Endocrinology

Question 0

What is the test for primary adrenal insufficiency?

Answer 0

Cosyntropin test.

Question 1

What is the test for central ( secondary) adrenal insufficiency ?

Answer 1

Insulin tolerance test

Question 2

What is the cortisol level that suggests no adrenal insufficiency vs having adrenal insufficiency?

Answer 2

>500 suggests no adrenal insufficiency <200 suggests adrenal insufficiency

Question 3

What is physiologic, stress and anti inflammatory dosing of steroids?

Answer 3

Physiological - 10/10 hydrocortisone , 5mg qd ( prednisone), o.5 mg qd dexamethasone Stress -30/30 hydrocortisone, 15 mg ( prednisone ), 1.5 mg qd dexamethasone ********iv 100 mg hydrocortisone is stress dose steroids*************** Anti inflammatory - 15-100mg (prednisone ), 4mg qd dexamethasone

Question 4

What is on the differential for a high pth In hypercalcemia?

Answer 4

Familial hypocalciuric hypercalcemia Primary hyperparathyroidism Tertiary hyperparathyroidism

Question 5

What two hormones are important in calcium regulation ?

Answer 5

Pth Vitamin d

Question 6

What is the typical acute treatment for hypercalcemia ?

Answer 6

Fluids

Question 7

What is the best test for a pheochromocytoma?

Answer 7

24 hour urine metanephrines

Question 8

What are the manifestations of hypoaldosteronism, and how do you confirm it?

Answer 8

High blood pressure and low potassium are signs of hypokalemia The test for hypoaldosteronism is aldosterone to renin level.

Question 9

What medications make an aldosterone/renin ratio useless?

Answer 9

Beta blockers Diuretics Spironlactone

Question 10

What are the tests for cushings disease?

Answer 10

1)1 mg dex suppression test and am serum cortisol looking for suppression 2) 24 hour urine cortisol 3)salivary late night cortisol

Question 11

How should ACTH be in primary, secondary and tertiary cushings? And what is the most common source of cushings?

Answer 11

1)primary ( adrenals ) - ACTH low 2)secondary ( pituitary) - ACTH high / normal—> most common cause of of cushings 3)exogenous - ACTH low

Question 12

What are the criteria for diagnosis of PCOS?

Answer 12

1)Polycystic ovaries + 2/3 of a)chronic estrogenized anovulation b)hyperandrogenism c)exclusion of other causes

Question 13

What is the diagnostic cascade for secondary amenorrhea?

Answer 13

6P’s and a T

1) Pregnancy test
2) If negative check prolactin –> if high then consider DDX of high prolactin including
a) TSH
b) prolactinoma
3) Progesterone withdrawl bleed
a) if she bleeds–> PCOS
b) if she does not bleed –> premature ovarian failure, pituitary tumor, hypothalamic amenorrhea

Question 14

What are the antibodies present in Hashimotos Thyroiditis vs Graves?

Answer 14

Hashimotos–>

• anti-thyroglobulin
• anti-peroxidase
• anti-TSH receptor

Graves

• anti-TSH
• anti-thyrotropin
• anti-TSH receptor