Endocrinology

Endocrine (Last Minute Revision)
1. diagnosis of diabetes mellitus Fasting BG>125 mg and post prandial >140mg, HbA1 >6.5%
2. Diabetes control is best monitored by: HbA1C
3. GLP-1 agonist, Exenatide
4. Insulin resistant if he needs more than – 200
5. Seen in DKA, Dehydration, Abdominal pain/tenderness
6. in DKA, Leukocytosis, Pseudohyponatremia occurs, Acute gastric dilatation
7. most dangerous complication of DKA, Cerebral edema
8. plasma of osmolality, 290
9. Deficiency of which of the following vitamins can lead to lactic acidosis , B1
10. The most reliable indicator for diabetic nephropathy is , Urine albumin >30 mg per day in 3 consecutive samples
11. Earliest feature of diabetic nephropathy, Raise GFR
12. Third nerve palsy with normal pupillary reaction, Diabetes
13. Drug used for DM gastropathy , Erythromycin
14. Drug is not used in erectile dysfunction, Apomorphine, Yohimbine, PgE1
15. Life threatening complications of diabetes mellitus are, Malignant otitis externa, Rhinocerebral mucormycosis, Emphysematous pyelonephritis
16. Weight loss may be seen in, Uremia, Pheochromocytoma , Adrenal insufficiency
17. parameter for Metabolic Syndrome (Syndrome X), Hypertriglyceridemia, Low HDL cholesterol, Hypertension
18. Hyperthyroidism following administration of supplemental iodine to subjects with endemic iodine deficiency goiter is known, Jod-Basedow effect
19. best marker to diagnose hypothyroid is, TSH
20. Decreased Radio iodine uptake is, Subacute thyroiditis , Factitious thyroiditis
21. ischemic heart disease [IHD] is diagnosed having hypothyroidism. Which of the following would be most appropriate line of management for, Start Levothyroxine at low dose
22. true about Hashimoto’s thyroiditis, Follicular destruction , Increase in lymphocytes, Oncocytic metaplasia , Orphan Annie eye nuclei
23. 'Hurthle cells' are seen, Hashimoto's Thyroiditis
24. feature of dequervan's disease, ESR, Painful & associated with enlargements of thyroid
25. common cause of hyperparathyroidism, Parathyroid adenoma
26. presentation of hyperparathyroidism is, Asymptomatic hypercalcemia
27. feature of hypercalcemia, Polyuria, Vomiting, Depression
28. Tufting of the terminal phalanges is seen in, Hyperparathyroidism
29. causes of hypercalcemia, Lithium therapy, Multiple myeloma, Vitamin A intoxication
30. true, Williams syndrome consists of precocious puberty, mental retardation & obesity
31. Hypercalcemia is seen in all, Sarcoidosis, Vitamin A toxicity, Phenytoin toxicity
32. Hypercalcemia is, Prolong immobilization,
33. Pseudohypoparathyroidism, ed PTH
34. Features of tumor lysis syndrome, Hyperuricemia, Hyperphosphatemia, Hyperkalemia
35. tumor lysis syndrome are, Hypocalcemia
36. Hypophosphatemia is seen in, Resolving phases of diabetic ketoacidosis, Respiratory alkalosis, Chronic alcoholism
37. Type I MEN involves, Pancreas, Pituitary, Parathyroid
38. associated with MEN 2, Pheochromocytoma, Medullary carcinoma thyroid, Parathyroid adenoma
39. features of MEN II b, Pheochromocytoma, Neuromas, Medullary ca thyroid
40. most common cause of Cushing's syndrome, Iatrogenic steroids
41. features of Cushing's disease, Central obesity, Easy bruising , Glucose intolerance
42. Cushing's disease is associated with, Increased ACTH and increased cortisol
43. earliest manifestation of Cushing's syndrome, Loss of diurnal variation
44. Conn's syndrome is most commonly associated with, Cortical adenoma
45. Conn's syndrome is associated with, Hypertension, Muscle weakness, Hypokalemia
46. cause pituitary apoplexy, Diabetes mellitus, Sickle cell anemia, Hypertension
47. Octreotide is useful for, Insulinoma, Glucagonoma, Carcinoid tumor
48. brain tumors spreads via CSF, Medulloblastoma
49. Heal pad thickness is increase in, Acromegaly
50. Commonest cause of increase heal pad thickness, Trauma
51. Hypoglycemia is seen in, Hepatoma
52. Hypercalcemia occur in, Breast, Bladder, Head & Neck
53. SIADH occur in, Small cell lung cancer
54. To diagnose a case of diabetes, the fasting blood sugar should be, 126
55. Type 1 diabetes is associated with, DR4
56. hyperglycemia occurs, Cushing syndrome
57. Hypoglycemia is a important feature, Addison disease
58. DPP IV inhibitor, Sitagliptin
59. Drug which can be used in both type I and type II diabetes, Acarbose
60. DKA case is treated with insulin the serum sodium level, Rise
61. Most common type of diabetic neuropathy, Sensory neuropathy
62. condition can lead to hypothyroid, Hemochromatosis
63. drug can lead to hypothyroid, Lithium
64. condition can lead hypothyroid, Scleroderma
65. Non pitting edema, Hypothyroid
66. Hung up reflex is seen, Hypothyroid
67. Which of the following is most common seen in hypothyroid, Raised LDL
68. Cyst in the bones are seen in, Hyperparathyroid
69. Edema feet is not a feature, Conn syndrome
70. Triad of pheochromocytoma includes, Palpitation, Headache, Sweating
71. Profuse sweating is a feature, Pheochromocytoma
72. Desmopressin is used in the treatment, Cranial diabetic insipidus
73. Hyponatremia occurs in which of, Small cell lung carcinoma

MODY

The most common MODY type is HNF1 alpha. This is responsible for 70% of MODY.

