Endocrine
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| Prolactin >200: due to: | Hyperprolactinemia; Pit Adenoma; Renal Fail; PG
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| Acromegaly Dx | Elevated IGF-1; GH Fails to Suppress <2 ng/mL after 75 g CHO load
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| If suspect pt is hypocalcemic, measure 1,25-D? | No; measure 25-OH D
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| Looser zones & Milkman lines on xray = | Pseudofractures (seen in osteomalacia)
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| Pituitary adenoma diagnosed by: | CT or MRI of brain to evaluate sella turcica
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| GH lab testing | GH on fasting AM samples (often not diagnostic); GH Stim tests (hyperglycemia normally suppresses GH secretion); GH remains elevated in acromegaly
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| IGF-1 levels influenced by: | nutrition (low in malnutrition)
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| ADH measurement | usually unmeasurable; 2.3-3.1 pg/mL
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| SIADH labs: | low serum osmolality, low serum sodium & high urine osmolality
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| ADH problems: tests | DI: H2O deprivation test (pos if central DI); SIADH: water loading test
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| Water loading study results | (1L H2O; hourly urine/serum x 5 hrs) Normal: urine osmo < serum osmo; SIADH: urine osmo > serum osmo
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| Pituitary dwarfism: IGF-1 & GH | Useful to compare IGF-1 levels to GH; IGF-1 is low whenever GH is deficient; IGF1 more stable than GH; mediate GH fx on sk mx
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| DEXA used for: | PA spine, lateral spine, hip, forearm, total body
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| Quantitative CT bone scan used for: | spine (trabecular only)
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| Osteomalacia labs | Low serum Ca, PO4, 25-OH vit D. High PTH and alk phos. Check renal labs.
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| Transvers radiolucent markings on imaging (pseudofractures) suggest: | Osteomalacia
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| Paget disease labs | High alk phos (2/2 osteoblast activity). Ca & PO4 normal. Urinary pyridinolines or N-telopeptide.
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| Paget disease imaging | increased uptake on technetium bone scan. Early dz: lytic lesions on x-ray; later, coarse, dense, chaotic, deformed cortical bone
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| PCOS LH:FSH ratio | >2.0 common
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| Hirsutism / virilization: lab eval | Serum testost (total & free); androstenedione (>1000: ovar adrenal neoplasm); DHEAS (>700: adrenal source of androgen xs; Need adrenal CT to detn if hyperplasia or ca)
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| Hirsutism / virilization: Imaging | Pelvic Exam & US; Abd CT (esp adrenal glands/ fine cuts): adenoma / ca / hypertrophy
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| gene for achondroplasia | FGFR3
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| central diabetes insipidus confirmed by | vasopressin challenge test (pos if reduced UOP)
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| Paget dz labs | high alk phos & urine Ca; normal serum Ca & PO4
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| Paget disease on x-ray | dense, expanded bone; fissures in long bone
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| Osteoporosis: bone turnover markers | Urine N-telopeptide, pyridinium crosslinks, serum osteocalcin. All used to monitor response to tx; should decrease >35% in 3 months
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