16 - obesity and Cushing's syndrome

Question 1

What is BMI?

Answer 1

Kg/ height²

Question 2

What is overweight in BMI?

Answer 2

Greater than 25

Question 3

What is obesity?

Answer 3

Greater than 30

Add 1 grade per increase of 5 BMI

Question 4

When is a patient eligable for bariatric surgery?

Answer 4

BMI > 35 with comorbidites OR BMI > 40 with no comorbidities

and has demonstrate weight loss

Question 5

What is olistat and when is it indicated?

Answer 5

lipase inhibitor in the gut

for BMI > 30

Patients must demonstrate 5% reduction in weight within 5 months

Question 6

What test are good in order to screen for cushing’s syndrome?

Answer 6

Overnight dexamethsone supression test

24 hour urinary free cortisol

Question 7

A patients shows that they have increased cortisol in urin/ raised cortisol after dexamethasone supreesion test. What is the next investigation?

Answer 7

ACTH test

Question 8

ACTH come back and shows high levels of ACTH. What does this indicate and what is the next most appropraite investigaiton?

Answer 8

A ectopic or pituitary tumour.

Next use petrosal venous sampling. Sometimes pituitary MRI can be used.

Question 9

If ACTH test came back and showed low ACTH what is the likely cuase and what is the next most appropriate investigation?

Answer 9

Adrenal cause - hyperplasia

Do abdo CT

Question 10

If petrosal venous sampling showed high levels of ACTH: what would be the likely cause and what is the next most appropriate investigation?

Answer 10

Pituitary adenoma

Pituitary/ head MRI

Question 11

If petrosal venous sampling showed low levels of ACTH: What is the likely cause and what is the next most appropriate investigation?

Answer 11

Ectopic ACTH release

Do CXR as small cell carcinoma of the lung is a common cause

Question 12

A patient has hyponatraemia, what infomation do you need to know and in what order?

Answer 12

1st serum osmolority

2nd asses fluid status

3rd urine osmolarity

Question 13

A patient is hyponatraemic with normal to high serum osmolarity. What could be the cause?

Answer 13

psuedo-hyponatraemia

Question 14

What is pseudohyponatraemia?

Answer 14

high protein or lipids in serum

Question 15

Patient is hyponatraemic, hypotonic with hypovolaemia. What is test next?

Answer 15

If low sodium this indicates renal losses.

If high sodium then this indicates extra renal cause: D&V etc…

Question 16

Patient is hyponatraemic, hypotonic with eurovolaemia and has a high urine osmolality. What could this indicate?

Answer 16

Adrenal insufficiency

SIADH

Question 17

Patient is hyponatraemic, hypotonic with eurovolaemia and has a low urine osmolality. What could this indicate?

Answer 17

Polydipsia, are they a psychiatric patient

Question 18

Patient is hyponatraemic, hypotonic with hypervolaemic and has a high urine sodium. What could this indicate?

Answer 18

renal failure

Question 19

When should a patient carry a steroid card?

Answer 19

If they take steroids more than 3 times a week

Question 20

What is Nelsons syndrome?

Answer 20

Pituitary adenoma which has developed after bilateral adrenolectomy resulting in raised ACTH.

Question 21

What is Pichwichian syndrome?

Answer 21

Hypoventilation due to obesity

Question 22

Waterhouse-frederichsen syndrome

Answer 22

Adrenal failure due to heamorrage into the aderenal gland. This is commonly due to infection or sepsis

Question 23

What is Metryaprone?

Answer 23

Supressors cortisol production. Can be used for diagnosis as well as managment. Increased ACTH after consumption ind.icates pituitary adenoma where as the same ACTH would indicate ectopic ACTH release

Question 24

What does normal creatinine and high urea indicate?

Answer 24

dehydration

Question 25

What is the management during an addisonian crisis?

Answer 25

• Treat hyperkaleamia + ECG
• 100mg IV hydrocotisone
• fluid challenge - 500ml 0.9% saline
• blood glucose
• consider infection