Endocrine: Cushing

Question 1

Cushing. Location? 20 min

Answer 1

Office -> home

Question 2

Cushing. Exam?

Answer 2

General
Neuro/psych - nes buvo chief complaint depression

As zymejau viska, ir taip daryciau, nes buvo weight gain, hirsuitism etc.

Question 3

Cushing. why CBC?

Answer 3

patient has fatigue, therefore need to evaluate possibly low hematocrit levels.

Question 4

Cushing. BMP?

Answer 4

important to rule out other conditions.

Question 5

Cushing. if patient childbearing age?

Answer 5

PATIENT DID NOT HAVE MENSES FOR 6 MONTHS!!!
and was childbearing age.

HCG beta urine or serum

Question 6

Cushing. Standard test to Dx?

Answer 6

Dexametasone supression test (galima ir cortisol 24h urine)

Question 7

Cushing. After Dexametasone –>?

Answer 7

Hormone, ADRENOCORTICOTROPIC, plasma

Question 8

Cushing. If ADRENOCORTICOTROPIC > 20 pg/ml –>?

Answer 8

it means that ACTH dependent

jie is karto pateike low ir high dexa results, nors uzsakiau tik viena.

Question 9

Cushing. If ACTH dependent?

Answer 9

Bus arba pituitary arba ectopic secretion.
Pradedam nuo galvos del pituitary tumor: MRI with/without gadolinium.

Question 10

Cushing. Visi kiti tyrimai: ECG, lipid, A1b, TSH, T4 - nebuvo. Visus zymejau

Answer 10

.

Question 11

Cushing. Tx - vienintelis variantas buvo.

Answer 11

Consult - neurosurgery

Aš pažymėjau octreotide (nebuvo prie taškų), paskui neurosurgery consult –> iš karto davė atsakymą, kad atlikta operacija, nebuvo jokio pasiruošimo operacijai, t.y neužsakiau jokių krešumų nieko.

Question 12

Cushing. Jeigu yra numatoma operacija, uzsakyti kresumus - sitoj situacijoj nereikejo, bet kitose reikejo. Tai tiesiog jeigu yra tiketina surgery = kresumai.

Answer 12

.

Question 13

Cushing. jeigu ACTH is low, aka below 5 pg/ml?

Answer 13

It means it is ACTH- INDEPENDENT ==> THEN DO CT of adrenal glands to look for adrenal mass

Question 14

Cushing. del to kad buvo depresija - neteisingas gydymas SSRI or consult mental health. Tx should be based on underlying cause.

Answer 14

.