Endocrinology Flashcards

Question

Addison's disease management?

Answer 1

This usually means that patients take a combination of: - Hydrocortisone: usually given in 2 or 3 divided doses. Patients typically require 20-30 mg per day, with the majority given in the first half of the day - Fludrocortisone Patient education is important: - emphasise the importance of not missing glucocorticoid doses - consider MedicAlert bracelets and steroid cards - patients should be provided with hydrocortisone for injection with needles and syringes to treat an adrenal crisis - discuss how to adjust the glucocorticoid dose during an intercurrent illness. Management of intercurrent illness: - Glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same.

Answer 2

Until recently people with diabetes who used insulin could not hold a HGV licence. The DVLA changed the rules in October 2011. The following standards need to be met (and also apply to patients using other hypoglycaemic inducing drugs such as sulfonylureas): there has not been any severe hypoglycaemic event in the previous 12 months the driver has full hypoglycaemic awareness the driver must show adequate control of the condition by regular blood glucose monitoring*, at least twice daily and at times relevant to driving the driver must demonstrate an understanding of the risks of hypoglycaemia here are no other debarring complications of diabetes From a practical point of view patients on insulin who want to apply for a Group 2 (HGV) licence need to complete a VDIAB1I form. Other specific points for group 1 drivers: if on insulin then patient can drive a car as long as they have hypoglycaemic awareness, not more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months and no relevant visual impairment. Drivers are normally contacted by DVLA if on tablets or exenatide no need to notify DVLA. If tablets may induce hypoglycaemia (e.g. sulfonylureas) then there must not have been more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months if diet controlled alone then no requirement to inform DVLA

Answer 3

Patients over the age of 60 with new onset diabetes and weight loss should be referred for an urgent CT abdomen to exclude pancreatic cancer!

Answer 4

The initial management of hypercalcaemia is rehydration with normal saline, typically 3-4 litres/day. Following rehydration bisphosphonates may be used. They typically take 2-3 days to work with maximal effect being seen at 7 days Other options include: calcitonin - quicker effect than bisphosphonates steroids in sarcoidosis Loop diuretics such as furosemide are sometimes used in hypercalcaemia, particularly in patients who cannot tolerate aggressive fluid rehydration. However, they should be used with caution as they may worsen electrolyte derangement and volume depletion.

Answer 5

Primary hyperparathyroidism is caused by excess secretion of PTH resulting in hypercalcaemia. It is the most common cause of hypercalcaemia in outpatients and is often diagnosed following an incidental finding of an elevated serum calcium concentration. Causes of primary hyperparathyroidism: 85%: solitary adenoma 10%: hyperplasia 4%: multiple adenoma 1%: carcinoma Around 80% of patients are asymptomatic and are diagnosed on routine blood tests. The symptomatic features of primary hyperparathyroidism may be remembered by the mnemonic: 'bones, stones, abdominal groans and psychic moans': - polydipsia, polyuria - depression - anorexia, nausea, constipation - peptic ulceration - pancreatitis - bone pain/fracture - renal stones - hypertension

Answer 6

- Raised calcium, low phosphate - PTH may be raised or Normal (inappropriately given the raised calcium)********* - Technetium-MIBI subtraction scan X-ray findings: - pepperpot skull - osteitis fibrosa cystica

Answer 7

- the definitive management is total parathyroidectomy. conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage. patients not suitable for surgery may be treated with cinacalcet, a calcimimetic. a calcimimetic 'mimics' the action of calcium on tissues by allosteric activation of the calcium-sensing receptor

Answer 8

Hashimoto's thyroiditis (chronic autoimmune thyroiditis) is an autoimmune disorder of the thyroid gland. It is typically associated with hypothyroidism although there may be a transient thyrotoxicosis in the acute phase. It is 10 times more common in women - features of hypothyroidism - Goitre: firm, non-tender Antibodies: - anti-thyroid peroxidase (anti-TPO) - antibodies → positive in >90% of cases anti-thyroglobulin antibodies → present in ~60–80%, less specific Associations: - other autoimmune conditions e.g. coeliac disease, type 1 diabetes mellitus, vitiligo - Hashimoto's thyroiditis is associated with the development of MALT lymphoma

