Endocrine

Question 1

patient presents with chronic weakness/fatigue, weight loss, GI sxs, hyponatremia and hyperkalemia asso w low-normal cortisol level

Answer 1

primary adrenal insufficiency (Addison disease)

Question 2

potential causes of primary adrenal insuffiency

Answer 2

autoimmune adrenalitis, infections (e.g. TB), malignancy, adrenal hemorrhage

Question 3

acute adrenal crisis can be caused by

Answer 3

hemorrhage, surgery, hypotension, trauma; sudden removal of chronic high dose steroids; it is less common to have an acute adrenal crisis from loss of the pituitary because aldosterone is not under ACTH control

Question 4

acute adrenal crisis presents with

Answer 4

profound hypotension, fever, confusion, and coma

Question 5

most specific test of adrenal function is

Answer 5

cosyntropin (a synthetic ACTH) stimulation test - check plasma cortisol before and after

Question 6

tx of adrenal insufficiency

Answer 6

replacement of steroids with hydrocortisone and fludrocortisone

Question 7

most serious side of effect of antithyroid medications is (propylthiouracil, methimazole)

Answer 7

both - agranulocytosis

Methimazole - first trimester teratogen

PTU - hepatic failure