Endocrinology

Question 1

Hypoglycemia in pt taking sulfonyurea p/w sweating, confusion

Answer 1

d/c sulfonyurea esp with RF/HF - check FSG - can have focal neuro findings - tx with GLUCOSE

Question 2

Graves opthalmopathy (exophthamos, conjunctival injection, periorbital edema, iritis, dipolpia)

Answer 2

thyroidectomy - don’t use radioactive iodide - will cause transient worsening of symptoms (surgery with opthalmopathy, intolerance of iodine drugs, large/obst goiters

Question 3

Adrenal insufficiency with minor illness

Answer 3

if on hydrocortisone replacement - inc dose for few days to avoid adrenal crisis

Question 4

Vitamin D deficiency

Answer 4

check 25-OH vit D (not 1,25) - high PTH normal in response to low Ca/low vit D, osteoporosis, secondary hyperparathyroid (normal kidney fxn so not tertiary)

Question 5

Manage incidental sellar mass

Answer 5

check serum prolactin, thyroid fxn, adrenal function

Question 6

Young non-smokers with recurrent cough/PNA, evidence of endobronchial obstruction

Answer 6

Carcinoid tumor - no association with tobacco - endobronchial location - neuroendocrine tumor - smoothly bordered - surgical resection - good prognosis

Question 7

AdenoCA

Answer 7

most common cancer in non-smoker but RARELY endobroncial

Question 8

Pheochromocytoma - biochemically active

Answer 8

alpha blockade (short acting) then surgery - (sx HTN, palpitations, sweating, h/a) - elev plasma metanephrine, 24 hr urine catecholamine, metanephrine, VMA, adrenal mass - NEVER USE BB first

Question 9

Opiate induced hypogonadism

Answer 9

methadone etc - central hypogonadism - downregulates FSH, LH, dec’d testosterone prodxn -

Question 10

Anabolic steroid use

Answer 10

muscular, infertility, high libido, inc acne