127 onwards first line management

Question 1

Hypercalcemia

Answer 1

IV fluids
+/- diuretics
Bisphosphonates

Question 2

Hypocalcemia

Answer 2

Cardiac monitoring
IV/PO calcium
IV/PO magnesium
PO vit D

Question 3

Addisons

Answer 3

Corticosteroids (reducing dose throughout day BD or TDS); pred or dex avoids slumps

Fluid resuscitation: IV if crisis
Fludrocortisone sometimes

Question 4

Cushings

Answer 4

Disease: transsphenoidal pituitary resection

Ectopic tumour: resection

Adrenals: adrenalectomy

Question 5

Secondary amenorrhoea

Answer 5

HRT

Donor oocytes if needed

Question 6

Primary amenorrhoe

Answer 6

Oestrogen

Thyroxine if hypothyroidism
GH if e.g. Turner’s
Diabetic agents if e.g. PCOS

Question 7

Hyperandrogenemia (PCOS)

Answer 7

Weight loss, healthy lifestyle, exercise

OCP - induces periods, reduces long term endometrial cancer risk, and decreases ovarian testosterone production

• Metformin
• Clomiphene citrate
• Leuprolide

(All for pregnancy)

Question 8

Hirsutism

Answer 8

Cyproterone acetate / spironolactone (antiandrogens)

Question 9

VOT/VAT

Answer 9

Resection e.g. salpingooopherectomy

Question 10

CAH

Answer 10

Glucocorticoids

+/-mineralocorticoids

Question 11

Ovarian cysts

Answer 11

None usually needed - shoul regress

Question 12

Mccune Albright syndrome

Answer 12

Synthetic oestrogen blockers / anti-oestrogens

Question 13

Central precocious puberty

Answer 13

Remove cause e.g. if tumour

GnRH analogue e.g. leuprolide, S/C or intranasal; to downregulate receptors and delay puberty

Question 14

Sweating, episodic headaches, tachycardia

Answer 14

Alpha blockade (PHENTOLAMINE MESYLATE or phenoxybenzamine)

Then resection