Showing posts with label Endocrinology. Show all posts
Showing posts with label Endocrinology. Show all posts

Monday, May 30, 2022

Tuesday, December 21, 2021


1-Plasma TSH is the first investigation of choice  in a patient with suspected thyroid diease.
This may be mildly elevated in mild or subclinical hypothyroidism
TSH levels may be suppressed  in hyperthyroidism.
The anterior pituitary is very sensitive to minor changes in thyroid hormone levels which is why TSH is usually considered to be the most reliable investigation of thyroid function. 

2- Plasma free T4- confirms the diagnosis and assesses the severity of hyperthyroidism.  It is also used to diagnose secondary hypothyroidism. 

Both TSH and free T3 and T4 levels should be considered as it may be misleading in patients suffering from any pituitary disease. 

Eg: TSH may be normal or low in secondary hypothyroidism 
Raised T4 and T3 levels may be seen in initial stage of levothyroxine therapy. 

Other investigations may include measurement of antibodies against TSH receptors or other Thyroid antigens 
For instance: Antibodies to TPO, Thyroglobulin, TSH Receptor.

Some drugs may affect TFTs. For example: amiodarone may cause a decrease in free T4 and elevation of TSH. Amiodarone may also cause a decrease in TSH  causing hyperthyroidism in certain patients.


Friday, June 11, 2021

Hormone Basics - Part 1

 Hormones are divided into 2 groups

Group 1 hormones- Act via nuclear receptors

    Type 1- Have cytoplasmic receptors with effector elements in the nucleus e.g Steroid hormones (cortisol), Gonadal hormones (Androgens, estrogens, progesterones)

Mnenonic- There is only 1 General Secretary

  Type 2 -Directly act at the nucleus e,g, vit D,vit A, Thyroxine

Mnemonic-Directly AcT at the nucleus

Group 2 hormones-  Act via the cell membrane surface receptors

1. GPCR- Very extensive, will require a second post

2.Tyrosine Kinase- All Growth factors(Except TGF alpha and beta) and Insulin (Tip to remember: TKI or tyrosine kinase inhibitors are used in a lot of malignancies, there's abnormal growth in malignancies and hence TKIs stop that growth, also I in TKI will remind you of insulin, Insulin causes fat to grow!!)

3. JAK-STAT(cytokine receptor) Mr. JAcK is a Drunkard!! all he needs is PEG 



Growth hormone.

(Pro tip: GH and PRL are called as twin hormones, JAK STAT mutations are involved in Myeloproliferative disorders say Polycyathemia and erythropietin is needed there)

4.Serine threonine Pathway: This pathway is a perfect BAIT for the hormones.

Bone morphogenic protein  



Trasformation growth factor alpha and beta

That's all for today!

Have fun and stay safe!

How did you find the post?

Let me know in the comments section below!

Dr. ShilPill

Wednesday, June 2, 2021

Complete Androgen Insensitivity- A perfect female

 Hello everyone!

In today's post I'll try to explain you what Complete Androgen Insensitivity Syndrome (CAIS) is.

Androgens are primarily male hormones required for a normal male development. But also, these androgens are secreted in females by their adrenal glands and have some role in female body development too, e.g Growth of pubic and axillary hair.

Now imagine, a very very beautiful adolescent girl, say around 16 years of age, comes to your clinic with a history of primary amenorrhoea. She has absolutely flawless skin (No acne like other 16yr olds), breast development normally, no pubic and axillary hair and on further examination, some inguinal mass, maybe a hernia.

You ask the radiologist for an USG abdomen and pelvis. Don't be surprised to find testes as the hernia content and no uterus!!

This is a classic case of CAIS.

Karyotype analysis- 46XY

Inheritance- XL recessive, mutation in the AR (Androgen Receptor) gene

Genitalia- Female with blind vaginal pouch

Wolffian duct- Often present

Mullerian Duct- Absent

Gonads- Testes

Hormone Profile- Increased LH and Testosterone (But the receptors have resistance to it's action)

Increased Estradiol, FSH slightly raised.

For more pictographic representation, Watch HOUSE MD S02E13 "Skin deep"

That's it!

Happy Studying

Stay awesome!

Dr. ShilPill

Friday, September 25, 2020

Sodium-glucose co-transporter 2 (SGLT2) inhibitors notes and mnemonics

 A short post on SGLT2i!

