endocrinology *

What is the Role of Calcium in the Human Body

1) Cofactor in Coagulation
2) Skeletal Mineralisation
3) Membrane Stabilisation
- Neuronal Conduction

New cards

What happens to the Parathyroid Gland when Calcium Levels Decrease

If Calcium Levels decrease, parathyroid glands produce Parathyroid Hormone to bring Calcium Levels back up.

New cards

How Does Parathyroid Hormone increase Serum Calcium Levels (3)

1) Increased Bone Resorption increasing Calcium Release
2) Increase Calcium Absorption from the Intestine
3) Increasing Calcium Reabsorption from the Kidneys

New cards

How does Parathyroid Hormone increase Calcium Absorption

Parathyroid Hormone lowers Serum Phosphate by decreasing Renal Reabsorption of Phosphate. This increases the production of 1,25-dihydroxyvitamin D which decreases Serum Calcium. Resulting in Increased Calcium Absorption from the Gut.

New cards

What are the causes of Hypocalcemia (7)

1) Vitamin D Deficiency (Osteomalacia)
2) Hypoparathyroidism
3) Chronic Renal Failure
4) Magnesium Deficiency
5) Pseudohypoparathyroidism
6) Acute Pancreatitis
7) Multiple Citrated Blood Transfusions

New cards

What are the Hypoparathyroidism causes of Hypocalcaemia (4)

1) Post Surgery, Radiation, Autoimmune Disease

2) Hereditary (Autosomal Dominant Hypocalcemia)

3) Syndromes (Di George, HDR (Hypopara, Deafness, Renal Dysplasia)

4) Infiltration (Wilson's Disease, Haemochromatosis)

New cards

What are the Consequences of Hypocalcaemia (7)

1) Paresthesia (Tingling in Hands & Feet)
2) Muscle Spasm
- Chvostek's Sign
- Trousseau Sign
3) Seizures
4) Basal Ganglia Calcification
5) Cataracts
6) Dental Hypoplasia
7) ECG Abnormalities
- Long QT Interval

New cards

What is Chvostek's sign?

Tap on facial nerve and get a twitch with low Ca.

Look for spasms of Facial Muscles

New cards

What is Trosseau sign?

Inflate the Blood Pressure Cuff to 20 mmHg above Systolic for 5 minutes.

New cards

What are the Signs of Hypocalcaemia (7)

1) History of Neck Surgery
- Removal of Parathyroid during Thyroid Surgery

2) Presence of Other Autoimmune Conditions i.e. Graves, Addison's Type I Diabetes

3) History of Congenital Defects and Immunodeficiency

4) Family History to suggest Genetic Cause

5) Drug History i.e. Antiepileptics

6) Neck Scar, Candidiasis, Vitilgo, Generalised Bronzing

7) Growth Failure & Hearing Loss.

New cards

What is Mild Hypocalcaemia

Asymptomatic >1.9mmol/L

New cards

What is Severe Hypocalcaemia

Symptomatic <1.9mmol/L

New cards

What are the causes of Hypercalcaemia (10)

1) Primary Hyperparathyroidism
2) Thiazides
3)Thyrotoxicosis
4) Sarcoidosis
5) Familial Hypocalciuric/Bengin Hypercalcaemia
6) Immobilisation
7) Milk-Alkali
8) Adrenal Insufficiency
9) Phaeochromocytoma
10) Malignancy
- Bone Metastasis, Myeloma, PTHrP, lymphoma

New cards

What are the 2 Main causes of Hypercalcaemia

1) Primary Hyperparathyroidism
2) Malignancy

New cards

What are the symptoms of Hypercalcaemia (4)

1) Thirst
2) Polyuria
3) Constipation
4) Nausea

New cards

What are the Signs of Hypercalcaemia

1) Confusion
2) Hypotonia (Low Muscle Tone)
3) Hyporeflexia (Low Reflexes)
4) Dehydration
5) Signs of Malignancy
6) Faecal Impaction
7) Irregular Pulse (Arrhythmia and Thyrotoxicosis)

New cards

What are the Signs of Malignancy shown in Hypercalcaemia (5)

1) Enlarged Liver
2) Finger Clubbing
3) Thyroid Mass
4) Breast Lump
5) Lymph Nodes

New cards

Which Drugs can cause Hypercalcaemia (3)

1) Thiazides
2) Lithium
3) Vitamin D Supplements

New cards

What should you suspect if PTH is high/normal and Urine Fractionated Calcium Excretion is >0.01mmol/l

- Suspect Primary Hyperparathyroidism

New cards

What should you suspect if PTH is high or normal and urine calcium excretion <0.01 mmol/l

FHH

(Familial Hypocalcaemic Hypercalcaemia)

New cards

What should you suspect if PTH is low or suppressed

exclude Malignancy, Hyperthyroidism, Addison's, Sarcoidosis, Granulomatous Disorders.

