Endocrinology indications

Question 1

Indications of primary aldosteronism screening

Answer 1

• BP > 150/100 mmHg on 3 different occasions on different days
• BP > 140/90 mmHg despite treatment with 3 antihypertensive drugs (including a diuretic)
• Controlled BP (< 140/90 mmHg) on 4 antihypertensive drugs
• HTN and hypokalemia
• HTN and adrenal incidentaloma
• HTN and sleep apnea
• HTN and family history of early-onset HTN or CVA
• HTN and 1st degree relative with PA

Question 2

Indicators for activating rapid response teams

Answer 2

• May include changes in vital signs: heart rate of < 30/min or ≥ 139/min
• Systolic blood pressure < 70 mm Hg or ≥ 200 mm Hg
• Respiration rate < 9/min or > 35/min
• Temperature < 34.0 °C [93.2 °F] or ≥ 39.0 °C [102.2 °F]
• Oxygen saturation less than 85%
• Development of altered mental status or coma

Question 3

Criteria for resolution of DKA are

Answer 3

• plasma glucose <11.1 mmol/L (<200 mg/dL)
• serum bicarbonate >18 mmol/L (>18 mEq/L)
• venous pH>7.3
• anion gap <10

MCQ

Question 4

Pheochromocytoma: Indications to prefer measuring plasma-fractionated metanephrines

Answer 4

Measuring plasma-fractionated metanephrines is the recommended
first-line test when there is a high index of suspicion for pheochromocytoma. The following scenarios warrant a high index of suspicion:

• family history of pheochromocytoma,
• genetic syndrome that is associated with pheochromocytoma (MEN2, VHL, NF1),
• prior resection of pheochromocytoma, or
• adrenal mass consistent with pheochromocytoma.

24-hour urine-fractionated metanephrines is the recommended test for patients with low index of suspicion