Online Med Ed--Endocrinology

Question 1

Work-up of woman with amenorrhea and galactorrhea

Answer 1

med check
TSH
Prolactin level only if above two negative
MRI brain if prolactinemia

TX with carbergoline and bromocriptine (dopamine agonists)

Question 2

Causes of prolactinemia

Answer 2

hypothyroidism (specifically low T4 causing high TRH and high prolactin)

Dopamine antagonizing meds (takes negative feedback off prolactin)

Question 3

Diatolic HF and DM in person with coarse facial features and enlarged hands/feet

Answer 3

acromegaly

Question 4

work-up of suspected acromegaly

Answer 4

ILGF-1 (screening test)
glucose suppression test
MRI (if suppression test with glucose load fails to suppress GH)

F/U with surgical resection

Question 5

W/u of chronic hypopituitarism

Answer 5

usually shows decreased FSH/LH and GH with preserved ACTH and TSH

insulin/vasopressin stim test (will fail to stimulate GH increase)

Question 6

Empty Sella syndrome: mangament

Answer 6

NOTHING

Question 7

Diabetes insipidus

Answer 7

central or nephrogenic

presents with polyuria and polydipsia and normal glucose

W/u with water deprivation test

tx
nephrogenic with gentle diuresis with furosemide and amiloride

central with ddAVP

Question 8

Antibodies in graves vs hashimotos

Answer 8

graves: TSI
hashimotos: TPO

Question 9

Types of thyroid cancer

Answer 9

papillary: most comon, orphan-annie nuclei on biospy, resect

Follicular: FNA shows thyroid, spreads hematogenously, complete recovery with radioactive ablation

Medullary: C-cells and calcitonin, RET-oncogene and pheo associations

Anaplastic: elderly, locally invasive, fatal (chokes out trachea)

Question 10

Work-up of suspected cushings

Answer 10

(1) low-dose dexamethasone suppression test (failure to suppress indicates cushings syndrome)
(2) ACTH level (normal levels indicate an adrenal tumor that needs to be identified with CT and resected; high levels indicate ACTH-dependent cushings)
(3) For ACTHdependent cushing–> high dexamethasone suppression test (if suppression, central tumor; if no suppresion, look for ectopic tumors)

Question 11

Tests that diagnos cushings

Answer 11

24hr urine cortisol or
late night salivary cortisol +
failed low-dose dexamethasone suppression

Question 12

Work up/of addisons disease

Answer 12

morning cortisol showing low cortisol

cosyntropin stimulation (ACTH) test–if cortisol rises then pituitary issue, if doesnt then issue with adrenal gland

Question 13

Salt suppression test to diagnose___

Answer 13

conns syndrome

fails to be suppressed, and alo/renin ratio still high

Question 14

Different tests for diabetes

Answer 14

(1) Random BG: if >200 with sxs, you diagnose DM
(2) Fasting BG x2: if >125, diagnose DM, if <100 nl
(3) 2-hr glucose tolerance test: if >200, DM; if <140, NL
(4) A1c: if >6.5%, DM

Question 15

insulins

Answer 15

Long-acting: lantus and levemir (basal)

short-acting: novolog and humalog (bolus)

Question 16

Way to determine insulin requirements in someone with DM refractory to 2 non-insulin meds

Answer 16

(1) start long-acting insulin (0.1/kg and titrate until at goal fasting blood glucose or have reached max dose)
(2) If A1c not at goal, start short-acting insulin and blood sugars before meals, one meal at a time

NOTE: if cannot handle this regimen, may start patient on mixed basal-bolus twice a day routine, but not as good control

Question 17

Primary vs central adrenal insufficiancy: clinical features

Answer 17

primary: severe symptoms, hyperpigmentation, hyperkalemia, hyponatremia, hypotension

central (secondary or tertiary): less severe sxs, no hyperpigmentation, no he=yperkalemia, possible hyponatremia

Question 18

Pt newly diagnosed with HTN and prescribed diuretic comes in with muscle cramps, weakness, and palpitations =

Answer 18

diuretic-induced hypokalemia in the s/o mild primary hyperaldosteronism

Question 19

Hyperglycemic hyperosmolar nonketotic coma

Answer 19

Diabetes II

No ketones, no acidosis as in DKA

BG 800-1000
UA: no ketones
ABG: no acidosis
BMP: no gap

Tx: fluids and IV insulin