New cards

What are the consequences of Hyperparathyroidism

Bone Disease
- Osteitis Fibrosa Cystica
- Osteoporosis

Kidney Stones

Psychic Groans
- Confusion

Abdominal Moans
- Constipation
- Acute Pancreatitis

New cards

What is Tertiary Hyperparathyroidism

when chronic secondary hyperparathryoidism progresses to an unregulated state, resulting in hypercalcemia

New cards

What is the management of Hypercalcaemia

1) IV Fluids Normal 0.9% Saline
2) Loop Diuretic if risk of overload ONLY
3) IV Bisphosphonates
4) Cinacalcet (Calcium Sensory Receptor Agonist)
5) Corticosteroids
6) Denosumab

New cards

What hormones does the Thyroid Gland produce

1) Triiodothyronine (T3) and Thyroxine (T4)
- Regulate Basal Metabolic Rate

2) Calcitonin
- Regulating Blood Calcium Levels

New cards

What do T3 & T4 Hormones do?

T3 and T4 regulate Basal Metabolic Rate

T4 is converted to T3 as T3 is the hormone that exerts most basal metabolic functions in cells and tissues.

New cards

Describe the Surface Anatomy of the Thyroid Gland

- Clasps Anterior and Lateral Surfaces of the Pharynx, Larynx, Oesophagus and Trachea like a shield.

- Parathyroid Glands lie between posterior border of the Thyroid Gland and its Sheth

- Internal Jugular Vein and Common Carotid Artery lie postero-lateral to the Thyroid Gland

New cards

Describe the Hypothalamus-Pituitary Thyroid Axis

Higher Centres stimulate the Hypothalamus to release Thyroid Releasing Hormone.

This Hormone stimulates the Pituitary Gland to secrete Thyroid Stimulating Hormone.

TSH stimulates the Thyroid Gland to secrete T3 and T4

When sufficient T3 and T4 is released, Negative Feedback is sent to the Hypothalamus to stop releasing TRH

New cards

How are Thyroid Hormones measured (3)

Measure Hormone Levels in Blood
- Free Thyroxine (T4)
- Free Triiodothyronine (T3)
- Thyroid Stimulating Hormone (TSH)

We measure TSH initially and then depending on the level of that we decide to measure T3 and T4.

In majority of the cases, if TSH is normal, we do not measure T3 or T4

New cards

What are the 3 causes of Hypothyroidism (3)

1) Primary Failure of Thyroid Gland

2) Secondary to Hypothalamic or Pituitary Gland Failure

3) Dietary Iodine Deficiency

New cards

Describe the Hormonal Changes in Hypothyroidism caused by Primary Failure of Thyroid Gland (2)

1) Decreased T3 and T4
2) Increased TSH

New cards

Describe the Hormonal Changes in Hypothyroidism caused Secondary to Hypothalamic or Pituitary Gland Failure (2)

1) Decreased T3 and T4
2) Decreased TSH +/- Decreased TRH

New cards

Describe the Hormonal Changes in Hypothyroidism caused by Dietary Iodine Deficiency (2)

1) Decreased T3 and T4
2) Increased TSH

New cards

List 10 Symptoms of Hypothyroidism

- Weight Gain
- Lethargy
- Increased Sleep
- Constipation
- Cold Intolerance
- Dry Skin
- Hair Loss
- Menorrhagia
- Deafness
- Muscle Weakness

New cards

List 5 Signs of Hypothyroidism

- Facial Puffness
- Periorbital Oedema
- Bradycardia
- Hoarseness
- Delayed Reflexes

New cards

What are the Primary Causes of Hypothyroidism (6)

1) Dyshormonogenesis
2) Iodine Deficiency
3) Autoimmunity
4) Post Radioactive Iodine
5) Post Thyroidectomy
6) Iodine Excess