The amount of insulin produced by the pancreas becomes less as the person gets older, and MODY develops during adolescence or the early twenties.

Glucokinase is the second type of MODY, and occurs when this gene (that aids the body in recognising blood glucose levels) malfunctions.

This type of MODY can be hard to identify, and symptoms can be particularly slow in manifesting themselves.

It is usually picked up during routine testing. When a person is pregnant, it is important to screen for it.

HNF4 - alpha is a less common form of MODY that is often diagnosed at a later stage. HNF1 - beta is a type of MODY associated with renal cysts.

PDX1 and IPF1 are the same type of MODY, and are incredibly rare, affecting only one UK family to date.

NeuroD1 is another rare type of MODY, affecting only two families in the UK. Little information is available about the rarer forms of MODY.

Hcg

10 Question: Regarding HCG true is all except (PGI) Options:
(1 ) A glycoprotein
(2 ) Has 2 subunits
(3 ) Secreted by trophoblast
(4 ) Alpha subunit is specific✅

HCG :
1. HCG is secreted by Trophoblast cells

2. It is a glycoprotein with high Sialic acid concentration

3. Synthesized by syncytiotrophoblast

4. Has two subunits –

a) Alpha sub-unit – similar biologically to LH, FSH, TSH

b) Beta Sub-unit – unique to HCG

5. Similar structurally to FSH

6. Molecular weight of Alpha – 18000;
Beta – 28000

7. Half life of Beta HCG – 24 hrs

8. HCG is primarily Lutinizing and Leutrotrophic and has little FSH cativity

9. Doubling time of HCG – 1.4 – 2 days

10. Detected in Maternal serum as early as 8 days by immunoassay

11. Level is 100 IU/L

12. Maximum levels of 10,0000IU/L at 8 – 10 weeks (70days)

13. Falls till 18th weeks and remains at low level of 10,000 till term.

14. High levels seen in – Hydatidiform mole; Multiple pregnancy; Down’s syndrome

15. HCG disappears from circulation by 2 weeks following delivery

Other actions of HCG :
1. Sustains Corpus leuteum
2. Stimulates Leideg cells of male fetus to produce testosterone and there by induces development of male external genitalia
3. Immuno-suppressive action helps in the maintenance of pregnancy

Cinical condition where Beta- HCG levels are low are :

1. Threatened / Spontaneous abortion
2. Ectopic pregnancy
3. Trisomy 18 (Edward syndrome)

Rest in all it is increased ! List for Increased Beta-HCG :
1. Pregnancy
2. Successful therapeutic insemination
3. Hydatidiform mole
4. Choriocarcinoma
5. Multifetal pregnancy
6. Erythroblastotic fetus
7. Down syndrome
8. Ovarian and testicular tumour
9. Certain neoplasm of lung, stomach, and pancreas !

Pheochromocytoma

Some important single liners about pheochromocytoma:(Ref:Harrison 18th ed)

i)Most sensitive biochemical test for pheochromocytoma- Plasma metanephrine

ii)Most specific biochemical test for pheochromocytoma- Urinary metanephrine

iii)Investigation of choice for adrenal pheochromocytoma-MRI

iv)Investigation of choice for extra-adrenal pheochromocytoma-DOPA PET>MIBG scan

v)Major catecholamine secreted by adrenal pheochromocytoma-Nor-epinephrine

vi)Major catecholamine secreted by extra-adrenal pheochromocytoma- Nor-epinephrine

vii)Major catecholamine secreted by malignant pheochromocytoma- Dopamine

viii)The major catecholamine secreted by a NORMAL adrenal gland- Epinephrine

Eye signs in thyroid diseases

The "NO SPECS" scheme is an acronym derived from the following eye changes:

0 = No signs or symptoms
1 = Only signs (lid retraction or lag), no symptoms
2 = Soft-tissue involvement (periorbital edema)
3 = Proptosis (>22 mm)
4 = Extraocular-muscle involvement (diplopia)
5 = Corneal involvement
6 = Sight loss

Thyroid signs

Order of appearance of signs

1. Stellwags sign — Mild
First sign to appear

2. Von Graefes sign — Mild

3. Joffroys sign -Moderate

4. Moebius sign — Severe

Important signs to be remembered

Visible lower sclera- sign of exophthalmos

Naffziger's sign

VonGraefes sign—upper lid lag— contraction /overactivity of the involuntary part of the
levator palpebrae superioris muscle
Muller's muscle

Joffroy’s sign

Moebius sign— most important—early sign of ophthalmoplegia

Types of endocrine stimuli

Hormones that do not cross placenta

Insulin
PTH
calcitonin

Few points regarding Human chorionic gonadotropin

• hCG can be detected in maternal urine after 7-8days of ovulation

• The rapidly rising hCG seen between 3-4 and 9-10 weeks gestation coincides with the proliferation of immature trophoblastic villi and the extent of the syncytial layer

• Plasma levels increase, doubling in concentration every 2-3 days between 60 and 90 days of gestation.

•Failure of hCG doubling with time. This suggests the presence of an anviable or ectopic pregnant or threatened miscarriage.

• The average peak hCG level is approximately 110,000 mIU/mL and occurs at 10 weeks gestation

• Between 12 and 16 weeks, average hCG decreases rapidly with the concentration

•Levels continue to fall from 16 to 22 weeks at a slower rate.

•During the third trimester mean hCG levels rise in gradual, yet significant, manner from 22 weeks until term.

•hCG levels are comparatively higher in women bearing female fetuses.

•Human chorionic gonadotropin may stimulate steroidogenesis in the early fetal testes resulting in virilization and sexual differentiation in males