Endocrinology

Question 1

Addison’s treatment

Answer 1

Hydrocortisone, Fludrocortisone combo

Question 2

Addison’s pathology

Answer 2

autoimmune adrenal gland destruction = reduced cortisol & aldosterone production
low Na, glucose, calcium
high K

Question 3

Addison’s investigations

Answer 3

ACTH stimulation test
9am serum/salivary cortisol = usually low, should be high
Short synACTHen test - exclude Addisons if high

Question 4

Addisonian crisis

Answer 4

• acute exacerbation of chronic insufficiency
• adrenal haemorrhage WF syndrome
• steroid withdrawal

Question 5

Addisonian crisis management

Answer 5

100mg hydrocortisone IM/IV
1L saline 30-60 mins
infused w dextrose if needed
no fludrocortisone

Question 6

Addison’s symptoms

Answer 6

lethargy, weak, anorexia, N, V, weight loss, salt craving, hyperpigmentation, vitiligo, loss of pubic hair, hypotension

Question 7

Addisonian crisis symptoms

Answer 7

collapse
shock, pyrexia
hypoglycaemic

Question 8

Cushing’s pathology

Answer 8

chronic glucocorticoid excess = too much cortisol

Question 9

Cushing’s features

Answer 9

proximal myopathy, striae, bruising, osteoporosis, DM, obesity,
HTN
hypokalaemia

Question 10

Cushing’s appearance

Answer 10

moon face, acne, hirsutism, fat pads, striae, thin limbs, bruising, thin skin

Question 11

Cushing’s causes

Answer 11

iatrogenic steroids
adrenal adenoma/carcinoma/hyperplasia
cushings disease
ectopic ACTH secretion

Question 12

Cushing’s disease

Answer 12

pituitary adenoma > ACTH secretion > bilateral adrenal hyperplasia

Question 13

High dose dex suppression

Cushing’s syndrome

Answer 13

Cortisol not suppressed

ACTH suppressed

Question 14

High dose dex suppression

Cushing’s disease

Answer 14

Cortisol & ACTH suppressed

Question 15

High dose dex suppression

Ectopic ACTH

Answer 15

Cortisol & ACTH NOT suppressed

Question 16

How to treat Cushing’s

Answer 16

Disease = trans-sphenoidal excision
Adrenal adenoma/carcinoma = adrenelectomy
Ectopic ACTH = tumour excision, metyrapone

Question 17

Primary hyperaldosteronism?

Answer 17

excess aldosterone independent of RAAS
Hypokalaemia - weak, hypotonia, hyporeflexia, cramps
Paraesthesia
HTN

Question 18

Causes of primary hyperaldosteronism

Answer 18

Bilateral adrenal hyperplasia 70%

Adrenocortical adenoma 30% = Conn’s syndrome

Question 19

Primary hyperaldosteronism investigations

Answer 19

mixed Na,
low K
alkalosis

Aldosterone renin ratio = increased

ECG - flat/inverted T waves, U waves, depressed ST
segments, prolonged PR and QT intervals

Adrenal CT/MRI

Question 20

Primary hyperaldosteronism mgmt?

Answer 20

Conn’s: laparoscopic adrenelectomy

Hyperplasia: spironolactone, eplerenone, amiloride

Question 21

Secondary hyperaldosteronism?

Answer 21

Increased renin from decreased renal perfusion

Diuretics, CCF, hepatic failure, nephrotic syndrome

Question 22

Secondary hyperaldosteronism investigation

Answer 22

Aldosterone renin ratio = normal

Question 23

Phaeochromocytoma

Answer 23

Catecholamine-producing tumours (adreneline)
sympathetic paraganglia
adrenal medulla/aortic bifurcation
(MEN2a, 2b assoc)

Question 24

Phaeochromocytoma presentation

Answer 24

Triad:
episodic headache
sweating
tachycardia

lots fo adrenergic features

Question 25

Phaeochromocytoma investigations

Answer 25

Plasma + urine metadrenaline & vanillylmandellic acid

MIBG scan

Question 26

Phaeochromocytoma mgmt?

Answer 26

Chemo, radiolabelled MIGB
Surgery - adrenelectomy
A & B blockers prep

Question 27

Hypertensive crisis

Answer 27

Pallor
Pulsating headache Impending doom
↑↑BP
Cardiogenic shock (ST elevation)

Question 28

Hypertensive crisis mgmt?

Answer 28

• Phentolamine 2-5mg IV α-blocker
• Labetalol 50mg IV
• until dBP <110
• phenoxybenaime to maintain
• surgery too