New cards

What is Tertiary Hypothyroidism

Characterised by abnormally low levels of Thyroid Hormone T3 and T4, where the defect is at the level of the Hypothalamus leading to inadequate levels of TRH

New cards

What are the Indications for Screening a Patient with Suspected Hypothyroidism (5)

1) Congenital Hypothyroidism
2) Treatment of Hyperthyroidism
3) Neck Irradiation
4) Pituitary Surgery or Irradiation
5) Patients on Lithium and Amiodarone

New cards

What are the Investigations done to Diagnose Hypothyroidism

Thyroid Function Tests involving measuring the level of Thyroid Antibodies

New cards

How is Hypothyroidism treated

Levothyroxine

Oral Tablet given 30-60 minutes before a meal.

New cards

What are the Dental Complications of Hypothyroidism (6)

1) Delayed Eruption
2) Enamel Hypoplasia
3) Macroglossia (Large Tongue)
4) Micrognathia (Small Mandible)
5) Thick Lips
6) Dysgeusia (Distortion of the sense of Taste)

New cards

What are the 3 causes of Hyperthyroidism

1) Abnormal Thyroid-Stimulating Immunoglobulin (Grave's Disease)

2) Secondary to Excess Hypothalamic or Pituitary Secretion

3) Hypersecreting Thyroid Tumour

New cards

Describe the Hormonal Changes in Hyperthyroidism caused by Abnormal Thyroid Stimulating Immunoglobulin i.e. Grave's Disease

1) Increased T3 and T4
2) Decreased TSH

New cards

Describe the Hormonal Changes in Hyperthyroidism caused Secondary to Excess Hypothalamic or Pituitary Secretion

1) Increased T3 and T4
2) Increased TSH +/- TRH

New cards

Describe the Hormonal Changes in Hyperthyroidism caused by Hypersecreting Thyroid Tumour

1) Increased T3 and T4
2) Decreased TSH

New cards

List 3 Common Causes of Hyperthyroidism

1) Autoimmune Thyroid Disease
- Graves Disease
- Postpartum Thyroiditis

2) Toxic Nodular Goitre

3) Toxic Adenoma

New cards

List 8 Signs of Hyperthyroidism

1) Goitre
2) Tremor
3) Warm Moist Skin
4) Tachycardia
5) Eye Signs
6) Thyroid Bruit
- Continuous sound coming from Thyroid when stethoscope is placed.
7) Muscle Weakness
8) Atrial Fibrillation

New cards

What are the Clinical Features of Grave's Disease (5)

1) Diffuse Goitre
2) Eye Signs
- Starts with Grittiness and Dryness of the Eyes
3) Pretibial Myxoedema (Red Lesions of the Skin)
4) Vitiligo
5) Family History of Autoimmune Thyroid Disease

New cards

Describe the Ophthalmological Features of Grave's Disease

Patient complains of dry gritty eyes

Chemosis (swelling of the conjunctiva)

Nerve Palsies

Exophthalmos (eyes are bulging anteriorly out of the orbit)

New cards

What are the Dental Complications of Hyperthyroidism (6)

1) Accelerated Dental Eruption
2) Maxillary or Mandibular Osteoporosis
3) Increased Susceptibility to Caries
4) Periodontal Disease
5) Increased Sensitivity to Adrenaline resulting in Arrhythmias or Palpitations
6) Surgery, Oral Infection and Stress may precipitate Thyroid Cases

New cards

How are Thyroid Nodules Assessed

Perform Thyroid Function Tests to exclude Hyperthyroidism/Hypothyroidism first.

Primary Diagnostic Tool is Fine Needle Aspiration +/- Ultrasound guidance.

New cards

What Hormones does the Pituitary Gland produce (6)

Sex Hormones
- FSH
- LH

Growth Hormone

PRL - needed for Breast Milk Production

Thyroid Stimulating Hormone

ACTH - regulation of Adrenal Gland

New cards

What is Empty Sella Syndrome

A condition where the pituitary gland appears flattened or shrunken within the sella turcica on a MRI scan. Pituitary Gland is pushed down into the Sella.