Answer 9

Subclinical hypothyroidism TSH raised but T3, T4 normal no obvious symptoms Significance: - Risk of progressing to overt hypothyroidism is 2-5% per year (higher in men). - Risk increased by the presence of thyroid autoantibodies Management: Not all patients require treatment. NICE have produced guidelines. Note that not all patients will fall within the age boundaries given and hence these are guidelines in the broader sense. TSH is > 10mU/L and the free thyroxine level is within the normal range consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart TSH is between 5.5 - 10mU/L and the free thyroxine level is within the normal range if < 65 years consider offering a 6-month trial of levothyroxine if: the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and there are symptoms of hypothyroidism in older people (especially those aged over 80 years) follow a 'watch and wait' strategy is often used if asymptomatic people, observe and repeat thyroid function in 6 months

Answer 10

They work by increasing pancreatic insulin secretion and hence are only effective if functional B-cells are present. On a molecular level they bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells. Common adverse effects: - hypoglycaemic episodes (more common with long-acting preparations such as chlorpropamide) - weight gain Rarer adverse effects: - hyponatraemia secondary to syndrome of inappropriate ADH secretion - bone marrow suppression - hepatotoxicity (typically cholestatic) - peripheral neuropathy Sulfonylureas should be avoided in breastfeeding and pregnancy.

Answer 11

Maturity-Onset Diabetes of the Young (MODY) is a form of monogenic diabetes, typically characterized by an autosomal dominant inheritance pattern, onset usually before 25 years of age, and impairment in insulin secretion with minimal or no defects in insulin action. Unlike more common forms of diabetes, such as Type 1 and Type 2, MODY is not primarily driven by lifestyle factors. It is thought that around 1-2% of patients with diabetes mellitus have MODY, and around 90% are misclassified as having either type 1 or type 2 diabetes mellitus. Classification and Genetics MODY is a heterogenous group, with over 14 types identified as of the latest revision, each corresponding to mutations in different genes. The most common types are MODY2 (GCK mutation) and MODY3 (HNF1A mutation), but others include MODY1 (HNF4A), MODY4 (PDX1), MODY5 (HNF1B), and so on. MODY 3 accounts for around 60% of cases with MODY 2 causing 20% of cases. Each subtype varies in its clinical presentation, management, and prognosis, emphasizing the importance of precise genetic diagnosis in order to guide treatment strategy and genetic counselling. Clinical Features Patients with MODY often present with mild non-ketotic hyperglycemia that is often detected incidentally or during routine screening. It may also be discovered during pregnancy. Unlike Type 1 diabetes, patients with MODY usually do not present with diabetic ketoacidosis except under severe stress conditions, and unlike Type 2 diabetes, they are often of normal weight and do not exhibit signs of insulin resistance. The specific clinical manifestations and complications can vary depending on the subtype of MODY. For example, individuals with MODY2 generally have mild, stable fasting hyperglycemia and rarely develop severe complications, whereas those with MODY3 or MODY1 may have progressive hyperglycemia and are at higher risk for complications typically associated with diabetes, such as retinopathy, nephropathy, and cardiovascular disease. Diagnosis MODY should be suspected in individuals with persistent, asymptomatic hyperglycemia detected before the age of 25, without the typical features of Type 1 or Type 2 diabetes. The diagnosis is confirmed by genetic testing, which is crucial for identifying the specific type of MODY, as this has direct implications for management. It's important to remember, however, that genetic testing can be expensive and may not be available in all settings. Treatment The treatment for MODY depends on the specific genetic subtype. For example, MODY2 often does not require specific treatment, as the hyperglycemia is mild and usually does not lead to complications. In contrast, MODY associated with HNF1A often respond well to treatment with low-dose sulfonylureas. Insulin therapy may be necessary in some cases, especially during pregnancy or if sulfonylureas are contraindicated or ineffective.

Answer 12

Serum IGF-1 levels have now overtaken the oral glucose tolerance test (OGTT) with serial GH measurements as the first-line test. The OGTT test is recommended to confirm the diagnosis if IGF-1 levels are raised. Growth hormone (GH) levels vary during the day and are therefore not diagnostic.

