Diagnosis in Endocrine Flashcards
Diagnosis of Addison’s?
on bloods: low Na, high K and hypoglycaemia
Also do SHORT SYNACTHEN test - serum cortisol should rise substantially
Diagnosis of Addison’s?
on bloods: low Na, high K and hypoglycaemia
Also do SHORT SYNACTHEN test - serum cortisol should rise substantially, but in Addison’s disease, it will not
Secondary adrenal insufficiency
SHORT SYNACTHEN, serum cortisol will rise, but steadily instead of substantially
Cushing’s syndrome
Overnight dexamethasone suppresion test
Cortisol and ACTH should decrease due to negative feedback, but in Cushing’s, cortisol will not be decreased
Primary aldosteronism?
confirm aldosterone excess by measuring renin and aldosterone and expressing in in a ratio, if ratio is high then investigate further with a saline suppression test
Confirm subtype with CT scan
Congenital adrenal hyperplasia?
basal progesterone
genetic mutation analysis
Phaeochromocytoma?
Biochem abnormalities: hyperglycaemia, low K level, raised Hb, mild hypocalcaemia, lactic acidosis
Cataclamine excess in urine and plasma
Identify source of cetecholamine excess using MRI scan, MIBG, PET scan
Diagnosis of Hashimotos?
presence of thyroid peroxidase antibodies in blood and T cell infiltrate and inflammation on microscopy
TSH high, T4/3 low
High CK
increased LDL
What happens to prolactin in Hashimoto’s?
increases (increased TRH leads to increased prolactin secretion)
Myxoedema coma?
ECG - bradycardia, heart block, T wave inversion, QT prolongation
Type 2 resp failure: hypoxia, hypercarbia, resp acidosis
Grave’s?
antibody positive (TRAbs) High T3/T4, low TSH Scintigraphy, assymmetrical goitre
Sub acute thyroiditis (De Quervians)?
T4 is high in early stages, low in late, then normal
TSH is low, then high then normal
Thyroid cancer?
ultrasound guided FNA of lesion
Excision biopsy of lymph nodes
(No role for isotope scan or CT/MRI)
Hypercalcaemia?
raised calcium, raised PTH, increased urine calcium excretion
Primary Hyperparathyroidism?
PTH and Ca raised
Secondary Hyperparathyroidism?
PTH raised, Ca low
Tertiary Hyperparathyroidism?
PTH and Ca raised
PseudoHyperparathyroidism?
PTH raised, Ca low
PseudoPseudoHyperparathyroidism?
PTH raised, Ca normal
Paget’s?
X ray
Raised ALP
Isotope bone scan
Cervical lymphadenopathy?
CXR
ENT opinion
Fine need aspiration
Branchial cyst?
fine needle aspiration will show cholesterol crystals
Cystic hygroma?
transillumination
Diabetes insipidus?
urine osmolality is less than 300 and serum osmolality is more than 300
Dyname test- water deprivations test
Diagnosis of DM?
fasting glucose > 7
Random >11.1
Diagnosis of type?
mostly history based
Reduced ovarian reserve?
raised TSH, low anti mullerian hormone, reduced antral follicle count US
POS?
ultrasound
Endrometriosis?
uterus may be fixed and retroverted, scan may show CHOCOLATE CYSTS on ovary
Discrimanatory test between diabetes T1 and T2?
GAD/anti-islet cell antibodies, ketone, C-peptide
DKA?
blood glucose
urine dipstick may show glucose and ketones
ABGs show metabolic acidosis
Hyperosmolar hyperglycaemic non-kerotic state?
urinalysis - marked glucose in urine with NORMAL KETONE levels
Acromegaly
glucose tolerance test
Ig GH levels are not suppressed by glucose and levels of IGF-1 are elevated then diagnosis is confirmed
MRI scan pituitary and hypothalamus
Imperforate hymen?
ultrasound
Asherman syndrome?
sonohysterography
hysterosalpinography
Struma ovarii?
TFTs only in patients with symptomatic hyperthyroidism
