endocrinology

Question 1

MC pituitary adenoma? tx?

Answer 1

prolactinoma, consider in amenorrhea/hypoT

tx- bromocriptine or cabergoline even if macro

Question 2

order of hormones lost in hypopituitarism?

Answer 2

1. FSH and LH
2. GR
3. TSH
4. ACTH

Question 3

polyuria, polydipsia, hyperNa, hyperOsm, dilute urine

Answer 3

DI lack of ADH (or non-fxnl)

do water deprivation test to tell if crazy

Question 4

urine Osm still decreased s/p water depriv. urine osm is high w/ddAVP

Answer 4

central DI

Question 5

urine Osm still decreased s/p ddAVP and water deprivation test

Tx?

Answer 5

nephrogenic DI

tx- w/ HCTZ/amiloride

Question 6

see low TSH. high free T3/T4

next best step?
tx?

Answer 6

I^123 RAIU scan. if increased-graves, if decreased-factitious or thyroditis

tx- propanalol + PTU/MTZ. I^131 ablation/surgery for children or pregnant

Question 7

Tx of thyroid storm

Answer 7

PTU+Iodine (lugol’s sol’n) + propanalol

Question 8

thyroid nodule work-up… 1st step? if it is low? if it is normal?

Answer 8

check TSH- do RAIU to find the “hot nodule” of TSH comes back low. excise or radioactive I^131

Normal- FNA

Question 9

Cold thyroid nodule.. what to do?

Answer 9

surgically excise and check pathology

Question 10

thyroid…MC type, spreads via lymph, psammoma bodies

Answer 10

papillary

Question 11

thyroid… spreads via blood, must surgically excise whole thyroid!

Answer 11

follicular

Question 12

thyroid…assoc. w/ MEN II (look for pheo, hyerpCa); amyloid/calci

Answer 12

medullary

Question 13

thyroid… 80% mortality in 1st year

Answer 13

anaplastic

Question 14

thyroid… hashimoto’s predisposes to it

Answer 14

thyroid lymphoma

Question 15

FNA of thyroid… benign? malignant? indeterminate?

Answer 15

benign- leave it alone

malignant- surgically excise and check pathology

indeterminate re-biopsy or check RAIU

Question 16

osteoporosis, central fat, DM, hirsutism… suspect? best screening test-if abnormal? next best test? suppression to <50% of control? no suppression? next best test?

Answer 16

suspect- cushing’s

best screening test- 1mg on DEXA suppression test or 24hr urine cortisol-if abnormal- diagnoses cushing syndrome
next best test- 8mg on DEXA suppression test

suppression to <50% of control- pituitary adenoma (cushing disease)

no suppression- either adrenal neoplasia or ectopic ACTH

next best test- plasma ACTH. chest CT if smoker. abdominal CT/DHEAS

Question 17

weakness, hypotension, weight loss, hyperpigmentation, increased K, decreased Na, decreased pH…. best screening test? MC cause? Tx?

Answer 17

suspect adrenal insufficiency and do a cosyntropin stimulation test (60 min after 250mcg)

MC- autoimmune (addison’s dx)
tx- NaCl resuc. long term replacement of dexamethasone and fludrocortsione

Question 18

work up of an adrenal nodule… best 1st step?

Answer 18

check functional status

Question 19

adrenal nodule… high blood pressure, catechol. symptoms, urine/plasma- free metanephriens

Answer 19

pheochromacytoma

Question 20

adrenal nodule… high blood pressure, low K+, low PRA, plasma aldosterone-to-renin ratio

Answer 20

primary aldosteronism

Question 21

adrenal nodule… virilization or feminization, urine 17-ketosteroids

Answer 21

adrenocortical carcinoma

Question 22

adrenal nodule… cushing sxs. or normal examination results , overnight 1-mg dexamethasone test

Answer 22

cushing or silent cushing syndrome

Question 23

adrenal nodule if <5cm and non-functional

Answer 23

observe w/ CT scans q6mo

Question 24

adrenal module… >6cm or functional

Answer 24

surgical excision

Question 25

perioral numbness, chvortek, trousseau s/p thyroidectomy

- decreased Ca, increased phosphate, decrased pth

Answer 25

hypoparathyroidism

Question 26

kidney stones, constipation/abd pain, or psychiatric sxs.
- increased Ca, decreased phosphate, increased vitD, increased PTH

DX? TX?

Answer 26

hyperparathyroidism

Dx w/ FNA of suspicious nodules. can use sestamibi scan
Tx w/ surigcal removal of adenoma. if hyperplasia, remove all 4 glands and implant 1 in forearm

Question 27

MEN 1

Answer 27

pituitary adenoma, parathyroid hyperplasia, pancreatic islet cell tumor

Question 28

MEN 2a

Answer 28

parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma

Question 29

MEN 2b

Answer 29

medullary thyroid cancer, pheochromocytoma, marfanoid

Question 30

Diagonsis of diabetes?

Answer 30

FBGL>126x2
2hr OGTT>200
random glc>200
+ SXS- polyuria, plydipsia, blurred vision

Question 31

N/V, abd. pain, Kussmaul respirations, coma w/ BGL=400?

Tx? Dx?

Answer 31

DKA

Dx- ketones in blood (+urine), AGMA, hyperkalemia
TX- high vol NS + insulin bolus + drip, add K once peeing. add glucose <200

Question 32

polyuria, polydipsia, profound dehydration confusion and coma w/ BGL=1000

tx?

Answer 32

HHS

Tx- high vol. fluid and electrolytes. may require insulin

Question 33

diabetes cause of death (MC)?

Answer 33

cardiovascular disease

Question 34

diabetes… important screening

1. heart
2. kidney
3. eye
4. nerves

Answer 34

1. heart- LDL<100, BP<130/80
2. kidney- check for microalbuminemia (30-300 in 24hrs) start ACEi
3. eye- annual screening for prolif. retinopathy –> vitreous hemor/neovascular
4. nerves- podiatric exam annually. Tx gastroparesis w/ metoclopramide or erythromycin. may get ED, 3rd, 4th, 6th CN palsy