Parathyroid/Adrenal

Question 1

Symptoms associated with HyperCalcemia

Answer 1

Stones, Bones, Moans, Groans, and Psychic overtones.

Question 2

Treatment of symptomatic hypercalcemia

Answer 2

Hydration is most important, IV furosemide and diuretics are falling out of favor. IV bisphosphonate infusion should then be started and will lower Ca level over 2-4 days. Calcitonin has limited duration of action but can be used in emergency when saline is ineffective.

Question 3

Mechanism of malignancy associated hypercalcemia?

Answer 3

secretion of PTH-like substances that increase serum calcium (PTH stimulates osteoclasts to increase bone resorption.

Question 4

Medications that can help manage chronically elevated Calcium levels.

Answer 4

Bisphosphanates- decrease serum Ca and increase bone density, Oral Phosphate decreases Ca absorption in gut and bone reabsorption of Calcium. glucocorticoids decrease intestinal absorption of Ca.

Question 5

Meds that can cause hypercalcemia

Answer 5

Thiazides, lithium, tamoxifen, megesterol, methytestosterone, mycophenalate, tacrolimus, theophylinne toxicity.

Question 6

Chokstek sign- what does it look for and how do you do it?

Answer 6

Hypocalcemia, tap cheek just anterior to tragus then causing twitching

Question 7

Trousseau Sign

Answer 7

hypocalcemia- Carpopedal spasm after placement of bp cuff

Question 8

How to you correct serum calcium for hypoAlbuminemia?

Answer 8

Add 0.8 mg/dL to serum Ca for each 1g/dL the albumin is

Question 9

Most common cause of Cushing’s Syndrome?

Answer 9

Exogenous Steroids, other causes are cushing’s disease, adrenal neoplasms, or ectopic ACTH production (lung, pancreas, kidney).

Question 10

Hyperpigmentation, hypotension, fatigue, weight loss, syncope, what do you think of?

Answer 10

Addison’s Disease

Question 11

Labs indicative of Addison’s Disease (primary adrenal insufficiency)

Answer 11

HypoNa, HyperK, HypoGlycemia

Question 12

Test to diagnose adrenal insufficiency

Answer 12

Cosyntropin test- cosyntropin is synthetic ACTH which should induce a burst of cortisol. Can also check random serum cortisol but not as good. Note, Moring serum Cortisol

Question 13

Main cause of Addison’s in the US vs World wide

Answer 13

Autoimmune vs tuberculosis

Question 14

Hyperpigmentation in Addison’s is more indicative of primary or secondary cause?

Answer 14

Primary since ACTH is in excess and causes stimulation of melanocyte stimulating hormone.

Question 15

Treatment of Addison’s?

Answer 15

Glucocorticoids (prednisone or hydrocortisone) and Mineralocorticoid (fludrocortisone) indefinitely, increase doses during times of stress.