Investigations

Question 1

Best test: Acromegaly (1)

Answer 1

1. IGF-1 Levels

Question 2

Best Test: Phaeochromocytoma (1)

Answer 2

1. 24hr Urinary Metanephrines

Question 3

Conn’s (2)

Answer 3

1st line:

Aldosterone:Renin ratio - if renin high then 2* hyperaldosteronism

2nd line:
High Res CT-Adrenals/Abdo

3rd Line:
Adrenal Vein Sampling - diffs between B/L hyperplasia vs U/L Adenoma

Question 4

Best Test: Cushing’s (1)

Answer 4

1. Dexamethasone Suppression Test

Question 5

Best Test: Addison’s (1)

Answer 5

1. ACTH / Synactin Stimulation Test - should stimulate normal adrenals to release cortisol - if they dont its positive

Question 6

Test to dofferentiate Unilateral Adrenal Adenoma from Bilateral Adrenal Hyperplasia (1)

Answer 6

1. AVS - Adrenal Vein Sampling

Question 7

Test to tell apart T1DM from T2DM (1)

Answer 7

1. Anti-GAD Antibody

Question 8

Addison’s Algorithm (8)

Answer 8

Signs and Sxs of low cortisol prompts

1. 9am cortisol level
2. If >500 = normal
3. If <100 = Definitely not normal
4. If 100 - 500 = prompts a
5. Short Synachten test (ACTH Stim test) - give it and remeasure cortisol 30 mins later
6. Failure to raise significantly = Adrenal insufficieny
7. 21-Hydroxylase levels
8. +/- CT Adrenals