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Endocrinology (Diabetes Mellitus (Conditions where HbA1c can't be used…
Endocrinology
Diabetes Mellitus
Conditions where HbA1c can't be used: Haemoglobinopathies, haemolytic anaemia, untreated Fe deficient, suspected gestational diabetes, children, HIV, CKD - use fructosamie instead - can't use HbA1c if increased cell turnover
IGT = increased risk of T2DM; HbA1c = 42-47mol/mol, GF 6.1-6.9 OCT 7.8-11.1
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Diabetic Neuropathy: Pain 1st line Duloxetine, gabapentin, pregabalin or amitriptyline - tramadol can be used in a cute attacks
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Phaeochromocytoma
Give alpha blockers before beta as beta alone can cause unopposed alpha stimulation = vasoconstriction and hypertensive crisis
Adrenal Cortex - Aldosterone, cortisol, androgens
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Ulcers
Venous
Gaiter area, sloughed edges, venous eczema,haemosiderin
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Arterial
Punched out, painful, toes, heels, top of foot, cold foot, weak pulses
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DI
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Water deprivation 1) Deprive to see if urine becomes more conc 2) If it doesn't give desmopressin to see if its purely cranial
MEN
MEN 1: Parathyroid adenoma, pancreatic tumour, pituitary adenoma
MEN 2a: Thyroid carcinoma, adrenal (phaeochro), parathyroid hyperplasia
MEN 2b: Thyroid carcinoma, mucous neuroma, marfanoid appearance
SIADH
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Cause, headache, hyporeflexia,
Pituitary tumours
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Prolactinoma - Rx = Bromocriptine 9dopamine agonist to control effects of prolactin) - Transohenoidal if this doesn't work
Addisons
Crisis
Causes: Sepsis (causes acute exacerbation of hypoadrenalism) adrenal haemorrhage, steroid removal
Rx: Tachy, hypo, abdo pain, vomiting, confusion, collapse
Rx: Hydrocortisone 100mg IV/IM, IV fluids, dextrose if hypo, calcium if hyperkal
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