Endocrine Diagnosis

Question 1

What happens after an endo referral is received?

Answer 1

See patient, take history and perform physical examination
Next take endocrine test- pre test probability
Options for diagnosis: blood test, imaging
Troubleshoot: are results concordant with pretest probability

Question 2

What is the pre-test probability?

Answer 2

Probability patient has a disorder before diagnostic test results are known

Question 3

What is postural hypertension?

Answer 3

Bp falls when you stand up

Lack of blood flow to brain

Question 4

Why do we take bloods along with imaging?

Answer 4

Imaging can generate false positives- you should look at what bloods show first

Question 5

What kind of blood tests are taken?

Answer 5

Static blood test: shows hormone levels of when blood test was taken
You can measure cortisol/ ACTH but this should be done at 8/9 am- takes into account circadian cycle and pulsatility

Dynamic blood test:

• carry out suppression test if you think they have too much of a hormone: if theres a disease there won’t be a decrease in levels
• carry out stimulation test if you think they have too little of a hormone- if theres a disease there won’t be an increased hormone levels

Question 6

What does trouble shooting include?

Answer 6

Look at the patient- has something changed?
Look at pre-test probability
Look at logistics of test- wrong patient? time of day? lab error?
Repeat test if things remain difficult to explain