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Clinical Exam - Management Issues > Endocrine > Flashcards

Flashcards in Endocrine Deck (3)
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1
Q

Long term steroid spiel

A
Complications:
Cataracts/glaucoma
Proximal myopathy
Diabetes
Skin integrity
Infections
Adrenal insuffiency
Osteoporosis and AVN
Mood and sleep disturbance
Weight gain - cushingoid appearance
Increased cardiovascular risk and dyslipidemia
GI - gastritis, peptic ulcer disease (not commonly in isolation)

Management:
Lowest possible dose and shortest course
Consider steroid sparing agents

Baseline measurements: BMI, BP, calculate FRAX score, BMD, lipids, HBA1c, test for Tb
Vaccinations

Patient education

  • medical alert bracelet
  • steroid treatment card
  • regular physical excercise, appropriate diet
  • unwell plan
    • seek medical attention
    • minor illness -> double steroid dose for 2-3 days
  • don’t stop suddenly

Osteoporosis

  • vitamin D supplementation
  • bisphosphonates for those on 7.5mg prednisone or greater for 3 months or more
  • annual measurement of BMD

Hyperglycemia

  • check blood sugars
  • target 4-7 fasting, 7-10 post prandial
  • if not achieving with lifestyle
    • oral hypoglycemic if BSLs less than 15
    • insulin if BSLs greater than 15 (combined with metformin)
  • target HBA1c less than 7 (3 monthly)

Pre-operative

  • hydrocortisone before anesthetic
  • every 8 hours after surgery for 4 doses then taper back to physiological dose

Testing for adrenal insufficiency
- taper down steroid to physiological dose, withold steroid night before then test early morning cortisol (if less then 80 confirmed adrenal suppression)

Physiological daily dose of steroids:
5-7.5mg of prednisone
20-30mg hydrocortisone

2
Q

Diabetes spiel

A

Duration of disease
Mode of presentation

Treatment:
Insulin - type, dose, insulin sensitivity factor, carbohydrate counting, injection sites (lipodystrophy), who injects
Orals - side effects
Adherence to treatment

Control:
Monitoring BSL, HBA1c

Complications:

  1. Microvascular
    - peripheral neuropathy
    - autonomic neuropathy
    - retinopathy
    - nephropathy
  2. Macrovascular
    - peripheral vascular disease
    - cardiovascular disease
    - cerebrovascular
  3. Hypoglycemia
    - frequency
    - symptoms
    - treatment plan
  4. DKA/HHS
    - admissions
    - management plan
  5. Hyperglycaemia
    - management plan
    - sick day rules
  6. Infections
    - urine/skin
    - foot ulcers

Psychosocial: driving, work, mental health, acceptance, social support, insight, medical alert bracelet, social support, employer support

Associated illnesses:
Autoimmune, pancreatitis, steroid use, vision, cognitive impairment

Management:
diabetes nurse
ophthalmology - every 2 years
podiatry - annually
monitoring of renal function - microalbuminuria testing
assessment for neuropathy
postural BP
modification of other cardiovascular risk factors
- ACE-I to reduce progression to ESRF
obstetric health and risks
avoidance of hypoglycemia

Patient education

  • exercise - decrease insulin or supplement with glucose
  • sick day - continue insulin, supplement food for liquid glucose, test for ketones, test BSL more frequently, early presentation to hospital
3
Q

Management of hyperthyroidism

A

Pharmacological:

  1. antithyroid drugs
    - Carbimazole
    - Propylthioruracil
  2. Beta-blockers
    - for tremor and tachycardia
  3. Iodine
    - causes transient hypothyroidism (Wolff-Chaikoff effect)
    - only if plan to remove thyroid within 2 weeks

Thyroid removal:
- require life-long thyroid hormone replacement
1. Radioactive iodine
Indications:
- Graves with moderate goitre and no eye signs
- Toxic adenoma with mild hyperthyroidism
- Toxic multinodular goitre with severe manifestations - CHF, AF, psychosis
CI:
- pregnancy and breastfeeding
- incontinence
- allergy to iodine
2. Surgery
- indications: large goitre, drug compliance concerns, disease relapse
- risks of surgery and damage to surrounding structures
- requires GA