Endocrinology

increased bone resorption -> increased Ca and phos Increased Ca reabsorption from kidney increase in active vit D production in kidneys

stress exercise hypoglycaemia Glucagon

check if functioning if not and >1cm repeat MRI in6mo-1yr

glucose somatostatin obesity

IGF1

98% GH producing pit tumour most >1cm

surgery 1st line (50% cure rate with macroadenomas) if not cured -> medical therapy (octreotide, lanreotide or pasireotide binding to SST2) rarely dopamine antagonists if not succesful -> Rdx Pasireotide causes new onset DM in 60% (also binds to SST5 on beta islet cells)

CVD in uncontrolled

pituitary tumour 50%

cabergoline (dopamine agonists) - side effects: valvular heart disease, impuse control surgery if doesn’t respond

Free T4 the same total T4 increased or decreased

Increased TBG -> OCP, preganacy , acute hepatitis decreased TBG -> testosterone tx, steriods, anything which reduced general protein amounts

grave’s disease

HLA DR3

T cells present antigen to B cells uses CD 40 to CD 154 (can be targeted by Iscalimab) -> inhibits autoreactive B cell activation works in 50%

TSH receptor antibodies if they are negative can do scinti scan -> diffuse uptake over whole gland

carbimazole 12-15mo (50% remission rate) if relapse or dont go into remission -> radioactive iodine or thyroidectomy

most common rash and arthralgias agranulocytosis (if repeat infections need CBE) PTU -> hepatotoxicity, ANCA vasculitis

PTU in 1st trimester (carbimazole can cause issues)

PTU -> slows down thyroid hormone production and reduces peripheral conversion

smoking radioiodine letting pt become hypothyroid

IV methylpred can add cyclosporin, rituximab, RTx tocilizumab teprotumumab (anti-IGF1) if still unresponsive -> surgery

radioactive iodine Not likely to leave hypothyroid due to only targeting goitres

if TSH receptors negative do scinti scan -> diffuse uptake graves if no uptake -> thyroiditis