Endocrine

Question 1

Evaluation of hyperandrogenism

Answer 1

Both ovaries and adrenals contribute to testosterone in healthy women. If testosterone is >200 this suggests that ovaries are overproducing (look for ovarian tumor) . DHEAS is produced in the adrenal glands. If >7 this suggests coming from adrenal glands.

Question 2

Evaluation of hypogonadism

Answer 2

A random serum testosterone of >350 excludes hypogonadism, 200-350 are equivocal (get free level). Primary hypogonadism would have elevated LH and FSH levels. If no testicular insult get karyotype to look for Klinefelter. If these are low or normal obtain prolactin level and ferritin. If testosterone level is less 150 is another reason to get pituitary MRI

Question 3

Vitamin D levels with normal renal function

Answer 3

Care about the 25-hydroxy level as should not have a problem converting

Question 4

Adrenal insufficiency in critical illness

Answer 4

A random serum cortisol of 15 or greater or 12 or greater if albumin 2.5 or less makes it very unlikely

Question 5

Alcohol in diabetes

Answer 5

Alcohol inhibits liver’s ability to release glucose into the blood

Question 6

Thyroiditis treatment and dx

Answer 6

Should get a uptake scan, this will allow differentiation between thyroiditis and Graves. Antithyroid agents will NOT help as the actual production is low, it just leaked out. Treat with BB or steroids if necc.

Question 7

Evaluation of gynecomastia

Answer 7

Results from an imbalance of testosterone and estrogen. (medications, liver disease, renal disease, hypogonadism, testicular cancer, hyperthyroid, adrenal tumors, HCG secreting tumors, androgen insensitivity).
Obtain:
- testosterone
- estradiol (if up testicular u/s then adrenal imaging)
- HCG (if up obtain testicular u/s)
- LH and TSH

Question 8

MEN1

Answer 8

Pituitary tumors
Parathyroid tumor
Pancreas

Question 9

MEN2

Answer 9

Primary parathyroid hyperplasia
PHEO
Medullary thyroid cancer

Question 10

Imaging for insulinoma

Answer 10

Once biochemical dx made start with CT abdomen and pelvis, if this does not find it use EUS. Octreotide scanning will not find it.

Question 11

Management of adrenal incidentaloma

Answer 11

if >6 cm evaluate for function and remove

If 50% at 10 minutes) okay for follow up based on if functional or not

Question 12

Thyroid FNA findings

Answer 12

Need a thyroidectomy if follicular neoplasm (does not mean it is cancer) or malignant/suspicious

Question 13

Hirsutism treatment in PCOS

Answer 13

First line is estrogen-progesterone contraceptive, if this does not work can try spironolactone. Possibly metformin

Question 14

Prolactinoma management

Answer 14

as long as visual loss is not unstable or progressive can try dopamine agonist therapy first

Question 15

Thyroid lymphoma

Answer 15

Rapidly enlarging neck mass
Older patients with history of Hashimoto’s thyroiditis
Get a core needle biopsy

Question 16

Primary hyperaldosteronism

Answer 16

• suspect with HTN and spontaneous hypokalemia

- obtain aldo:renin ratio, if >20 and aldo is >15 then dx primary hyperaldo