Endocrine Cpx, Dx

Question 1

What is the presentation of Pheochromocytoma?

Answer 1

• high blood pressure unresponsive to therapy
• headaches, palpitations, and sweating

Question 2

What labs should you order if you suspect pheochromocytoma?

Answer 2

24 hour Urine metanephrines and VMA (will be elevated)

VMA is a metabolite of epinephrine

Question 3

What is a Pheochromocytoma?

Answer 3

catecholamine secreting adrenal tumor which secretes norepinephrine and epinephrine autonomously and intermittently, causing hypertension, palpitations, headaches, excessive sweating

Question 4

What disease is Pheochromocytoma associated with?

Answer 4

Neurofibromatosis Type 1

Question 5

What are the 5 Ps of Pheochromocytoma?

Answer 5

Pressure (↑ BP)

Pain (headache)

Perspiration

Palpitations (tachycardia)

Pallor

Question 6

What is the most common visual complain in patients with a pituitary adenoma?

Answer 6

Diminished temporal vision or bitemporal hemianopsia

Question 7

Patient will present as → a 31-year-old woman who complains of irregular, infrequent menstrual periods. On further questioning, she complains of headaches, fatigue, and breast discharge. She takes ibuprofen only occasionally. The serum prolactin level is 380 μg per L.

What dz?

Answer 7

Pituitary Adenoma

Question 8

What is the diagnostic test of choice for Pituitary Adenoma?

Answer 8

MRI: look for sellar lesions/tumors

Question 9

What labs should you order for pituitary adenoma?

Answer 9

Endocrine studies: Prolactin, GH, ACTH, TSH, FSH, LH

Question 10

1st line Tx for Pituitary Adenoma

Answer 10

Cabergoline or Bromocrpitine (dopamine agonists)

Dopamine inhibits prolactin

Question 11

Tx of pituitary adenoma if active or compressive

Answer 11

trannsphenoidal surgery

Question 12

Best diagnostic test for pt w/suspected pheochromocytoma who is at high risk?

Answer 12

Plasma fractionated metanephrines

Question 13

Best diagnostic test for pt w/suspected pheochromocytoma who is at low risk?

Answer 13

24-hour urine fractionated metanephrines and catecholamines

Question 15

What will Thyroid Carcinoma Labs show?

Answer 15

normal thyroid function, cold nodule

Question 16

Dx for thyroid carcinoma?

Answer 16

initial: US

confirmation: FNA

Question 17

What is the most common type of thyroid carcinoma?

Answer 17

Papillary (popular)

Question 18

What is the most aggressive type of thyroid carcinoma?

Answer 18

anaplastic

Question 19

What is associated with psammoma bodies on FNA?

Answer 19

Papillary thyroid cancer

Question 20

Colicky abdominal pain, distention, and emesis

What is the dz?

Answer 20

small bowel obstruction

Question 21

What will PE show for small bowel obstruction?

Answer 21

high pitched bowel sounds

Question 22

What is the diagnostic test of choice for small bowel obstruction?

Answer 22

abdominal radiograph:

dilated bowels

air fluid levels in step ladder pattern

stack of coins or string pearls sign