Endocrine

Question 1

Work up for s/s of low cortisol

Answer 1

1. 8am cortisol
   -can proceed to cosyntropin stim test pending results

Question 2

If 8am cortisol is low then

Answer 2

check ACTH (central)

Question 3

If central is the cause ..work up ?

Answer 3

MRI
Prednisone
Treat for panhypopit

Question 3

Primary causes of primary adrenal insufficiency

Answer 3

AI adrenalitis
look for 21beta antibodies (Addisons)

if pos then don’t do CT of adrenals

Replace with fludro and prednisone

Question 4

Treat for chronic primary adrena insufficient is both

Answer 4

Fludro and prednisone

Question 5

Causes of Waterhouse Freidrischson

Answer 5

Neisseria , sepsis, DIC,

Question 6

Treatment of adrenal crisis

Answer 6

1. Potent IV steroid (hydrocortisone)
2. May need abx if infection
3. 2-3 L fluid bolus
4. Fludro when fluids are stopped 0.1 mg daily

Question 7

Empty sella syndrome

Answer 7

Ant pit is displaced generally patients are normal

Question 8

Acute adrenal Insufficiency requires

Answer 8

1 liter/ hr bolus with CCM followed by…

200 mg hydrocortisone/24 hours

Mineralacorticoid once hydrocortisone has been reduced to less than 50 mg.

Question 9

Long acting steroids

Answer 9

prednisolone and dexamethasone

Question 10

Concerns for people with isolated primary adrenal insuffienciency

Answer 10

Premature ovarian failure

AI thyroid disease

Question 11

40 mg hydrocortisone is equivalent to

Answer 11

100-150 micrograms of fludro