M2 Endo Path

Question 1

Pseudo-Cushing’s

Answer 1

High cortisol state without a tumor

Caused by over exercise, eating disorders, uncontrolled diabetes, sleep apnea, pain, alcoholism, psychiatric disorders, stress, obesity

Treatment: treat underlying cause of elevated cortisol

Question 2

Screening tests for Cushing’s Syndrome

Answer 2

1. 24 hour urine free cortisol
2. Dexamethasone suppression
3. Midnight salivary cortisol

Question 3

Tests to determine if elevated ACTH is coming from pituitary or an ectopic source

Answer 3

1. CRH stimulation test: CRH will cause an increase in ACTH if problem is in pituitary but will have no effect if problem is ectopic
2. Dexamethasone suppression test:

Question 4

Dexamethasone suppression test

Answer 4

a. Low dose: give 1mg dexamethasone at night; am cortisol is not suppressed in patients with Cushing’s
b. High dose: give 8mg dexamethasone at night; in patient with pituitary problem, am cortisol will be 50% of baseline, but in patient with ectopic source of ACTH, cortisol will remain elevated

Question 5

Most common cause of primary mineralocorticoid excess

Answer 5

bilateral adrenal hyperplasia

Question 6

Presentation: mineralocorticoid excess

Answer 6

HTN
Hypokalemia
metabolic alkalosis

Question 7

MEN 1

Answer 7

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumor

Question 8

MEN 2A

Answer 8

Parathyroid hyperplasia
Medullary thyroid carcinoma
Pheochromocytoma

Question 9

MEN 2B

Answer 9

Mucosal neuromas
Marfanoid body habitus
Medullary thyroid carcinoma
Pheochromocytoma

Question 10

Adrenocortical carcinoma

Answer 10

Rare and deadly
Irregular margins, rapid growth
Look for rapidly enlarging mass with sudden onset of Cushings, increased androgens, HTN with hypokalemia, gynecomastia
Abdominal pain from mass effect

Question 11

Euthyroid Sick Syndrome

Answer 11

Defect in peripheral deiodination seen in systemically ill ppl; may be an adaptive hypometabolic state
Usually present with low free T3, but normal TSH and T4 (total and free)

Question 12

Central hypothyroidism

Answer 12

Pituitary or hypothalamic disease (radiation, tumor, infiltrative diseases)
TSH is normal or low, T3/T4 is low
Thyroid is normal or small in size

Question 13

Subacute thyroiditis

Answer 13

transient hypothyroidism that is painful
Referred jaw pain
often occurs post-viral infection

Question 14

When is a RAI indicated?

Answer 14

when TSH is low in order to rule out a hot nodule
Hot nodules suppress TSH
Hot nodules are not associated with cancer

Question 15

Whipple’s Triad

Answer 15

Associated with insulinoma

1. low blood glucose
2. symptoms of low glucose
3. resolution of symptoms after administration of glucose

Question 16

Triad of symptoms: Grave’s Disease

Answer 16

1. Goiter
2. Exopthalmos
3. Pretibial myedema