High yield comprehensive revision notes on Endocrinology. Written by a top decile Cambridge University Student.
It will be covering:
- Diabetes Mellitus
- Thyroid Disorders
- Pituitary Axis
- Adrenal Gland
- Blood Pressure control
- Calcium metabolism
Signs
- Necrobiosis lipoidica diabeticorum – shiny, painless areas of
yellow/red. Associated with telangiectasia.
Complications
- Diabetic ketoacidosis
- Macrovascular
o Ischaemic heart disease
o Cerebrovascular disease
o Peripheral vascular disease
- Microvascular
o Retinopathy
o Neuropathy e.g. glove and stocking, autonomic dysfunction,
mononeuritis multiplex
o Nephropathy (nephrotic syndrome)
Pathology
- Autoimmune condition
o Reduction in pancreatic B cells and lack of insulin synthesis
o Antiglutamic acid decarboxylase (GAD) autoantibodies
found in large amount of patients
o Some evidence it may follow an environmental trigger e.g.
virus
Investigations
GP may take urinalysis / capillary glucose
WHO guidelines:
- Fasting plasma glucose >7mM
, - Plasma glucose >11.1 mM when take 2 hours after ingesting 75g of
glucose (oral glucose tolerance test)
HbA1c
- Should be monitored every 3-6 months
- Target of 48mmol/mol or lower
Management
Conservative
- Self-monitoring of blood glucose
o 4x per day, before each meal and bed
o More frequent if: hypoglycaemic episodes, during period of
illness, surrounding sport, planning pregnancy, during
pregnancy, breastfeeding
o Targets:
5-7mmol/l on waking
4-7mmol/l before meals
Medical
- Typical Insulin Regime
o Basal/background – 1-2 injections per day/insulin pump e.g.
twice-daily detemir. Second-line: once-daily glargine
o Bolus – to cover sugar/carbohydrate in food e.g. aspart,
lispro, glulisine
- Alternative
o Twice-daily mixed insulin regime – 1-3 daily injections of short
+ intermediate acting insulins mixed.
- Consider metformin if BMI >25
2. Type II Diabetes Mellitus
Overview
- Most common cause of diabetes in the developed world
- Relative deficiency of insulin due to excess of adipose tissue
- Prediabetes
o People who haven't yet met T2DM criteria but are likely to
develop the condition over the next few years
o Require close monitoring/lifestyle interventions e.g. weight
loss
Presentation
Often picked up routinely in blood tests
Other signs:
- Polydipsia
- Polyuria
Investigations
Diagnosis
, - Symptomatic patients:
o Fasting glucose >/= 7mmol/l
o Random glucose >/= 11.1 mmol/l (or after 75g oral glucose
tolerance test)
- Asymptomatic patients - above demonstrated on two separate
occasions
- HbA1c
o >/= 48mmol/mol is diagnostic of diabetes mellitus (6.5%)
o Misleading Hb1Ac can be caused by increased red cell
turnover:
Haemoglobinopathies
Haemolytic anaemia
Untreated iron deficiency anaemia
Suspected gestational diabetes
Children
HIV
Chronic kidney disease
Medications causing hyperglycaemia
Manage
ment
Conservative
- Monitoring and treating for complications related to diabetes
- Modifying cardiovascular disease risk factors
- Dietary advice
o High fibre, low glycaemic index sources of carbohydrates
o Low-fat dairy products and oily fish
o Control intake of foods containing saturated fats
o Weight loss
Medical
- First-line is metformin
o Stop during intercurrent illness - increased risk of lactic
acidosis
o CI: CKD (stop if eGFR <30); iodine-containing contrast; alcohol
abuse
- Second-line drugs include sulfonylureas, gliptins and pioglitazone
- If oral medication is not controlling blood glucose - insulin is used
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller cambridgemedic. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.99. You're not tied to anything after your purchase.
