common endocrine presentations

Question 1

what is the deawhat investigation is used for the definitive diagnosis of acromegaly ?

Answer 1

first line iis IGF-1
if raised then perform oral glucose test to see the suppression of the growth hormone

Question 2

what is the GI association with acromegaly ?

Answer 2

carries a high risk for colonic polyps and cancer colon

Question 3

what is the cause of acromegaly ?

Answer 3

mostly due to pituitary adenoma
if not - then GH secreting tumors

Question 4

what is the first line management of acromegaly ?

Answer 4

trans-sphenoidal surgery

Question 5

if surgery is not possible for cases of acromegaly what is the best management ?

Answer 5

somatostatin analogue ( octreotide )
or radiotherapy

Question 6

what are the different result interpretations associated with thee dexamethasone suppression test ?

Answer 6

used to test the level of ACTH and cortisol

1- not suppressed by low dose - cushing syndrome
2- not suppressed by low dose but suppressed by high dose - cushing disease
3- not suppressed by high or low dose - ectopic secretion of ACTH

Question 7

what is the cut off value to exclude cushing syndrome in association with the low dose dexamethasone suppression test ?

Answer 7

less than 1.8 mcg or 50 nmol

Question 8

what is the best treatment for cushing disease ?

Answer 8

transsphenoidal surgery
or adrenalectomy

Question 9

what is the second line treatment for cushing’s disease ?

Answer 9

bilateral adrenalectomy or radation

Question 10

what is the medical treatment for cushing’s disease ?

Answer 10

11 SAGA
1-11 beta hydroxylase : osilodrostat
2- somatostatin analogues : pasireotide
3- adrenal steroid inhibitors : ketoconazole
4- glucocorticoid receptor antagonist : Mifepristone
5- adrenolytic agents : Mitotane

Question 11

what is the action of somatostatin analogues ?

Answer 11

inhibits the production of ACTH which leads to decreased cortisol production

Question 12

what test is used to test for primary adrenal insufficiency ?

Answer 12

short synacthen test
a synthetic form of ACTH (synacthen ) is given in an attempt to stimulate the adrenal gland

Question 13

what is the difference in lab findings between primary and secondary hypoadrenalism ?

Answer 13

in primary hypoadrenalism - High ACTH with low cortisol levels
in secondary ACTH - Low ACTH and Low cortisol

Question 14

what hematological malignancies are associated with primary adrenal insufficiency ?

Answer 14

hodgkin and non hodgkin lymphoma

Question 15

what is the main autoantigen in idiopathic autoimmune adrenocortical insufficiency ?

Answer 15

21 hydroxylase

Question 16

what is the association of hashimoto’s and addison’s known as ?

Answer 16

schmidt syndrome
HHAI DOC

Question 17

what is polyglandular autoimmune syndrome type 1 ?

Answer 17

addisons disease
hypoparrathyroidism
candidiasis

Question 18

what is the other name for polyglandular autoimmune syndrome type 1 ?

Answer 18

APECED

Question 19

what mutation results in APECED ?

Answer 19

AIRE mutation

Question 20

what are the diseases in polyglandular autoimmune syndrome type 2 ?

Answer 20

addison’s
type 1 DM
hashimotos
Graves

Question 21

what is the treatment for addison’s disease ?

Answer 21

replacement with oral steroids
dose to be increased in infection and surgery

Question 22

what is the treatment of hyperprolactinemia secondary to pituitary adenoma ?

Answer 22

1st line - bromocriptine , cabergoline
transsphenoidal pituitary adenomectomy if medical therapy fails

Question 23

what are the causes of hyperprolactinemia ?

Answer 23

pituitary adenoma
drug induced hyperprolactinemia
pregnancy
primary hypothyroidism

Question 24

what must first be excluded in hyperprolactinemia ?

Answer 24

pregnancy

Question 25

if a patient presents with hypothyroidism and hyperprolactinemia , what is the best next step in management ?

Answer 25

treat thee hypothyroidism first

Question 26

what is the best test used to diagnose cushing ?

Answer 26

24h urinary cortisol
dexamethasone suppression test

Question 27

how should serum prolactin samples be taken ?

Answer 27

preferably in the morning and the patient should be fasting