Endo

Question 1

Tx SIADH

Answer 1

1. Water restriction 2.salt intake 3. Loops 4. Demeclocycline > lithium(4)

Question 2

Patient has sx of chronic electrolyte derangements(basal ganglia calcifications, cataracts), elevated P, Low Ca & elevated PTH. dx?

Answer 2

pseudohypoparathyroidism

Question 3

30 yo women with hx SLE presents with increasing truncal obesity, fatty hump between shoulder. Shes on long term steroids for SLE. Whats the next best step in management?

Answer 3

Exogenous steroids can cause iatrogenic cushing syndrome. If possible taper steroids & dc them prior to further evaluation for endogenous cushings disease(pituitary adenoma(ACTH excess) or lung tumor(ACTH producing small cell tumor) or adrenal zona fasiculata hyperplasia or tumor(straight up cortisol excess)).

Question 4

Cortisol’s actions:

Answer 4

BBIG!
Bone(decreases)
BP increase
Immunosuppressive/anti-inflam
Gluconeogensis(increases)

Question 5

Adrenal insufficiency which hormones arnt being made anymore?

Answer 5

low: aldosterone, cortisol, DHEA, Epi/NE

Question 6

Sx of adrenal insufficiency

Answer 6

chronic fatigue that is worse with exertion(no Epi/NE), Hypotension(no aldosterone), Hyperpigmentation(break down of excess ACTH), Hyponatremia, Hyperkalemia(no aldo), salt cravings, weight loss, decrease axillary/pubic hair in kids(lack of DHEA)

Question 7

electrolyte abnormalities with primary adrenal insufficiency

Answer 7

hyponatremia, hyperkalemia & mild hyperchloremic acidosis

Question 8

why no electrolyte abnormalities(or if present mild) with secondary adrenal insufficiency?

Answer 8

Aldosterone is triggered to be secreted by the renin-angiotension system!

Question 9

Where is the baroreceptor that triggers ADH release? What inhibits ADH release?

Answer 9

• hypothalamus - hypotension or increased osmotic pressure will trigger release & Angiotension II
• ANP(from atrial stretch) will inhibit release

Question 10

Sx of hyperaldosteronism

Answer 10

hypertension, hypokalemia(muscle weakness, arrhythmias), metabolic alkalosis, mild hypernatremia

Question 11

causes of primary vs secondary hyperaldosteronism

Answer 11

primary = adenoma of the zona glomerulosa of the adrenal cortex

secondary = renin-secreting tumors or renovascular disease causing excess aldosterone(renal artery stenosis, edematous states with decreased arteral volume(HF, Cirrhosis, nephrotic syndrome)).

Question 12

65 yo M with a recent dx of melanoma presents with vague complaints of dizziness, weakness, fatigue and weight loss. Basic labs reveal hyponatremia. what further testing is needed to determin dx?

Answer 12

AM serum cortisol & AM serum ACTH.

*likely due to adrenal insufficiency possibly from melanoma mets to adrenals or pituitary(plasma ACTH diff 1 vs 2)

Question 13

what test would you order to dx hyperaldosteronism?

Answer 13

plasma renin acitivty(PRA) & plasma aldosterone concentration(PAC)

Question 14

48 yo F has not seen a physician in many years. Takes no meds & has no concerns. BMI 24. BP 172/110. BMP K 3.3 & Cr 0.68. dx? test to order?

Answer 14

Plasma renin acitivity & plasma aldosterone concentration & ratio of the two.

Question 15

Diagnostic criteria for diabetes…

Answer 15

1. random plasma glucose >200 w/sx of the betus
2. x2 fasting plasma glucose levels of >126 on 2 separate occations
3. 2 hr PP glucose >200 after 75g challenge
4. A1C > 6.5%

Question 16

What prolactin level would you expect in a prolactinoma?

Answer 16

> 200

Question 17

What insulin adjustments need to be made in a T1DM who is planning on starting an exercise regimen?

Answer 17

To reduce the risk of hypoglycemia during exercise, patients should decrease the dose of short-acting insulin within 1-3 hours prior to exercise, with the reduction proportionate to the intensity of exercise. If the exercise is expected to be prolonged (>60 minutes) or will occur in the morning before breakfast, the dose of basal insulin should also be reduced. However, basal insulin does not need to be reduced for shorter durations of exercise, as in this patient

Question 18

Nelson’s Syndrome

Answer 18

Pituitary enlargement and hyperpigmentation following bilateral adrenalectomy(usually due to cushing’s dz). Pituitary enlarges due to loss of feedback by the adrenal glucocorticords. tx w/radiation or surgery.