Endocrine

Question 1

What are the 3 major proposed mechanisms for CIRCI?

Answer 1

1. decreased cortisol production
2. impaired metabolism (hepatic/renal)
3. Target tissue resistance to cortisol

Question 2

What is the relationship between ACTH and cortisol during CIRCI?

Answer 2

dissociation - high cortisol, low ACTH

Question 3

what is the biologically active thyroid hormone?

Answer 3

T3

Question 4

How to diagnose thyroid storm?

Answer 4

Clinical signs
Evidence of thyrotoxicosis: elevated or high normal TT4 with increased free T4

Question 5

What are the 4 areas of focus for the treatement of thyroid storm?

Answer 5

1. reduce production +/- secretion of thyroid hormone
2. counteract peripheral effects of thyroid hormone
3. provide systemic support
4. elimitate precipitating factors

Question 6

what causes the myxodema in some patients with hypothyroid crisis?

Answer 6

• accumulation of the GAG hyaluronic acid in the dermis
• impaired renal perufsion due to CV dysfunction causing fluid acculumation
• excess ADH secretion

Question 7

3 defining features of HHS:

Answer 7

1. Severe hyperglycemia (>600mg/dL or 33mmol/L)
2. Minimal/absent urine ketones
3. Serum osmolality > 350 mOsm/kg

Question 8

What is an example of a SGLT-2 inhibitor?

Answer 8

Sodium glucose co-transport type 2 inhibitor e.g. bexaglifozin
Once daily oral medication

Question 9

How does SGLT-2 inhibitors work?

Answer 9

SGLT-2 are found in early PT: usual role to reabsorb filtered glucose
Inhibiting it: massive glucosuria and renal excretion
Reducing glucose reduces insulin resistance and damage to pancreas, giving the pancreas a chance to make more insulin

Question 10

How is SGLT-2 inhibitor implicated in euglycemic DKA?

Answer 10

• lowers plasma glucose levels and decreases insulin secretion, stimulating glucagon release
• increased glucagon/insulin favours lipolysis and ketone body production, gluconeogenesis
• also increase renal ketone body reabsorption

Question 11

List 6 roles of insulin:

Answer 11

1) Inhibits gluconeogenesis and glycogenolysis
2) Promotes glycogen storage
3) Stimulates glucose uptake and utilization by insulin-sensitive cells
4) ↓ glucagon secretion
5) Promotes TG formation in adipose tissue
6) Synthesis of protein and glycogen in muscle