease, testicular cancer, ectopic tumour secreiton, hyperthyroidism, haemodialysis , drugs

What drug is the most common cause of gynaecomastia?

Spironolactone

Name some drug causes of gynaecomastia

Spironolactone, cimetidine, digoxin, cannabis, finasteride, GnRH agonists eg goserelin, oestrogens, anabolic steroids, tricyclics, CCBs, heroin

Fasting glucose >7 or random glucose/OGTT > 11.1 =?

TIIDM

Define impaired fasting glucose

Impaired fasting glucose is defined as a fasting plasma glucose level between 6.1 and 6.9 mmol/L, indicating a higher risk of developing type 2 diabetes.

Depair impaired glucose tolerance

Impaired glucose tolerance is characterized by a 2-hour plasma glucose level between 7.8 and 11.0 mmol/L during an oral glucose tolerance test, indicating an increased risk of developing type 2 diabetes.

What group is sitagliptin in?

DPP-4 inhibitor - blocks these receptors - which break down GLP-1 and DIP - reducing the peripheral breakdown of these incretins in increases insulin release

How do GLP-1 mimetics eg exenatide, liraglutide work?

Increase insulin secretion and inhibit glucagon secretion. Can cause weight loss

What do Addison’s disease patients usually take for therapy?

Hydrocortisone and fludrocortisoneto manage adrenal insufficiency and maintain electrolyte balance.

Additionally to hydrocortisone and fludrocortisone, what should you give to all Addison’s pts?

Hydrocortisone for injection to treat adrenal crisis

Someone w/ Addison’s has COVID but stable, what would you advise them about their fludrocortiosne and glucorticoid dose whilst ill?

Double glucocorticoid (hydrocortisone), keep mineralocorticoid (fludrocortisone) - the same

First line treatment of microprolactinoma?

Dopamine agonists eg bromocriptine, cabergoline - they stop release of prolactin from pituitary gland

What is a prolactinoma?

Type of pituitary adenoma, benign tumour of pituitary gland

Someone presents with amenorrhoea, infertilty, galactorrhoea, osteoporosis - raised prolactin. What’s likely diagnosis?

Prolactinoma

What surgery is performed if bromocriptine is not working for pt with prolactinoma?

Trans-sphenoidal surgery

What should happen to prednisolone dose in patients with intercurrent illness?

You know you have to double it

Name two side effects of fludrocortisone?

Fluid retention, hypertension

Glucocorticoid side effects - endocrine

impaired glucose regulation, weight gain, hirsutism, hyperlipidaemia

What are 3 signs of Cushing’s syndrome and what causes it?

Moon face, buffalo hump, striae - caused by glucocorticoids

3 MSK side effects of glucocorticoids

Osteoporosis, proximal myopathy, avascular nerosis of femoral head

Immunosuppressive side effects of glucocorticoids?

Increased susceptibility to severe infection, reactivation of TB

Psychiatric side effects of glucocorticoids?

Insomina, mania, depression, psychosis

GI and opthalmic side effects of glucocorticoid

Peptic ulceration, acute pancreatiits, glaucoma, cataracts, (ICH, neutrophilia, suppression of growth in children)

Causes of hypoglycaemia?

Insulinoma, exogenous causes eg insulin/sulfonylureas, Addison’s disease, liver failure, alcohol, nesidiolastosis,

Low TSH and T4 suggest what?

Secondary hypothyroidism

What is the main cause of secondary hypothyroidism?

Pituitary failure, Down’s, Turner’s, coeliac

Name 2 medications that reduce the absorption of levothyroxine?

Iron, calcium carbonate

In what patients should levothyroxine be started at a lower dose?

Eldery and IHD pts

In pregnant ladies with hypothyroidism what should you do to levothyroxine dose?

Increase by 25-50 mcg

What’s the most common cause of hypercalcaemia in non-hospitalised patients

Primary hyperparathyroidism

What’s the most common cause of hypercalcaemia in hospitalised patients?

Malignancy

Name some cancers that can present with hypercalcaemia?

PTHrP from a tumour - eg SC lung cancer, bone metastases, myeloma

Name some other causes (not PTH or malignancy) of hypercalcaemia?

Sarcoidosis, vitamin D intoxication, acromegaly, thyrotoxicosis, thiazides, calcium-containing antacids, dehydration, Addison’s disease, Paget’s disease of bone

What side effects are SGLT-2s such as empaglaflozin associated with?

UTIs, genital infections, Fournier’s gangrene, normoglycaemic ketoacidosis, lower limb amputation

What is the MOA of SGLT-2 inhibitors such as empagflozin?

Block sodium-glucose co-transporter 2 receptors in the renal pct to reduce glucose reabsorption and increase urinary glucose excretion

Patient presents with tremor, weight loss, sweating, non tender goitre, raised T4/T3, reduced TSH - what’s the most likely cause

Graves disease

What is Grave’s disease?

Autoimmune condition, antibodies attack TSH receptor therefore causing overproduction

What are the two main autoantibodies for Grave’s disease

TSH receptor stimulating antibodies

Anti TPO antibodies

First line treatment for peripheral neuropathy?

Amitriptyline, duloxetine, gabapentin, pregabalin

How can diabetes affect the gut?

Gastroparesis - secondary to autonomic neuropathy - erractic BG control, bloating, vomiting

Someone presents with abdo pain, dehydration, Kussmaul respiration, raised glucose and raised ketones - likely diagnosis?

DKA

What are the three main principles of DKA management?

Fluid replacement, insulin and electrolyte disturbance correction

Should you continue long/short acting insulin in DKA?

Continue long acting, stop short

Pt presents with abdo pain, lethargy, skin hyperpigmentation and hypopigmentation, vitligo, hypotensive, low Na, raised K+ - what test would you do?

short synatchen test - Addison’s disease

What’s the first line treatment for a thyroid storm?

IV beta blockers