127 onwards

Question 1

Hypercalcemia

Answer 1

PTH (?hyper)
CXR (?cancer)
U&Es (?CKD)

High PTH / N renal function suggests hyperparathyroidism

Normal PTH suggests primary hyperparathyroidism (“abnormally normal”)

Low PTH suggests malignancy.

Question 2

Hypocalcemia

Answer 2

PTH
25(OH)VitD3 (Calcidiol)
Mg2+
PO43-

Question 3

Addisons

Answer 3

Short synacthen test
U&Es
Renin:aldosterone ratio (high in primary, normal in secondary)

Question 4

Cushings

Answer 4

Urinary free cortisol 24h

Overnight low-dose dexamethasone suppression test

Question 5

What is the high dose dex test for?

Answer 5

Distinguish ectopic from pituitary adenoma ACTH source.

Pituitary adenoma is suppressed, ectopic isn’t.

Question 6

Amenorrhea (primary or secondary)

Answer 6

FSH/LH levels
DHEAS&testosterone*
Dex suppression test

• Elevated in CAH, ovarian / adrenal tumours

Dex supp test: successful if non-tumour sex steroid source; failure to suppress suggests ovarian/adrenal tumour

Question 7

Hypergonadotrophic hypogonadism in female

Answer 7

Pelvic USS (e.g. small ovaries without follicles)

Question 8

Hypogonadotrophic hypogonadism

Answer 8

MRI brain (?pituitary/hypothalamic abnormality)

Question 9

Hirsutism, frontal balding, acne (?hyperandrogenemia)

Answer 9

Total testosterone
FSH & LH (+ ratio)
DHEAS
17-OHP

Sig total T raised = VOT; slight = PCOS

FSH + LH: ratio above 2:1 suggests PCOS

Raised DHEAS suggests adrenal tumour (mild in PCOS)

Raised 17-OHP = CAH

Question 10

Hyperprolactinaemia e.g. gynaecomastea

Answer 10

PRL level
TSH level
MRI pituitary

Hypothyroidism causes hyperPRL so if TSH is not raised and PRL is, you need an MRI pituitary for ?adenoma

Question 11

Amenorrhoea with rapid signs of virilisation

Answer 11

?VOT

Total testosterone
Dexamethasone suppression test
CT abdomen/pelvis
17-OHP

Total T = elevated in VOT
Dex supp test = no suppression of testosterone in VOT
17-OHP for CAH

Question 12

Precocious puberty

Answer 12

Wrist x-ray
LH/FSH levels
GnRH analogue stimulation test
Oestradiol

MRI brain if high FSH/LH
Pelvic USS (ovaries/adrenals)if low FSH/LH
Oestradiol raised if ovarian cyst/tumour

Question 13

Delayed puberty

Answer 13

Testes volume / auxology
Bone age
LH/FSH levels
IGF-1/IGF-NP
MRI brain

Question 14

Sweating, episodic headaches, tachycardia

Answer 14

3 x 24h urinary metanephrines (catecholamines)