Answer 13

Diabetes mellitus: GLP-1 drugs A number of drugs to treat diabetes mellitus have become available in recent years. Much research has focused around the role of glucagon-like peptide-1 (GLP-1), a hormone released by the small intestine in response to an oral glucose load Whilst it is well known that insulin resistance and insufficient B-cell compensation occur other effects are also seen in type 2 diabetes mellitus (T2DM). In normal physiology an oral glucose load results in a greater release of insulin than if the same load is given intravenously - this known as the incretin effect. This effect is largely mediated by GLP-1 and is known to be decreased in T2DM. Increasing GLP-1 levels, either by the administration of an analogue (glucagon-like peptide-1, GLP-1 mimetics, e.g. exenatide) or inhibiting its breakdown (dipeptidyl peptidase-4 ,DPP-4 inhibitors - the gliptins), is therefore the target of two recent classes of drug. Glucagon-like peptide-1 (GLP-1) mimetics (e.g. exenatide) Exenatide is an example of a glucagon-like peptide-1 (GLP-1) mimetic. These drugs increase insulin secretion and inhibit glucagon secretion. One of the major advances of GLP-1 mimetics is that they typically result in weight loss, in contrast to many medications such as insulin, sulfonylureas and thiazolidinediones. They are sometimes used in combination with insulin in T2DM to minimise weight gain. Exenatide must be given by subcutaneous injection within 60 minutes before the morning and evening meals. It should not be given after a meal. Liraglutide is the other GLP-1 mimetic currently available. One the main advantages of liraglutide over exenatide is that it only needs to be given once a day. Both exenatide and liraglutide may be combined with metformin and a sulfonylurea. Standard release exenatide is also licensed to be used with basal insulin alone or with metformin. Please see the BNF for a more complete list of licensed indications. NICE state the following: Consider adding exenatide to metformin and a sulfonylurea if: BMI >= 35 kg/m² in people of European descent and there are problems associated with high weight, or BMI < 35 kg/m² and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities. NICE like patients to have achieved a > 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetics. The major adverse effect of GLP-1 mimetics is nausea and vomiting. The Medicines and Healthcare products Regulatory Agency has issued specific warnings on the use of exenatide, reporting that is has been linked to severe pancreatitis in some patients. Dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g. Vildagliptin, sitagliptin) Key points dipeptidyl peptidase-4, DPP-4 inhibitors increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown oral preparation trials to date show that the drugs are relatively well tolerated with no increased incidence of hypoglycaemia do not cause weight gain NICE guidelines on DPP-4 inhibitors NICE suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if further weight gain would cause significant problems, a thiazolidinedione is contraindicated or the person has had a poor response to a thiazolidinedione

Answer 14

- Glucose > 11 mmol/l or known diabetes mellitus - pH < 7.3 - Bicarbonate < 15 mmol/l - Ketones > 3 mmol/l or urine ketones ++ on dipstick

Answer 15

- Urine should be dipped for glucose and ketones. - Fasting glucose and random glucose. - HbA1c is not as useful for patients with a possible or suspected diagnosis of T1DM as it may not accurately reflect a recent rapid rise in serum glucose. C-peptide levels are typically low in patients with T1DM. Diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes. 1. Antibodies to glutamic acid decarboxylase (anti-GAD) Present in around 80% of patients with T1DM. 2. Islet cell antibodies (ICA, against cytoplasmic proteins in the beta cell) Present in around 70-80% of patients with T1DM. 3. Insulin autoantibodies (IAA) Presence in T1DM correlates strongly with age, found in over 90% of young children with T1DM but only 60% of older patients. 4. Insulinoma-associated-2 autoantibodies (IA-2A)

Answer 16

Initial treatment to control symptoms propranolol is used to help block the adrenergic effects. Patients with Graves' disease are referred to secondary care for ongoing treatment. NICE suggest Carbimazole should be considered in primary care if patients symptoms are not controlled with propanolol. ATD therapy: 1. Carbimazole is started at 40mg and reduced gradually to maintain euthyroidism. 2. Typically continued for 12-18 months. 3. The major complication of carbimazole therapy is agranulocytosis. an alternative regime is termed 'block-and-replace' carbimazole is started at 40mg thyroxine is added when the patient is euthyroid treatment typically lasts for 6-9 months patients following an ATD titration regime have been shown to suffer fewer side-effects than those on a block-and-replace regime Radioiodine treatment: often used in patients who relapse following ATD therapy or are resistant to primary ATD treatment contraindications include pregnancy (should be avoided for 4-6 months following treatment) and age < 16 years. Thyroid eye disease is a relative contraindication, as it may worsen the condition. the proportion of patients who become hypothyroid depends on the dose given, but as a rule the majority of patient will require thyroxine supplementation after 5 years

Answer 17

The Hba1c target for patients on a drug which may cause hypoglycaemia (eg sulfonylurea) is 53 mmol/mol.

