Rest of Endocrine

Question 1

What does posterior pituitary secrete?

Answer 1

Vasopressin (ADH)

Oxytocin

Question 2

Why is GnRh special?

Answer 2

Inhibited by prolactin

Pulsatile release, effects LH & FSH

Question 3

Where does progesterone come from>

Answer 3

Corpus luteum

Question 4

S/S of pituitary issue?

Answer 4

Headache
Seizure
Vision changes

Question 5

What else do you order if suspect pituitary mass?

Answer 5

• Serum prolactin
• IGF 1 (growth hormone)
• LH / FSH
• TSH / Free T4
• 24hr free cortisol
• Testosterone
• Estradiol

Question 6

What are the parts of the adrenal gland?

Answer 6

• Medulla: Epi & NE

- Cortex

Question 7

What does cortex parts secrete?

Answer 7

Glomerulosa: mineralcorticoid (aldoesterone)
Fasiculata: glucocorticoids
Reticulata: androgens

Question 8

What are the nonfunctioning pituitary masses? What do you do if you find them?

Answer 8

Macro: 1cm or higher, refer for visual field testing

Micro: less than 1cm, repeat in 1 year

Question 9

What are the functioning pituitary masses?

Answer 9

Prolactinoma (treat with dopamine agonist) or GH / ACTH secreting tumor (refer to neuro

Question 10

What serum prolactin level suggests prolactinoma?

Answer 10

250 mcg / L

Question 11

What serum prolactin level suggests macroprolactinoma?

Answer 11

> 500 mcg / L

Question 12

What is stalk effect

Answer 12

under influence of Releasing Hormones (from hypothalamus) the pituitary works. If compression of stalk, this does not occur.

EG block dopamine then you will have hyperprolactinemia

Question 13

What is refractory HTN?

Answer 13

patient on 3 drugs, 1 must be diuretic, but still have HTN. You must test for Cushing

Question 14

If cortisol saliva is normal, what do you do? What if high?

Answer 14

Repeat no matter what

Question 15

What is after repeat saliva is high?

Answer 15

Low dose dexamethasone suppression test: take 1mg at 11pm, measure at 8am

Question 16

What should normal result of DST be?

Answer 16

Cortisol should be LOW (feedback loop is working properly so decrease steroid production)

Question 17

What if DST result is abnormal?

Answer 17

Order Adrenocorticotrop Hormone (ACTH)

Tells you pituitary

Question 18

What are the values of ACTH? What do they mean?

Answer 18

Less than 5 pg/mL: ACTH independent, adrenal gland issue so get adrenal MRI

Less than 200 pg/mL: ACTH dependent, pituitary issue so get MRI

More than 200 pg/mL: Ectopic ACTH so get MRI of pituitary

Question 19

What do you do for diagnostic if on tumor or prior to neurosurgery?

Answer 19

Inferior petrosal sinus sampling

Question 20

Diabetes Insipidus:

Urinary Output?
ADH Levels?
Na levels?
Hydration?
Fluid lost or retained?

Answer 20

• High urinary output
• Low levels ADH
• Hypernatremia
• Dehydrated
• Lose too much fluid

SIADH is just the opposite

Question 21

Which ADH issue presents with excessive thirst?

Answer 21

BOTH DI & SIADH?

Question 22

What is hyponatremia levels?

Answer 22

serum plasma sodium

Question 23

What HbA1c level is DM? What is not?

Answer 23

6.5%

Less than 6 is normal

Question 24

What fasting plasma glucose is DM?

Answer 24

126 mg/dL

Question 25

What is 2 hour plasma glucose level of DM for 75g OGTT?

Answer 25

200 mg/dL

Question 26

What random plasma glucose level in patient with s/s of hyperglycemia?

Answer 26

200 mg/ dL

Question 27

DKA is not diagnosed by what?

Answer 27

ketones in the urine

Question 28

``` For DKA Bood glucose pH Bicarb K Na ```

Answer 28

``` - more than 250 mg/dL pH less than 7.3 bicarb less than 15 high K low Na ```

Question 29

What level do you supplement K?

Answer 29

less than 5

Question 30

What blood sugar do you give insulin with D5W?

Answer 30

250

Question 31

What if you have 21 hydroxylase deficiency?

Answer 31

Hypoaldosteronism Hypocortisol Increased estrogen & testosterone

Question 32

Who get screened for primary aldosteronism?

Answer 32

- Stage 2 (>160–179/100–109 mm Hg) - Stage 3 (>180/110 mm Hg) - Refractory hypertension

Question 33

What is the PAC/PRA ratio in primary aldosteronism?

Answer 33

Increased, over 30

Question 34

What if the PAC/ PRA ratio is less than 10?

Answer 34

- Renin secreting tumor - Diuretic use - Renovascular HTN - Coarctation of aorta - Malignant phase of HTN

Question 35

How do you determine adrenal insufficiency?

Answer 35

8am cortisol, confirmed with less than 3 and ruled out if greater than 15

Question 36

What do you do if cortisol is between 3 and 15?

Answer 36

cosyntropin stimulation test if less than 18 there is AI

Question 37

What do you do if you suspect pheochromocytoma?

Answer 37

1) Plasma metanephrines | 2) Urinary metanephrines and plasma catecholamines