Endocrinology

Question 1

MC pituitary adenoma?

Answer 1

Prolactinoma. Consider in amenorrhea/hypothyroidism

Question 2

Tx for pituitary adenoma?

Answer 2

bromocriptine or cabergoline (even if macro >10mm)

Question 3

Order of hormones lost in hypopituitarism?

Answer 3

1. FSH&LH 2. GH 3. TSH 4. ACTH

Question 4

Polyuria, polydipsia, hypernatremia, hyperOsm, dilute urine

Answer 4

Diabetes insipidus- lack ADH

do water deprivation test to tell r/o primary polydipsia

Question 5

Central DI

Answer 5

urine Osm still depressed with water deprivation; urine Osm increased with DDAVP

Question 6

Nephrogenic DI

Answer 6

urine Osm will depressed with DDAVP; treat with HCTZ/amiloride

Question 7

Low TSH, high free T3/T4. Next best step?

Answer 7

RAIU scan. If increased= Graves. If decreased= factitious or thyroiditis.

Question 8

Tx hyperthyroidism?

Answer 8

1. propranolol + MTZ/PTU 2. Iodine ablation or surgery for preggos or kiddos

Question 9

Tx thyroid storm?

Answer 9

PTU + iodine + propranolol

Question 10

Workup of thyroid nodule?

Answer 10

1. TSH
2. if low, do RAIU to find hot nodule (excise or radioactive iodine)
3. if normal, FNA
4. if benign, leave it alone
5. if malignant, surgically excise
6. if indeterminate, re-biopsy or check RAIU
7. if cold, surgically excise

Question 11

What is Papillary thyroid cancer?

Answer 11

MC type, spreads via lymph psammoma bodies

Question 12

What is follicular thyroid cancer?

Answer 12

spreads via blood, must surgically excise whole thyroid

Question 13

What is medullary thyroid cancer?

Answer 13

A/w MEN2 (look for pheo, hyperCa). Amyloid/calcium

Question 14

What is anaplastic thyroid cancer?

Answer 14

80% mortality in 1st year

Question 15

What predisposes thyroid lymphoma?

Answer 15

Hashimotos

Question 16

Osteoporosis, central fat, DM, hirsutism

Answer 16

Cushing’s (screen with 1mg dexmathasone suppression test or 24hr urine cortisol)
–LOW then HIGH

Question 17

Suppression of high dexamethasone test to <50% of control dx?

Answer 17

Pituitary adenoma (Cushing’s disease)

Question 18

No suppression of high dexamethasone test?

Answer 18

Adrenal neoplasia or ectopic ACTH (get plasma ACTH or chest CT if smoker or abd CT/DHEAS)

Question 19

Dx if weakness, hypotension, weight loss, hyperpigmentation, hyperkalemia, hyponatremia, acidemic?

Answer 19

Adrenal insufficiency (get cosyntropin stim test)

Question 20

MC common cause of adrenal issue?

Answer 20

Autoimmune (Addison’s)

Tx with NaCl resuscitation. Long term replacement with dexamethasone and fludrocortisone

Question 21

Work up of adrenal nodule?

Answer 21

1. Check functional status
2. if <5cm and non-functional –> observe w/ CT scans q6mo
   if >6cm or function –> surgical excision

Question 22

Dx of high blood pressure, catecholamine symptoms?

Answer 22

Pheochromocytoma (get urine and plasma free metanephrines)

Question 23

Dx of high blood pressure, hypokalemia, low PRA?

Answer 23

Primary aldosteronism (get plasma aldosterone to renin ratio)

Question 24

Dx if perioral numbness, Chvosteck, Trousseau s/p thyroidectomy?

Answer 24

Hypoparathyroidism (decreased PTH and Ca, increased phosphate)

Question 25

Dx if kidney stones, constipation/abd pain, psychiatric sxs?

Answer 25

Hyperparathyroidism (increased PTH and Ca, decreased PTH, increased vitD)

Question 26

MEN1 sx?

Answer 26

pituitary adenoma, parathyroid hyperplasia, pancreatic islet cell tumor

Question 27

MEN2a sx?

Answer 27

parathyroid hyperplasia, medullary thyroid cancer, pheo

Question 28

MEN2b sx?

Answer 28

medullary thyroid cancer, pheo, marfanoid