Answer 18

Two conditions account for 90% of cases of hypercalcaemia: 1. Primary hyperparathyroidism: commonest cause in non-hospitalised patients 2. Malignancy: the commonest cause in hospitalised patients. This may be due to a number of processes, including; PTHrP from the tumour e.g. squamous cell lung cancer bone metastases myeloma,: due primarily to increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells for this reason, measuring parathyroid hormone levels is the key investigation for patients with hypercalcaemia

Answer 19

- Spironolactone (most common drug cause) - Cimetidine - Digoxin - Cannabis - Finasteride GnRH agonists e.g. goserelin, buserelin - Oestrogens, anabolic steroids

Answer 20

- Coarse facial appearance, spade-like hands, increase in shoe size - Large tongue, prognathism, interdental spaces - Excessive sweating and oily skin: caused by sweat gland hypertrophy - Features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia raised prolactin in 1/3 of cases → galactorrhoea 6% of patients have MEN-1

Answer 21

Each week, at least 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous intensity aerobic activity

Answer 22

Features of excess prolactin: men: impotence, loss of libido, galactorrhoea women: amenorrhoea, galactorrhoea Causes of raised prolactin: - prolactinoma - pregnancy - oestrogens - physiological: stress, exercise, sleep - acromegaly: 1/3 of patients - polycystic ovarian syndrome - primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release)

Answer 23

Autoimmune destruction of the adrenal glands is the most common cause of primary hypoadrenalism in the UK. This is termed Addison's disease and results in reduced cortisol and aldosterone being produced. Features: - Lethargy, weakness, anorexia, nausea & vomiting, weight loss, 'salt-craving' - Hyperpigmentation (especially palmar creases) ACTH is derived from a larger precursor molecule called proopiomelanocortin (POMC). When POMC is cleaved to produce ACTH, other melanocyte-stimulating hormones (MSH) are also produced. These MSHs have the effect of stimulating melanocytes in the skin to produce more melanin, the pigment responsible for skin colour. primary Addison's is associated with hyperpigmentation whereas secondary adrenal insufficiency is not. - Vitiligo - Loss of pubic hair in women - Hypotension - Hypoglycaemia - Hyponatraemia and hyperkalaemia may be seen - Crisis: collapse, shock, pyrexia

Answer 24

In a patient with suspected Addison's disease the definite investigation is an ACTH stimulation test (short Synacthen test). Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM. If an ACTH stimulation test is not readily available (e.g. in primary care) then sending a 9 am serum cortisol can be useful: > 500 nmol/l makes Addison's very unlikely < 100 nmol/l is definitely abnormal - 100-500 nmol/l should prompt a ACTH stimulation test to be performed Associated electrolyte abnormalities are seen in around one-third of undiagnosed patients: - Hyperkalaemia - Hyponatraemia - Hypoglycaemia - Metabolic acidosis

Answer 25

Metoclopramide, Domperidone Phenothiazines Haloperidol very rare: SSRIs, opioids

Answer 26

Hypernatraemia Hypokalaemia Autonomous aldosterone production from the adrenal glands leads to increased sodium reabsorption and potassium excretion in the distal tubule. The increased sodium reabsorption causes volume expansion and hypertension, while potassium loss leads to hypokalaemia.

Answer 27

Direct access urgent 2WW CT scan for Pancreatic cancer.

Answer 28

Calcium oxalate.

Answer 29

< 130/80 mmHg. A BP below 130/80 mmHg is advised in patients with chronic kidney disease and diabetes, or if urine albumin to creatinine ratio (ACR) exceeds 70 mg/mmol).

Answer 30

Orlistat can be trialled in primary care where a patient has a BMI ≥30 kg/m2, or ≥ 28 kg/m2 with other risk factors including high blood pressure or high cholesterol. Orlistat should be discontinued if the patient has failed to lose ≥5% of their body weight over the first three months of use.

Answer 31

Urinary albumin:creatinine ratio (ACR) Microalbuminuria is the earliest sign of diabetic nephropathy and is defined by a urinary albumin:creatinine ratio (ACR) of more than 3 mg/mmol.

Answer 32

In a woman with known stable hypothyroidism who becomes pregnant, immediately increase the levothyroxine dose even before seeing the updated results of thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels. This can all be done while waiting for referral to a specialist. The dose should be increased usually by adding at least 25–50 micrograms levothyroxine; the size of the initial increase in dose will depend on the dose the woman is already taking and the TSH and fT4 concentrations. A 30–50% increase in dosage may be required. If there is any uncertainty about what dose to prescribe, seek specialist advice so that there is no delay in the woman receiving an adequate dose of levothyroxine.

Answer 33

A two hour 75 g oral glucose tolerance test (OGTT) is recommended to test for gestational diabetes in women with risk factors or in whom glycosuria of 2+ or above on 1 occasion, or of 1+ or above on 2 or more occasions has been detected. Gestational diabetes is diagnosed if there is: A fasting plasma glucose level of 5.6 mmol/l or above or A two hour plasma glucose level of 7.8 mmol/l or above.

