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Endocrine - ABIM
Hypercortisol, pituitary hormones
| Question | Answer |
|---|---|
| Describe the set of symptoms that a patient presents with for you to suspect Cushing's syndrome | CHODA. central obesity, hirsutism, osteoporosis, diabetes, amenorrhea. Patients will also have proximal muscle weakness, psychiatric manifestations (depression, insomnia, psychosis), easy bruising, hypertension, decreased potassium |
| What is the primary defect in Cushing's syndrome? | High cortisol |
| How do you screen for a high cortisol state? What must you exclude first? When should you referred to endocrinology? | Must first exclude exogenous cortisol such as steroids or mineralocorticoid. 1. ON low-dose dexamethasone suppression test (LDST), 2. 24-h urine free cortisol x2, 3. late-night salivary cortisol x2. Referred to endo if two screening tests are abnormal |
| How does the overnight dexamethasone test work? Who should not get it? | 1 mg of dex at 11 PM, cortisol measured at 8 AM. Cortisol will typically be < 2 μg/dL. (total bound cortisol measured, so can't use in malnutrition, cirrhosis, nephrotic, and hyperestrogen (OCP or preg) since protein levels abnormal |
| When is the urine 24 hour cortisol test considered diagnostic of Cushing's syndrome? | A test is considered abnormal when UFC exceeds the upper limit of the normal range of the assay (45 μg/24 h [124 nmol/24 h]), while values greater than 3 times normal are diagnostic of CS. |
| What test to use when suspect patient has low cortisol? What do the results mean? | Use cosyntropin test, which is synthetic ACTH. If test increases cortisol, then problem is Hypothalamic or pituitary. Use CRH test to distinguish. If cortisol does not increase, then primary adrenal insufficiency (Addison's disease) |
| What stimulates prolactin? | Prolactin stimulated by TR H, which also upregulates TSH. |
| What inhibits prolactin? | Dopamine, bromocriptine, cabergoline |
| What medications can increase prolactin? | Antipsychotics like risperidone can increased prolactin because risperidone blocks dopamine. This relaxes dopamine's inhibition of prolactin, which increases prolactin and down regulates FSH and LH production. |
| What is the function of octreotide? | Octreotide is a somatostatin analog, so it inhibits growth hormone and TSH. |
| Name the components of MEN I | PPP. Pituitary, MRI brain to rule out pituitary tumor. Pancreas, PUD, hypoglycemia, VIPoma, Zollinger Ellison. hyperParathyroidism, elevated calcium level. |
| Name the components of MEN II | PPM. hyperParathyroidism, pheochromocytoma (check urine metanephrines if patient has hypertension and palpitations), medullary thyroid cancer ( do thyroid ultrasound) |
| Name the components of MEN III | PMM. pheochromocytoma (check urine metanephrines if patient has hypertension and palpitations), medullary thyroid cancer ( do thyroid ultrasound, mucosal neuroma |
Created by:
christinapham
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