New cards

What are Local Pituitary Tumour Mass Effects

1) Cranial Nerve Palsy
2) Temporal Lobe Epilepsy
3) Headaches
4) CSF Rhinorrhoea
5) Visual Field Defects

New cards

100

What are the effects of LH/FSH Deficiency (4)

1) Hypogonadism
2) Reduced Sperm Count
3) Infertility
4) Menstruation Problems

New cards

104

What are the effects of ACTH deficiency (2)

1) Adrenal Failure
2) Decreased Pigment

New cards

105

What is the treatment of ACTH Deficiency

Hydrocortisone

New cards

106

What are the effects of ADH Deficiency

1) Diabetes Insipidus
2) Decreased Water Absorption in Kidney resulting in Polyuria and Polydipsia

New cards

111

What are the Head & Neck Clinical Features of Acromegaly (5)

1) Coarse Facial Features
2) Enlargement of Supraorbital Ridges
3) Separation of Teeth
4) Prognathism (Extension or Protrusion of Mandible)
5) Macroglossia

New cards

114

How is Acromegaly Treated

Surgical Resection
- TSS (Trnassphenodial Surgery)
- TFS

Somatostatin Analogues

Pegvisomant
- Reduces IGF-1 to levels >90%

Radiotherapy in Unsuccessful Surgery

New cards

116

What is the effect of ACTH on the Adrenal Glands

Stimulates Adrenal Glands to secrete Cortisol

New cards

118

What is Cushing's Syndrome

Excessive Production of Glucocorticoids due to Increased Production of Cortisol.

New cards

121

What are the Clinical Features of Cushing's Syndrome (14)

- Weight Gain
- Menstruation Problems
- Moon Face
- Acne
- Hirsutism (Condition where Women have excessive growth of hair in a male-like pattern
- Brusing
- Striae
- Osteopenia
- Glucose Intolerance
- Hyperpigmentation
- Muscle Weakness
- Plethora
- Hypertension
- Oedema

New cards

124

What is Dexamethasone

A steroid that provides negative feedback to pituitary gland to suppress the action of ACTH

New cards

126

What is Addison's Disease

Adrenal Insufficiency, an uncommon disorder that occurs when your body does not produce enough Cortisol so the body makes more ACTH

New cards

128

What is Secondary Adrenal Insufficiency

Decreased pituitary ACTH production therefore decreased Cortisol

New cards

129

List causes of Primary Adrenal Insufficiency (8)

1) Autoimmune (Addison's Disease)
2) Tuberculosis
3) Fungal Infections
4) Adrenal Haemorrhage
5) Congenital Adrenal Hypoplasia
6) Sarcoidosis
7) Amyloidosis
8) Metastatic Neoplasia

New cards

130

List 3 causes of Secondary Adrenal Insufficiency

1) After Exogenous Glucocorticoids
2) After Treatment of Cushing's Syndrome
3) Hypothalamic or Pituitary Tumours

New cards

131

What are the Clinical Features of Adrenal Insufficiency (6)

1) Weakness
2) Skin and Mucous Membrane Pigmentation
3) Loss of Weight, Emaciation (Being Extremely Thin and Weak), Anorexia, Vomiting, Diarrhoea
4) Hypotension
5) Salt Craving
6) Hypoglycemic Episodes.

New cards

132

How is Adrenal Insufficiency Diagnosed

Hormonal Tests
- Dynamic Stimulation Tests (Synacthen Test) measuring Cortisol Levels
- ACTH, Adrenal Antibodies

If Cortisol Levels are above 439mol/l then the patient does not have an Adrenal Insufficiency. Below = Adrenal Insufficiency

Radiological Tests
- MRI Pituitary
- CT or MRI for Adrenal
- Chest X-Ray is suspecting TB

New cards

133

What is the Treatment for Adrenal Insufficiency

Steroid replacement → 15-30 mg cortisol equivalent/day

Hydrocortisone Replacement Treatment

New cards

134

Why may a patient be taking Glucocorticoids

1) On Treatment Therapy i.e. Asthma, Rheumatoid Arthritis
- Prednisolone >5mg for 4 weeks
- Dexamethasone >0.75mg
- Hydrocortisone >30mg

2) On Replacement Therapy i.e. ACTH Deficiency, Addison's

New cards

135

How should you manage Patients with Adrenal Insufficiency taking Glucocorticoids when doing Simple Dental Procedures

Double the Dose One Hour before Surgery,

Double Dose Oral Medication for 24 Hours

New cards

138

What Dental Considerations need to be taken place if a patient has Hyperthyroidism

Render Euthyroid before carrying out dental procedure

Euthyroid is The state of having normal thyroid gland function. Rendering the patient euthyroid requires 3 to 12 weeks of treatment with antithyroid drugs such as thionamides or propylthiouracil

