Endocrine Diagnostics Flashcards
What is the ore test probability?
Helps you to choose the right endocrine test
In practical terms this is gauged by history and examination findings
Why should you ask yourself if the patient really nests the test?
To see “if I do this test how wil it change the way I manage this patient”
Will it help you treat the patient? Is it for more than just curiosity
What are the options for diagnosis?
Do some blood tests
Do some imaging (CT/MRI)
Do both
What diagnostics happen first in endo?
You get the biochemistry sorted before doing the imaging
Imaging can generate false positives, you can see thing (such as nodules) that are actually of no clinical significance
What is a static blood test?
A snap shot of a persons hormone levels at the time when the persons blood was taken
However many hormones have a diurnal rhythm so it may be worth getting g a patient to come back at 9am the next day (they are secreted according to a 24hr circadian cycle)
If measured at the wrong time of day the hormone can appear to be low
Many hormones are also secreted in pulses
What are dynamic blood tests?
Allows you you ask “do I think this person has too much hormone?” Or too little?
Too much: do a surpression test. If their hormone levels fall then maybe they’re alright. If not then they prob have too much
Too little: stimulation test. If hormone levels increase then it is probably normal. If not then not normal
Logistically this may be more expensive. It takes a lot longer, can sometimes be overnight. Static tests are also generally safe. In dynamic, the agent you give them could cause harm
There may also be difficulty in interpreting the results (if low, how low is too low?)
How do you interpret endocrine results?
Look again at your pre test probability
If the results are not concordat then you can troubleshoot
What does troubleshooting involve?
Look at the patient again, has something changed?
Look at the pre test probability
Look at the logistics of the test (time of day, right patient, sample handling, lab error)
If still puzzling then repeat the test
