Endocrinology and Diabetes
Diabetes, thyroid, adrenal, pituitary and metabolic disease.
- Type 1 Diabetes Recognising it clinically rather than by HbA1c, basal-bolus insulin and closed-loop technology, and the sick day and driving rules every patient must know.
- Type 2 Diabetes The NICE algorithm that now starts with cardiovascular risk, the drug classes and their hazards, and why remission is a realistic goal in the first few years.
- Prediabetes The three definitions of non-diabetic hyperglycaemia, who to test, the trial evidence behind prevention programmes, and where metformin fits.
- Diabetic Ketoacidosis The three diagnostic criteria, fixed rate insulin alongside fluid replacement, the potassium rules that prevent deaths, and the cerebral oedema that threatens children.
- Hyperosmolar Hyperglycaemic State Calculating osmolality, why fluid comes before insulin and at half the DKA rate, and correcting slowly enough to avoid cerebral oedema and demyelination.
- Hypoglycaemia Autonomic then neuroglycopenic symptoms, the treatment ladder from glucose tablets to intravenous glucose, and reading the insulin and C-peptide screen.
- Diabetic Neuropathy Glove and stocking sensory loss, autonomic failure and the pupil-sparing third nerve palsy: screening with the monofilament, treating neuropathic pain, and excluding the mimics.
- Diabetic Foot Disease Risk stratifying the foot, separating neuropathic from ischaemic ulcers, treating infection and osteomyelitis, and recognising acute Charcot before the arch collapses.
- Hypothyroidism Interpreting TSH and free T4, when subclinical disease needs treating, prescribing and monitoring levothyroxine, and the steroid-before-thyroxine rule in myxoedema coma.
- Hyperthyroidism Using the uptake scan to separate overproduction from thyroiditis, carbimazole and agranulocytosis, radioiodine versus surgery, and the drug order in thyroid storm.
- Graves Disease and Thyroid Eye Disease TSH receptor antibodies and the four extrathyroidal signs, scoring eye disease activity against severity, and the features that need same-day ophthalmology.
- Thyroid Nodules and Goitre Why the TSH decides the next test, the U and Thy grading systems, the red flags for malignancy, and the four thyroid cancers and their very different outlooks.
- Cushing Syndrome The discriminatory features that separate it from obesity, the screening tests and their false positives, using ACTH to localise the source, and treating each cause.
- Adrenal Insufficiency Separating primary from secondary disease, the short Synacthen test, hydrocortisone and fludrocortisone replacement, sick day rules, and treating adrenal crisis.
- Primary Aldosteronism Who to screen, interpreting the aldosterone-to-renin ratio and the drugs that invalidate it, why adrenal vein sampling matters, and surgery versus spironolactone.
- Phaeochromocytoma Catecholamine-secreting tumours: the episodic triad of headache, sweating and palpitations, metanephrines for diagnosis, and why alpha-blockade always precedes beta-blockade.
- Acromegaly Insidious acral and facial overgrowth from a GH-secreting adenoma: screening with IGF-1, confirming with the OGTT, and the treatments that restore normal mortality.
- Hypopituitarism Deficiency of one or more pituitary hormones: the order in which axes fail, the dynamic tests that confirm it, and why hydrocortisone is always replaced before thyroxine.
- Pituitary Tumours The four ways an adenoma presents - mass effect, hormone excess, hypopituitarism or incidentally - the bitemporal hemianopia, and recognising apoplexy as an emergency.
- Hyperprolactinaemia Galactorrhoea, amenorrhoea and hypogonadism: excluding drugs and physiology before imaging, and why dopamine agonists beat surgery even for large tumours.
- Diabetes Insipidus Polyuria from absent or ineffective ADH: the water deprivation test, separating cranial from nephrogenic disease, and telling both from primary polydipsia.
- Syndrome of Inappropriate ADH Secretion Euvolaemic hypotonic hyponatraemia: the diagnostic criteria, excluding adrenal and thyroid disease first, and why correcting sodium too fast causes demyelination.
- Hyperparathyroidism Primary, secondary and tertiary disease: bones, stones, groans and psychiatric moans, the phosphate that tells them apart, and the criteria for parathyroidectomy.
- Hypoparathyroidism Hypocalcaemia with a raised phosphate: Chvostek's and Trousseau's signs, the QT interval to check, and why active vitamin D analogues are needed rather than colecalciferol.
- Hyperlipidaemia Excluding secondary causes, spotting familial hypercholesterolaemia and its tendon xanthomata, and the NICE statin thresholds with the targets and interactions that follow.
- Metabolic Syndrome Central obesity, hypertension, dyslipidaemia and insulin resistance together: the IDF and ATP III criteria, the shared driver, and why the cluster outweighs its parts.
- Obesity BMI and waist thresholds including ethnicity-specific values, the causes worth excluding, and the NICE ladder from behavioural support through GLP-1s to bariatric surgery.
- Refeeding Syndrome Why feeding a starved patient is dangerous: the insulin-driven electrolyte shift, the NICE risk criteria, and giving thiamine before the first calorie.
- Vitamin D Deficiency and Osteomalacia Defective mineralisation: rickets versus osteomalacia, low calcium and phosphate with a raised ALP, Looser zones, and loading then maintenance colecalciferol.