Day 3 - Endo2 Quiz

Question 1

Elevated bp, palpitations, HA, perspiration, & urinary VMA - effect of beta blockers?

Answer 1

Elevate bp; Need to give Alpha blocker first (Pheochromocytoma)

Question 2

Lactotroph v. Somatotroph adenoma

Answer 2

Lactotroph (prolactin): Prolactin-secreting, Pituitary adenoma; Somatotroph (somatotropin): GH-secretin, pituitary adenoma; 50% prolactin 20% GH pituitary adenomas

Question 3

High PTH w/ Decreased serum Ca, increased serum phosphate

Answer 3

Renal failure w/ Vit D def (PTH raised due to low calcium 2/2 vit D def; kidneys not function well, so phosphate not trashed, instead increased)

Question 4

DHEA/DHEA-S/Tesoterone; Which more specific for adrenal tumor/secretion in women?

Answer 4

DHEA-Sulfate; Testosterone & DHEA made by both adrenals & ovary in women

Question 5

HIgh specificity test for dx primary aldosteronism

Answer 5

High aldostosterone: renin ratio; more specific than high sodium or metabolic alkalosis

Question 6

Next step mgt hyperprolactinemia not due to drug use

Answer 6

MRI brain (pituitary adenoma); TSH

Question 7

Next step mgt absent pituitary on MRI

Answer 7

Empty sella syndrome; No sx - reassure that residual pituitary tissue acting normally; If sx - id deficient hormones & tx

Question 8

2 most common causes of Cushing syndrome; Test(s) help distinguish between 2

Answer 8

(1) Exogenous steroid use - low serum cortisol, no suppression regardless of dexamethasone dose (2) Pituitary adenoma, causes Cushing disease - no suppression w/ low dose dexamethasone but suppression with high dexamethasone; Dexamethasone for ACTH suppression test

Question 9

Drugs causing hyperprolactinemia

Answer 9

Phenethiazines, Antipsychotics (Risperidone, Haloperidone), Methyldopa, Verapamil

Question 10

Compare/Contrast Alk Phos, PTH, serum Ca, & serum phosphate levels: (1) Paget disease (2) Osteomalacia or Rickets (3) Renal failure (4) Osteopetrosis or Osteoporosis (5) Primary hyperparathyroid (6) Hypoparathyroidism (7) Pseudohyperparathyroidism

Answer 10

(1) Elevated Alk Phos (2) Vit D def: low serum Ca, elev PTH, low phosphate, Alk Phos norm or elev (3) Vit D def (but non-fx kidneys): low Ca, high PTH, high P, Alk Phos normal or high (4) All normal (5) High PTH, high Ca, low phosphate, Alk Phos usually high (6) Low PTH, low Ca, high phosphate, unchanged Alk Phos (7) PTH elevated BUT low Ca & high phoshate

Question 11

Indications for surgical parathyroidectomy

Answer 11

Any of following: (1) Sx (2) Serum Ca > 1 mg/dL above upper limit of norm (3) 24 hr urinary calcium > 400 mg (4) Cr clearance reduced by 30% (5) Bone mineral density T-score