Endocrinology

Question 1

What is in the osteoporosis screen?

Answer 1

Ca
Vit D
PTH
ALP - high in osteomalacia
TSH
EPG/IEPG
Anti-TTG
LFT
Renal function

Question 2

What is the management of new DM?

Answer 2

Weight loss: waist-hip ratio <0.9 F, <0.8 M
Fat intake < 30% of kJ
Monounsaturated fats
Nephropathy: restrict protein intake to ~10% of kJ intake.

Question 3

Which tests should be perfored in metabolic syndrome?

Answer 3

First line

• Fasting BSL, HbA1c, OGTT
• Lipid profile

Second line:

• Diabetic or hypertensive nephropathy: Cr, eGFR, urine ACR
• NAFLD: LFTs, liver US
• Hypothyroidism:TSH
• Uric acid level
• PCOS: hormones (testosterone, DHEAS, androstenedione, LH, FSH, SHBG), ovarian US
• Male hypogonadism: testosterone, SHBG

Question 4

What are the management options in obesity?

Answer 4

Goals

• Aim for waist circ 102cm (men) or 88cm (women). Ideally <94cm and <80cm respectively
• Aim for weight loss of 1-4kg per month short term, or 5-10% body weight long term

Diets

• Reduced energy diet: energy deficit of 480-960kcal/day
• Low energy diet: 1000-1200kcal/day total
• Very low energy diet 800kcal/day total. Recommended for 8-12 weeks.
• Dietitian referral

Exercise
- 300min moderate or 150min vigorous activity

Psychologist

Pharmacological

• Orlistat inhibits intestinal lipase, reducing fat absorption
• Phentermine (sympathomimetic) may be prescribed short term for 3 months. Appetite suppressant. SE of HTN, tachycardia, insomnia, pulmonary HTN.

Bariatric surgery
- Consider if BMI>40, or BMI>35 with comorbidities that may improve with weight loss

Question 5

What are the contraindications to a very low energy diet?

Answer 5

• Pregnancy/lactation
• Severe psychological disturbance (depression, anxiety), drug or EtOH abuse
• Recent ACS or stroke
• Porphyria
• Age>65

Question 6

What are the complications of obesity?

Answer 6

OSA
OHS
Asthma
OA
GORD
Biliary disease
NAFLD
T2DM
FSGS
HTN
Hyperlipidaemia
Coronary artery disease
Stroke
Cancers of breast, colon, endometrium
Depression
Infertility
Erectile dysfunction

Question 7

Which conditions should be screened for in obesity?

Answer 7

Hypothyroidism
Cushing’s syndrome
PCOS
Insulinoma