NEWMAN endocrine HYHO

Question 1

HPA axis is a neuroendocrine system that controls _____ and regulates digestion, immune system, mood, sexuality, and energy storage

Answer 1

controls reactions to stress

• short term stress response: adrenal medulla and catecholamines
• long term stress response: CRH stimulation –> ACTH –> mineralocorticoids and glucocorticoids release by adrenal cortex

Question 2

___ helps regulate concentration of HPA axis hormones in the blood to prevent over/under correction

Answer 2

negative feedback system

Question 3

RAAS regulates ___ ___ and __ physiology . ___ stimulates aldosterone release from adrenal cortex.

Answer 3

renal, vascular, and cardiac

-angiotensin II

Question 4

MCC of ambiguous genitalia in female infants

Answer 4

CAH -21 hydroxyls deficiency MC

Question 5

tx of infant in crisis due to CAH ? and acute adrenal crisis in adults ?

Answer 5

hydrocortisone (IV or IM)
fluids/ glucose (IV)
management of hyperkalemia
(fludrocortisone is adult adrenal crisis) topi

Question 6

in primary adrenal insufficiency nearly all pts complain of? most pts complain of?

Answer 6

all: fatigue, reduced stamina, weakness, anorexia, weight loss, skin hyperpigmentation
most: ab pain, N/V, MSK pain, pschyiatric sx, HA, salt craving, low blood pressure

Question 7

lab findings of “low 8 AM plasma cortisol and elevated ACTH” indicates

Answer 7

primary adrenal insuffciency

Question 8

acute adrenal crisis (insufficiency) causes metabolic acidosis or alkalosis ?

Answer 8

metabolic acidosis

Question 9

ectopic ACTH syndrome is usually due to

Answer 9

small cell carcinoma of the lung

Question 10

sx of primary aldosteronism (Conns syndrome)

Answer 10

HTN
Hypokalemia (muscle weakness, polyuria, polydipsia)
-low renin HTN

*LOW RENIN HTN , HYPOKALEMIA, METABOLIC ALKALOSIS

Question 11

(single/multiple) points are needed to eval the growth pattern, which is the only way you can eval if ____ is adequate

Answer 11

multiple points need to see is rate of growth is adequate

Question 12

normal growth velocity for school age children 5-> puberty

Answer 12

5cm/ year (2inches/year)

Question 13

“delayed bone age”

Answer 13

bone age that is 2 standard deviations or more below the chronologic age of the patient

Question 14

is head circumference (measure if <24 months) changes first or most dramatically on growth curve then you should consider

Answer 14

hydrocephalus , or brain, skull problem

Question 15

3 most common benign causes of short stature (height >2 standard deviation below the mean height i.e. <3rd percentile) and features of bone age

Answer 15

1. familial (small parents)
   - bone age is consistent with actual age
2. constitutional (“late bloomer”)
   - hallmark is delayed bone age (but end up being NL height)
3. idiopathic
   - bone age is consistent with age

Question 16

endocrine cause of short stature (decreased length)

Answer 16

growth hormone deficiency (can be measured with IGF-1 and IGFBP-3 at any time of the day)

Question 17

work up for precocious puberty (secondary sex traits before 8 in girls , 9 in boys)

Answer 17

1. thorough history and PE
2. lab tests (FSH, LSH, estradiol/testosterone, 17 hydroxyprogesterone)
3. bone age eval (will be advanced in precious puberty)

Question 18

when replacing potassium in DKA keep in mind:

Answer 18

renal function
baseline EKG -continous monitoring
verify urinary output and measure hourly

Question 19

criteria to start intermediate or long acting insulin in DKA patient (switch from IV insulin)

Answer 19

1. when pt is able to eat (mental status improved, no N/V, no ab pain)
2. normalized anion gap
3. allow overlap timing of IV and SQ insulin by at least an hour

Question 20

rapid or chronic hypercalcemia development causes dehydration

Answer 20

rapid (trying to get rid of it in urine)
sx: polyuria, dehydration, renal impairment

chronic: stones, bone problems, psychiatric issues