Endocrine, Metabolic and Nutritional Disorders
Diabetes
Master diagnosis (fasting ≥7.0 mmol/L, 2-h OGTT ≥11.1, HbA1c ≥6.5%, random ≥11.1 with symptoms), targets (individualised HbA1c), and therapy (metformin first-line; SGLT2 inhibitors/GLP-1 agonists for cardiorenal protection). Know hypoglycaemia management and sick-day rules.
Thyroid
Interpret TSH and free T4 together: primary hypothyroidism (high TSH, low FT4), subclinical (high TSH, normal FT4), hyperthyroidism (low TSH, high FT4). Know thyroid storm (Burch–Wartofsky), pregnancy (trimester-specific ranges; levothyroxine dose increases), and amiodarone-induced thyroid dysfunction.
Metabolic and nutritional
- Obesity: BMI, waist circumference, lifestyle, pharmacotherapy, bariatric surgery criteria.
- Dyslipidaemia: statin intensity by risk.
- Vitamin D deficiency: common in the region; supplementation and monitoring.
- Osteoporosis: DEXA T-score ≤ −2.5; FRAX; calcium/vitamin D; bisphosphonates.
- Electrolytes: hypo/hypernatraemia, hyperkalaemia management (calcium, insulin–glucose, salbutamol, dialysis).
Traps
- Diagnosing diabetes on a single random glucose without symptoms.
- Missing subclinical thyroid disease because FT4 is normal.
- Forgetting adrenal insufficiency before starting levothyroxine in hypopituitarism.
- Ignoring sick-day rules in a diabetic with infection.
Worked rule
Hyperkalaemia with ECG changes: give IV calcium first (cardioprotection), then shift (insulin–glucose, salbutamol), then remove (dialysis, binders).