Canagliflozin (brand name Invokana)
Empagliflozin (brand name Jardiance)
Dapagliflozin (Farxiga)
Ertugliflozin (Steglatro)

Mechanism: Blocks renal glucose absorption, resulting in glycosuria.
Mnemonic: GliFlozIN makes Glucose Flow In Nephrons

In addition:
Has beneficial effects on ASCVD events, heart failure, and CKD.
Causes weight loss  (Mnemonic: SGLT2 Surely Generates Less Tummy).
No risk of hypoglycemia.

Side effects:
Genital fungal infections.
Fournier’s gangrene.
Dehydration may result.
Euglycemic diabetic ketoacidosis (should be held 24H prior to scheduled surgeries).
Canagliflozin may increase the risk of leg amputation (should be avoided in those with peripheral vascular disease).

Caution: Renal dose adjustment is required in CKD.

That's all!

Metformin notes and mnemonics

 A short post on Metformin!

Decreases hepatic glucose output by reducing hepatic gluconeogenesis and glycogenolysis.
Enhances peripheral glucose uptake and enhances insulin sensitivity.
Decreases glucose absorption in the GI tract.
Reduces hemoglobin A1C levels by 1.5%.

In addition:
Decreases triglyceride levels.
Decreases LDL-cholesterol.
May increase HDL-cholesterol.

Side effects:
Vitamin B12 deficiency may develop
Risk of lactic acidosis in renal or liver disease or CHF

Contraindicated in: GFR <30ml/min.

That's all!

Related posts:
Oral hypoglycemic drugs used for diabetes mellitus mnemonic: Metformin meets glucose and advises it to stay out of the blood. It asks the liver to keep glucose in the house (Inhibits hepatic glucose production) and asks the glucose in the bloodstream to go into adipose and skeletal muscle (Stimulates peripheral uptake of glucose). Metformin never met a glucose molecule and did not tell him to not stay in the blood (Illustration in the original post).

Sunday, August 2, 2020

Technique of Breastfeeding

Hello friends!
On International Breastfeeding Week, I am sharing the proper technique for Breastfeeding. 
Must know methods for everyone.

Techniques of Breastfeeding 
Breastfeeding is nature's precious gift for infants. Breastfeeding is advised because human milk is species-specific nourishment for the baby, produces optimum growth and development, and provides substantial protection from illness. Lactation is beneficial to the mother's health and biologically supports a special MOTHER-BABY relationship.

But most breastfeeding problems are caused by the poor attachment of the baby to the breast. Thus, it is very important to learn how to feed the baby with the correct position and attachment.

Support the mother's body as support back well and use pillow, cushion, or footstool to provide comfort. Before breastfeeding, every mother should wash their hands. 
The correct way to support baby -
1. In sitting position 
a) Cradle hold-
Hold the baby horizontally facing the mother. When nursing from the right breast, use the right arm to rest on the forearm, baby's back supports on the same forearm and holds baby's bottom with hand. Support the breast with the left hand. 
b) Transition hold (cross over hold)
When nursing from the right breast, use the left arm to hold the baby. Support baby back with the left forearm, while placing the thumb and fingers at the base of the baby's head below the ears of the baby. Support the breast with the right hand. 
c) Football hold
Hold the baby under the mother's arm and let the baby face towards the breast. Support the baby with a pillow underneath. Hold the baby close the mother with the nose pointing to the nipple, use the forearm to support baby back and neck, and the hand to hold the baby head. This position is suitable for mothers who have had a Caesarean section. Since mother does not put pressure on the abdomen. 

2.Inside lying hold 
Baby and mother lying on their sides facing each other. The mother should be relaxed. The baby needs to well supported and secure as tuck a rolled-up towel or small pillow firmly behind baby' back to keep in position. Adjust the baby's distance from the lower breast by placing a folded blanket under the baby's head. To assist with the latch on using the opposite hand to support the breast(right hand for left breast vice-versa) 
Getting baby latch on to the breast -support the base of the baby's head. Baby's head slightly extended, so that the nipple is aimed at the roof of the baby's mouth. Lightly touch the baby's lip with the nipple and wait till baby opens his/her mouth wide. Bring baby to mother's breast. Not mother breast to the baby. 

