Anemia and adrenal

Question 1

treatment of IDA?

Answer 1

1. oral iron
2. IV iron
3. blood transfusion

Question 2

treatment of B12 deficiency?

Answer 2

IM hydroxycobalamin

Question 3

indications for blood transfusion?

Answer 3

• hemodynamically unstable
• Hb < 8
• active hemorhage
• symptomatic anemia?

Question 4

what investigations should you do for suspected hypercortisolism?

Answer 4

• 24 hour free urinary cortisol

- dexamethasone suppression test

Question 5

which screening tests shoudl you do for someone with cushing syndrome?

Answer 5

• Hba1c and blood glucose
• 24 hour bp
• DEXA
• opthalmogy (cataracts or increased IOP)

Question 6

first step in testing for adrenal insufficiency?

Answer 6

Short synacthen test

Question 7

how to do the short synacthen test?

Answer 7

-measure morning cortisol
-give synacthen IM
- measure cortisol 30 minutes later
(should normally increase > 500 nmol/L)

Question 8

work up for adrenal insufficiency?

Answer 8

• autoantibodies for adrenal gland
• if negative, antibodies against 21 alpha hydroxylase
• imaging of adrenal gland (TB/mets/lymphoma)

Question 9

treatment of unstable patient with possible adrenal insufficiency?

Answer 9

• obtain random ACTH + cortisol but do not delay treatment

- IV hydrocortisone

Question 10

treatment of patient with adrenal insufficiency?

Answer 10

• glucocorticoid replacement (hydrocortisone)

- mineralcorticoid replacmeent (fludracortisone)

Question 11

what are the SICK DAY rules for a patient with adrenal insufficiency?

Answer 11

double daily dose of meds

Question 12

What should a patient with adrenal insuffiency have at home?

Answer 12

emergency IM hydrocortisone kit