New cards

140

What Dental Considerations need to be taken place if a patient has Cushing's Syndrome

Avoid Infections and Pathological Fractures

Give Steroid Cover

New cards

141

What are the Endocrine causes of Hypertension (2)

1) Primary Aldosteronism
2) Phaeochromocytoma
3) Acromegaly
4) Cushing's Syndrome
5) Hypothyroidism
6) Hyperthyroidism

New cards

152

List 8 Organs/Glands that make up the Endocrine System

1) Hypothalamus
2) Pituitary Gland
3) Thyroid Gland
4) Parathyroid Glands
5) Adrenal Glands
6) Pancreas (Islets of Langerhans)
7) Pineal Gland
8) Ovary/Testes

New cards

154

What are the Adrenal Glands composed of

adrenal cortex and adrenal medulla

New cards

157

What does Aldosterone do

Increases reabsorption of sodium and increases secretion of potassium

Acts on the Distal Convoluted Tubule, if the body senses low sodium, Aldosterone will reabsorb Sodium Ions and release potassium and hydrogen ions.

New cards

159

What does Cortisol do (3)

reduce inflammation, raises blood sugar level, and inhibits release of histamine

New cards

163

What are the consequences of too much Aldosterone

- Hypertension due to Increased Sodium therefore increased Water and Increased Blood Volume

- Increased Heart Rate

New cards

164

What are the 4 most common Diagnostic Tests to diagnose Adrenal Pathology

- 24 Hour Urinary Cortisol
- Serum ACTH Levels
- Diurnal Pattern of Serum Cortisol Levels
- Dexamathasone Suppression Test

New cards

165

What are the Primary Causes of Adrenal Cortical Insufficiency (5)

1) Adrenal Disease
2) Developmental
3) Hemorrhagic Necrosis
4) Autoimmunity
5) Destruction by TB or Tumour

New cards

166

What are the Secondary Causes of Adrenal Cortical insufficiency

Disease of the Pituitary or Hypothalamus

New cards

168

What is Waterhouse-Friderichsen syndrome?

infant with meningococcemia with sudden vasomotor collapse and skin rash due to adrenal hemorrhage

Defined as a Adrenal Gland Failure due to Bleeding into Adrenal Glands.

New cards

169

What is Hypocortisolism

Also Known as Primary Adrenal Insufficiency or Addison's Disease

a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones. Can lead to Adrenal Crisis

New cards

170

What are the effects of Hypocortisolism (7)

1) Skin Pigmentation
2) Hypotension
3) Muscle Weakness
4) Hypoglycaemia
5) Hyponatraemia
6) Hyperkalaemia
7) Renal Dysfunction

New cards

173

What is Cushing's Disease

Hypercortisolism due to secondary causes i.e. Pituitary Microadenomas.

New cards

174

What is Conn's Syndrome

Primary hyperaldosteronism

New cards

175

What is Adrenogenital Syndrome

Excessive Androgen Production

New cards

176

What are the effects of Cushing's Syndrome (8)

1) Obesity
2) Hypertension
3) Osteoporosis
4) Hyperglycaemia
5) Myopathy
6) Skin Atrophy
7) Polycythaemia (High RBC)
8) Susceptibility to Infection

New cards

177

What is Phaeochromocytoma

Tumour of Adrenal Medulla

affecting the Chromaffin Cells which produce the hormone group Catecholamines which make Adrenaline and Noradrenaline

New cards

178

What hormones does Phaeochromocytoma affect

Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much adrenaline and noradrenaline, hormones that control heart rate, metabolism, and blood pressure

New cards

179

What is the commonest presentation of Pheochromocytoma

Paroxysmal Hypertension

- Rapidly increasing blood pressure which then slightly decreases and then rapidly increases in a cyclic manner.

New cards

180

What is Phaeochromocytoma associated with (5)

1) Familial (Autosomal Dominant)
2) Neurofibromatosis
3) Von-Hippel-Lindau Disease
4) Medullary Carcinoma of Thyroid
5) Parathyroid Adenomas

New cards

182

How is it determined if the Phaeochromocytoma is Benign or Malignant

Multiple Histological samples are used to come up with a score which indicates if it is Benign or Malignant.