Signs of good attachment-baby open his/her mouth wide with lips flanged out, more areola is seen above the baby's lip then below baby's chin is pressed onto the breast. 
Breastfeeding should not hurt if the mother keeps a finger into the corner of baby's mouth to break the suction and gently take baby off mother's breast.

Shashikala Kumari
2nd year MBBS
GMC Bettiah

Saturday, June 13, 2020

Clinical correlates: Epinephrine vs Norepinephrine reversal

Hey Awesome peeps :)

This post is about variation in the effects of epi- and norepinephrine depending on its dose.

Thursday, April 16, 2020

Thioamides in pregnancy


Propylthiouracil is a pro. It always comes first (used in first trimester of pregnancy).
Methimazole causes Malformations in the embryo (teratogenic).

There are two M's in MethiMazole. This drug is used in second (and third trimester of pregnancy).
Propylthiouracil piles up, causing liver toxicity, thus limiting its use.

Hope it helps
- Jaskunwar Singh

Saturday, December 28, 2019

Mnemonic for Dawn & Somogyi phenomenon

Hello everyone....

A diabetic patient who is taking NPH insulin regularly at early evening time presents with early morning headache. He also feels very stressed & tiredness. 
I have checked that he is hyperglycemic.

Suddenly I think about Dawn & Somogyi phenomenon. But I have a confusion between that 2 terms.
So I make a mnemonic…

Here it is ..
Dawn & Somogyi phenomenon
In both Early Morning High Glucose 
= Due to ⬆️ GH & Cortisol Surge 

What is the difference ??

Monday, December 23, 2019

Important Mnemonics for Oral hypoglycaemic drugs in Diabetes

Hello everyone .. 

I make mnemonics for some important side effects of oral hypoglycemic drugs. 

You must know that because you may prescribe it for 1 out of 11 adults in whole population the of world….!!

Side effects of Oral hypoglycaemic drugs along with it's class & mechanism of action 

#Mnemonic 1
Big Men ForminG Poor Diabetic neuropathy ( D/Dx B12 Deficiency ➡️ confirmed by doing  B12 LAB test.)

Biguanide = Metformin 
Inhibit mGPD 
It causes Vitamin B12 Deficiency & Lactic Acidosis (LA) 

#Mnemonic 2 
1st Key to SUccess is Lord "Ram"

1st Gen SUlfonylureas
Closes K+ Channel 
Ram = Disulfiram like reaction….

#Mnemonic 3 
Paragliding makes your heart failed or maybe a fracture or bladder injury 

Para = PPAR Y
Gliding = Glitazone activates it...

#Mnemonic 4
"Rosy red Blood don't reach to heart (MI) but goes into Pee = Red Pi ( Pee = Urine in Bladder Cancer )
MI (rosiglitazone) 
Bladder cancer (pioglitazone)

#Mnemonic 5
“Change your Daily Personal Passivity (DPP) otherwise your heart fails” 
DPP  = DPP-4 inhibitors 

#Mnemonic 6
“Candid Status is Very Good in Love Test”

SGLT-2 inhibitors can cause Vulvovaginal Candidiasis 

Drugs category & their Suffix 

Pramlintide = Amylin Analogue 

1st gen Sulfonylureas = “Amide”
2nd gen Sulfonylureas = “Ride” & “Zide”
Meglitinides = “Nide”

DPP-4 Inhibitors = “Gliptin”

Glitazones / thiazolidinediones = “Zone”

SGLT -2 Inhibitors = “Flozin”

#Mnemonic 7
Alpha glucosidase inhibitors = "Please Side your Car & Pay Toll"
Acarbose & Miglitol 

#Clinical Pearls 

Weight neutral = DPP 4 & Alpha Glucosidase inhibitors 

SGLT2 inhibitors & GLP-1 = Used in CVD
( Cardiovascular diseases) patients

In case of Renal failure you can only give 2 type of drugs orally = DPP 4 inhibitors & Glitazones 

Injectables can be given in renal failure.

3 times / day dosing = Pramlintide , Alpha Glucosidase inhibitors & Glinide 

Regular Insulin ( Short acting ) is preferred for 
Hyperklaemia (Add Glucose)
Stress Hyperglycemia

Thank you :)

- Dr. Drashtant Prajapati