extras more

Question 1

Why is GH special

Answer 1

doesnt really do anything alone, all actions mediated via IGF-1

Question 2

what cancer in acromegaly

Answer 2

bowel cancer!

Question 3

pseudo cushings how to tell apart

Answer 3

midnight or late night cortisol will be very low compared with true cushigns
usually under 140 as opposed to over 200 for cushings

Question 4

sella mass where there is DI..think

Answer 4

non pituitary origin

Question 5

why low K in cushings disease

Answer 5

increase mineralocorticoid activity

worse in ectopic ACTH but happens in both

Question 6

Normal ratio aldo to renin

Answer 6

under 30

under 50 is borderline

Question 7

What risks are LOWER in HRT?

Answer 7

Oestrogen only- breast cancer, MI, fracture

Combined- colon cancer, hip fracture

lower risk DM both

Question 8

What tests do you do when you find primary ovarian insufficiency?

Answer 8

karyotype analysis
FMR1 premutation- if positive, kids could have fragile X
Adrenal autoAb- lymphocytic autoimmune oophoritis
Pelvic ultrasound - enlarged multifollicular ovaries in autoimmune oophoritis

Question 9

How does the OCP work in PCOS

Answer 9

ovarian supression of androgen production

also increase SHBG so reduce free androgens

Question 10

Tests in PCOS

Answer 10

free testosterone up
SHBG down
increase LH
FSH normal or low
LH:FSH over 3
but normal androgen levels does not exclude PCOS

if dont want preg or problem with hirsutism–>OCP
if want preg–>clomipheme citrate/metformin
skin, obesity–>metformin

Question 11

How is prog challenge useful?

Answer 11

In hypothalamic amenorrhoea, will not respond to progesterone challenge withdrawl

also, if amenorrhoea and all tests normal- need to check if making enough oestrogen. If no withdrawl bleed after challenge, suggest low oestrogen state and hypothal or pic cause most likely given normal FSH

Question 12

GH deficiency- what test

Answer 12

low IGF1

glucagon or insulin provocation test

Question 13

What type of vitamin D should you measure in hyperparathyroidism?

Answer 13

25

because if deficient, PTH will ramp up conversion 25 to 1,25 and 1,25 might look normal

Question 14

Metformin does what

Answer 14

supress hepatic gluconeogenesis

Question 15

adrenal incidentaloma- how to manage

Answer 15

follow up just once at 6 months
some say 3 6 12
hormone test annually for 4 years
MUST exclude pheo before remove

over 6cm take out anyway even if nonsecretory
4-6 consider take out
under 4 leave in

Question 16

IV for pheo crisis

pre op for pheo

Answer 16

crisis- phentolamine
pre op- phenoxybenzamine

and beta blockers as needed
Mg pre op

Question 17

most common symptom of pheo

Answer 17

pain in the head

Question 18

three genetic causes of pheo

Answer 18

MEN2
VHL
neurofibromatosis

SDHB (malignancy risk high)
SDHC
SDHD

Question 19

what grouping of secretion from pit do you see from common origin?

Answer 19

FSH
LH
prolactin

Question 20

Prolactinoma effect on gonadotrophins

Answer 20

INHIBIT GnRH release
so LOW FSH and LH
This is how they get amenorrhoea

Question 21

association between hypothyroidism and prolactin

Answer 21

TRH increase can stimulate increase in prolactin!!!

Question 22

assoc with GH and prolactin

Answer 22

acromegaly can increase prolactin

Question 23

most common cancer with acromegaly

Answer 23

THYROID

but do colonoscopies from age 40 yearly

Question 24

weird blood findings in cushings

Answer 24

hypereosinophilia

lymphopaenia

Question 25

adrenal insufficiency what happens to calcium

Answer 25

low!

and eosinophils can be up