ITE - Endo

Question 1

Diabetes insipidus, central: Dx, Tx

Answer 1

Dx: Low urine osm, elevated serum osm, hypernatremia, polyuria
Tx: Desmopressin

Question 2

Cushing Syndrome: Dx, Tx

Answer 2

Dx: MR pituitary in setting of hypercortisolism (adrenocorticotropic hormone-dependent disease)
Tx: transsphenoidal resection of the pituitary adenoma, then glucocorticoid replacement

Question 3

MEN type 1: Dx, clues

Answer 3

Dx: germine MEN1 mutation

Pituitary adenoma, parathyroid neoplasia, pancreatic tumor

Question 4

MEN type 2A: Dx, clues

Answer 4

Dx: germline RET mutation
Clues: 
Parathyroid neoplasia
medullary thyroid carcinoma
pheochromocytoma

Question 5

MEN type 2B: Dx, clues

Answer 5

Dx: germline RET mutation
clues: 
Medullary thyroid cancer
Pheochomocytoma
Neuroma

Question 6

MEN 2: genetics

Answer 6

RET proto-oncogene on chromosome 10. MEN2A and 2B are inherited in an autosomal dominant pattern

Question 7

MEN 1: genetics

Answer 7

MEN1 gene; Chromosome 11, long arm

Question 8

Adrenal incidentaloma: Dx.

Answer 8

Dx: rule out pheo, subclinical Cushing, and if HTN or hi K rule out primary aldosteronism

Question 9

Pheochromocytoma: Dx, Tx.

Answer 9

Dx: 24hr urine total metanephrine, catecholamine levels
Tx: resection with pre-op alpha blockade (phenoxybenzamine or maybe doxazosin)

Question 10

Cushing Syndrome, subclinical: Dx, Tx.

Answer 10

Dx: 1-mg overnight dexamethasone suppression test (> 5 microg/dL), 24hr urine free cortisol, serial late-night salivary cortisol
Tx: ???

Question 11

Primary Aldosteronism: Dx, Tx.

Answer 11

Dx: plasma aldosterone/renin ratio
Tx: lap resection, if no surgery give aldosterone rec antagonist (spiro or eplerenone)

Question 12

Severe thyrotoxicosis and systemic hemodynamic decompensation in setting of extreme stressor or stopped therapy.

Answer 12

Thyroid storm, clues

Question 13

Thyroid storm: Dx, Tx.

Answer 13

Dx: elevated TFTs and shock
Tx: ICU, treat underlying cause, and medical therapy for thyrotoxicosis (B-block, thioamides, ‘roids, K-I)

Question 14

Thioamides: MOA, examples.

Answer 14

MOA: anti-thyroid function via inhibition of iodine binding
Examples: Propylthiouracil (PTU), methi/carbi-mazole

Question 15

Hyperthyroid symptoms (usually), thyroid is diffusely enlarged, may have a bruit, and has a firm, smooth texture on examination; cervical lymphadenopathy can also occur.

Answer 15

Graves disease, clues

Question 16

Graves disease: Dx, Tx.

Answer 16

Dx: Clinical
Tx: Thioamides, then radioiodine ablation, then surgery (esp if large goiter) and maybe beta-blocker for sxs. if planning pregnancy, non medical

Question 17

Graves disease that reponds poorly to medical therapy?

Answer 17

Dx: Graves Ophthalmology
Tx: add ‘roids or surgery

Question 18

Inpatient management of DM 1: critical vs noncritical.

Answer 18

critically ill: IV insulin and POC q1-2h

noncritically ill: basal insulin plus mealtime

Question 19

Inpatient management of DM 2: critical vs noncritical.

Answer 19

critical: IV insulin and POC q1-2h
noncritical: basal insulin plus mealtime for pts with glucose > 180