This is known as the PASS system - Phaeochromocytoma of Adrenal Gland Scoring System

New cards

192

What is Hashimoto Thyroiditis

autoimmune destruction of thyroid gland

Autoantibodies against Thyroglobulin and Thyroid Peroxidase

New cards

193

What is a consequence of Hashimoto Thyroiditis

Lymphocyte Mediated Destruction of Thyroid Follicles.

There is initial Hyperthyroidism followed by Hypothyroidism. It is a Painless Enlarged Thyroid.

New cards

194

Which age group does Hashimoto Thyroiditis affect

Middle Aged Women

New cards

196

What is the Treatment for Hashimoto Thyroiditis

Long Life Thyroxine

New cards

197

What is Grave's Disease

Autoimmune Hyperthyroidism Disease producing Autoantibodies against Thyroid Stimulating Hormones.

Anti-TSH bind to TSH receptors on Thyroid Gland causing increased T3 and T4 production.

New cards

200

What is the treatment of Graves Disease

Treated with Antithyroid Medications, Radioiodine Ablation and Surgery

New cards

201

List 4 Examples of Thyroid Masses

1) Cyst
2) Dominant Nodule in Multinodular Goitre
3) Benign Neoplasms
4) Malignant Neoplasms

New cards

202

List Benign Thyroid Neoplasms

Follicular Adenoma
- Usually Solitary and Encapsulated

New cards

203

List Malignant Thyroid Neoplasms

1) Papillary Carcinoma
2) Follicular Carcinoma
3) Medullary Carcinoma
4) Poorly Differentiated Carcinoma
5) Anaplastic Carcinoma Lymphoma

New cards

209

List 3 Types of Thyroid Lymphomas

1) Non-Hodgkin's Lymphoma
2) Mucosa Associated Lymphoid Tissues
3) Hashimoto's Thyroiditis

New cards

214

If a Patient is worried about Diabetes yet presents with no symptoms, what test will the GP generally do

Oral Glucose Tolerance Test (OGTT) using 75g Glucose.

Fasting Levels and 2 hours after the Glucose are Measured.

If fasting Levels are greater than or equal to 7mmol/l or the 2 hour value is greater than 11.1 mmol/l then patient is diabetic.

New cards

224

List 3 Aims of Type 1 Diabetes Treatment

1) Relieve Symptoms and Prevent Ketoacidosis

2) Prevent Microvascular and Macrovascular Complications

3) Avoid Hypoglycaemia

New cards

225

How can Type 1 Diabetes lead to Microvascular and Macrovascular Complications

Excess Glucose in vessels can stick to the vasculature of the body in eyes, brain, heart, kidneys giving rise to complications. If it affects large arteries you can get CVD, Stroke and Peripheral Artery Disease.

New cards

229

Type 2 Diabetes increases the risk of Cardiovascular Disease by 3/4 times.

What is the Pathogenesis of Type 2 Diabetes (7)

1) Increased Thrombogenesis
2) Early Hyperinsulinaemia
3) Hypertension
4) Central Obesity
5) Insulin Resistance
6) Hyperglycaemia
7) Abnormal Lipids (Low HDL Cholesterol)

New cards

232

By how many years does Type 2 Diabetes decrease the life expectancy

5-10 years

New cards

235

What is Metformin

A biguanide which reduces blood glucose by improving glucose uptake without increasing body weight and also reduce Cardiovascular Disease in long term.

New cards

236

What is Sulphonylurea

Act by stimulating release of insulin from pancreatic beta cells so can cause weight gain and hypoglycaemia.

New cards

237

Give 2 examples of Sulphonylurea

Gliclazide
Glibenclamide

New cards

238

What is the Last Line Management of Type 2 Diabetes

Insulin
- Insulin Secretion declines progressively in type 2 diabetes, over 50% will need insulin

DPPIV Inhibitor
- Sitagliptin

Incretin Mimetic
- Exenatide or Liraglutide

New cards

240

What is the action of Pioglitazone

Encourages the body to urinate more sugar, sugar in the blood reduces, leading to loss of weight, reduction in blood pressure and reduction in Risk of stroke and MI

New cards

243

Name a complication of Diabetic Ketoacidosis in children

Cerebral Oedema

New cards

244

What is Hyperosmolar Hyperglycaemic State

a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.

Blood Glucose over 50 mmol/L

Hyperosmolality over 350 mosmoles/l

New cards

246

What are the Symptoms of Hypoglycaemia (3)

1) Sweating
2) Tremor
3) Palpitations

New cards