Endo

Question 0

Osteoporotic man, think…

Answer 0

Hypoginadism
Myeloma
HyperPT
Vitamin d def
Calcium malabsorption eg  Coeliac

Question 1

physical signs in cushings

Answer 1

facial plethora
striae livid and wide
central obesity
wasting limbs and buttocks
think skin and bruising
proximal myopathy
hisrutism
facial plethora
exophthalmos 
osteoporosis
oligoaemenorrhoea
psych changes
glucose intolerance, DM
hypertension

Question 2

Does phenytoin cause osteoporosis?

Answer 2

No. It causes osteomalacia.

Question 3

What are some secondary causes of osteoporosis?

Answer 3

RA
Diabetes
Myeloma
Chronic renal failure

Question 4

Causes of prolactin elevation (6 ps)

Answer 4

Pregnancy
Prolactinoma
Primary hypothyroidism (TRH stimulates prolactin release)
Phenothiazines, metocloPramide, domPeridone (also haloperidol, SSRIs, opioids)
PCOS
Physiological- exercise, stress, sleep
acromegaly 1/3 patients

Cimetidine causes gynaecomastia but not really galactorrhoea

Question 5

What is the most important modifiable risk factor for thyroid eye disease?

Answer 5

Stop smoking

Question 6

Most common pancreatic tumour in MEN1

Answer 6

gastrinoma

Question 7

Why do Addison’s people hypo between meals?

Answer 7

Because cortisol normally stimulates hepatic gluconeogenesis but this is absent.

Question 8

Why striae in cushings?

Answer 8

Extra protein collagen in subcutaneous tissue is easily torn.

Question 9

Which antibodies could you check for in autoimmune destruction of the adrenals?

Answer 9

CYP21A2
or
21-hydroxylase Ab

Question 10

What is in the autoimmune polyglandular syndromes?

Answer 10

Type 1 : Addison’s, hypoPT, mucocutaneous candida

Type 2: Addisons, hypothyroid, Type 1 DM

Question 11

What are the lab findings in anorexia?

Answer 11

Everything low except Cs and Gs

• cholesterol, carotinene, cortisol
• GH, glucose, salivary Gland big

See reduced K, FSH, LH, oest, testost, IGT, LOW T3, BMI, bradycardia, hypotension

Question 12

What is the alpha blocker for pheo crisis?

Answer 12

Phentolamine- IV
For crisis

Use phenoxybenzamine in non crisis as long half life
Prazosin is short acting and does not cross the BBB

Question 13

Genetic causes of pheo?

Answer 13

MEN2
VHL
Neurofibromatosis 
SDHB- malignancy Common
SDHC- usually benign

Question 14

best predictor of a benign adrenal incidentaloma?

Answer 14

HU under 10

Also usually small and have rapid contrast washout- 50% by 10 mins

Question 15

In general, how to manage an adrenal incidentaloma?

Answer 15

If functioning (DST, ald/renin, metanephrines)-->take out
If over 6cm then exclude pheo and take out
If 4-6 cm base decision on imaging phenotype

Otherwise repeat imaging 3,6,12 months