Endocrinology

Question 1

Benefits of Tight Glycemic control

Answer 1

1. Improves wounds healing
2. Reduces rate of infection
3. Avoids exacerbating CNS injury associated with ischemia in presence of increased serum glucose
4. Decreases risk of dehydration 2/2 osmotic diuresis

Question 2

Sequelae of long-term uncontrolled Diabetes

Answer 2

1. Peripheral and autonomic neuropathy
2. CAD
3. HTN
4. Increased risk of aspiration (gastroparesis)
5. Renal insufficiency

Question 3

What is Carcinoid Syndrome?

Answer 3

A constellation of symptoms including flushing, diarrhea, bronchoconstriction, right heart valvular disease (pulmonic stenosis, tricuspid regurgitation) and hypotension

• D/t excessive amounts of circulating hormones (histamine, bradykinin, serotonin) in the systemic circulation

Question 4

How is carcinoid syndrome diagnosed?

Answer 4

• 24-hr urine levels of 5-hydroxyindoleacetic acid (5-HIAA)
• PET/CT Scan
• Octreoscan (Scintigraphy)

Question 5

Why don’t all patients with carcinoid tumors develop carcinoid syndrome?

Answer 5

Most carcinoid tumors are located in GI tract
- vasoactive substances enter portal circulation and removed by liver prior to systemic circulation

Symptoms occur when substance bypass portal system

• Metastasis to liver
• Tumors outside GI tract (pulmonary, ovarian)

Question 6

What’s the treatment of carcinoid crisis?

Answer 6

1. Somatostatin analogue (Octreotide)

2. Optimize intravascular fluid volume

Question 7

Would you use Succinylcholine in a patient with Carcinoid Syndrome?

Answer 7

No

• Fasciculations and potential histamine release could lead to increased release of vasoactive substances