Endocrine

Question 1

Phaeochromocytoma Sx triad

Answer 1

Episodic headache
Sweating
Tachycardia

Question 2

Phaeo Ix

Answer 2

24 hr urine collection
Serum free metanephrines
Genetic testing

Question 3

Cushing’s aetiology

Answer 3

ACTH dependent

• Pit adenoma
• Ectopic ACTH

ACTH Independent

• Adrenal adenoma/carcinoma
• ORAL STEROIDS

Question 4

Cushing’s Sx

Answer 4

Inc weight 
Fatigue 
Proximal myopathy
Thin skin
Easy bruising 
Bad wound healing 
Moon face
Central obesity  
Intrascapular fat pad

Question 5

Cushings Ix

Answer 5

Urinary free cortisol (24hr urine collection) - >50 mcg/24 hrs
Late night salivary cortisol

Low dose dex suppresion test - endogenous vs exogenous

High dose dex suppresion test - ectopic aren’t suppressed

CXR etc if ectopic suspected

Question 6

Cushing’s management

Answer 6

Discontinue steroids, use lower dose etc

Medical (both can lead to adrenal insufficiency, so use short term)

• Meytrapone (11b-hydroxylase inhibitor)
• Ketoconazole (17a-hydroxylase inhibitor)

Surgical
- Resections of tumours

Question 7

Adrenal insufficiency aetiology

Answer 7

Addisions (AI)
Pit/hypothalamic disease

TB
CMW

Mets
Lymphomas
Amyloidosis

Question 8

Addison’s diesease Sx

Answer 8

Bronze pigmentation of skin (melanocytes due to inc ACTH)
Weight Loss 
Weakness
Hypoglycaemia 
Postural hypotension 
Hair loss 

Vitiligo

Question 9

Addisonian crisis signs

Answer 9

Hypotensive shock 
Tachycardia 
Pale
Cold 
Clammy 
Oliguria

Question 10

Adrenal insufficiency Ix

Answer 10

To confirm diagnosis:
9am Serum cortisol (<100nmol/L)
If between 100-550, do short SynACTHen test (measure cortisol levels after bolus of synthetic ACTH)

To identify level of defect in axis:
- Long Synacthen test

Question 11

Addisonian Crisis treatment

Answer 11

Rapid IV fluids
50mL of 50% dextrose
IV 200mg hydrocortison bolus

Question 12

Chronic Adrenal insufficiency treatment

Answer 12

Replace glucocorticoid with hydrocortison

Replace mineralocorticoid with fludrocortisone

Question 13

Diabetes insipidus aetiology

Answer 13

Central vs Nephrogenic

Common causes:

• idiopathic
• brain tumour
• severe head injury & complicaitons during surgery

Question 14

DI Sx

Answer 14

Polyuria
Nocturia
Polydipsia

Maybe signs of dehydration

Question 15

DI Ix

Answer 15

Bloods

• Sodium elevated
• Hypercalcaemia and hypokalaemia if nephrogenic DI

WATER DEPRIVATION TEST

Question 16

Cranial DI Rx

Answer 16

Find causes: MRI Head

Desmopressin

If mild; chlorpropamide or carbamazepine

Question 17

Nephrogenic DI Rx

Answer 17

Sodium and protein restriction
Thiazide diuretics
NSAIDs help to lower urine vol due to dec prostaglandin synth

Question 18

SIADH aetiology

Answer 18

Neurohypophysial malfunction

• Haemorrhage/thrombosis
• Meningitis
• Abscess
• Trauma
• Tumour

Ectopic secretion by tumours

• Lung
• leukaemia/lymphoma

Question 19

SIADH Sx

Answer 19

Dec urine vol

Hyponatraemia Sx

Question 20

SIADH Ix

Answer 20

Look for other causes of hyponatraemia

TO get diagnosis of SIADH, need to rule out:

• Adrenal insufficiency
• Hypovolaemia
• Oedema
• Rneal failure
• Hy;othyroidism

Question 21

SIADH Rx

Answer 21

Immediate fluid restriciton
Demeclocycline (tetracycline)
VAPTAN

Question 22

Carcinoid Syndrome Sx

Answer 22

Facial Flushing 
Diarrhoea 
Crampy abdo pain (+/- RUQ pain [liver mets])
Wheeze
Sweating 
Palps 

Right sided murmurs (due to fibrosis cos of inc serotonin)

Question 23

Carcinoid syndrome Ix

Answer 23

24 hrs urine collection for 5-HIAA (met of serotonin)
CT/MRI scan - to localise tumour
Radioisotope scan

Question 24

MEN 1 tumours

Answer 24

Pit adenoma
Parathyroid
Pancreatic islet cell
Fascia angiofibromas

Question 25

MEN 2a tumours

Answer 25

Parathyroid
Medullary thyroid
Phaeos

Question 26

MEN 2B tumours

Answer 26

MEN 2A +
Marfanoid appearance
Neuromas of GI tract