Answer 34

FBC and LFT check is needed prior to commencing carbimazole but repeat testing is only recommended if clinically indicated. Thyroid function tests are recommended by NICE every 3 months for patients taking antithyroid drugs such as carbimazole or propylthiouracil.

Answer 35

Sub-clinical hyperthyroidism is diagnosed when the thyroid stimulating hormone (TSH) levels are suppressed but T4 levels are normal. If these results occur then the thyroid function tests (TFTs) should be repeated within 2-3 months and then monitored annually thereafter. These abnormalities are often transient but around 5% of patients will convert to overt hyperthyroidism each year. Persistent sub-clinical hyperthyroidism has been associated with increased rates of atrial fibrillation, osteoporosis and heart failure and it is recommended that these patients are discussed with secondary care.

Answer 36

Patients with severe hypercalcaemia (>3.5mmol/l) should be referred urgently (same day) for assessment and treatment.

Answer 37

Patients with CKD and an ACR >30 mg/mmol with hypertension should be treated initially with an angiotensin-converting enzyme inhibitor such as ramipril. Patients with CKD and an ACR < 30 mg/mmol should be offered an agent such as a calcium channel blocker first line or thiazide diuretic if not tolerated.

Answer 38

PSA. Regular follow-up is essential to monitor therapy efficacy and potential adverse effects. This includes periodic assessments of haematocrit levels, prostate-specific antigen (PSA), and lipid profiles. Monitoring these parameters helps ensure the safe and effective use of testosterone replacement therapy and allows for timely adjustments to the treatment regimen. Annual check-ups are essential to evaluate long-term health markers, including PSA levels, haematocrit, and liver function. Patients on testosterone should have testosterone and haematocrit levels tested annually, with three-monthly haematocrit checks in the first year of treatment.

Answer 39

- Has a vocational driving job - Has a job for which vigilance is critical for safety - Has unstable cardiovascular disease (e.g. poorly controlled arrhythmia, nocturnal angina or treatment-resistant hypertension) - is pregnant - Undergoing preoperative assessment for Major surgery - Has non-arteritic anterior ischaemic optic neuropathy.

Answer 40

1. Obesity (body mass index [BMI] of 30 kg/m2 or more). 2. Raised arterial or arterialised capillary carbon dioxide (CO2) level when awake. 3. Breathing abnormalities during sleep, which may consist of obstructive apnoeas and hypopnoeas, or hypoventilation, or a combination of both.

Answer 41

Gliclazide. MODY causes reduced insulin secretion and symptoms may not be severe. First-line treatment aims to stimulate the pancreas, and most patients with MODY are very sensitive to sulfonylureas. If MODY causes no symptoms medication may not be needed.

Answer 42

Duloxetine.

Answer 43

All patients aged 65 years and above should take a daily supplement of 400 international units equivalent to 10 micrograms of vitamin D throughout the year. Women aged over 65 years, men aged over 75 years and those with a high risk of falls and fragility fractures require an osteoporosis assessment. A risk assessment will need to be performed using QFracture or fracture risk assessment tool (FRAX), with further investigation e.g. dual energy x-ray absorptiometry (DEXA scan), bone protection or referral as determined by this assessment.

Answer 44

If endogenous Cushing syndrome is suspected, referral to an endocrinologist is recommended. Initial tests could include 24h urinary free cortisol, late night salivary cortisol or a dexamethasone suppression test.

Answer 45

C peptide C peptide is co-secreted with insulin from the β cell and can be measured in blood or urine. Levels gradually reduce in type 1 diabetes and after 3–5 years should be undetectable. In contrast, this test will be near normal in MODY as the pancreas remains active.

Answer 46

Screening for gestational diabetes should be offered to women who have had a previous baby weighing 4.5 kg or more at birth.

Answer 47

If Ca ↑ and PTH ↑ → think Primary or Tertiary HPT. If Ca ↓ and PTH ↑ → think Secondary HPT (renal failure patients) If Ca ↑ and PTH ↓ → think Malignancy or other non-PTH cause.

Answer 48

Selenium slows disease progression and improves quality of life in mild thyroid eye disease.

Answer 49

Pulse, blood pressure and temperature should be documented in patients presenting with thyrotoxicosis.

Answer 50

NICE guidelines suggest starting levothyroxine at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.

Answer 51

The "gold standard" investigation for postural orthostatic tachycardia syndrome diagnosis is a head-up tilt test with non-invasive beat-to-beat haemodynamic monitoring. In a control population, the heart rate increases by only 15 beats per minute in the first minute of standing and a further increase for nine minutes. In postural orthostatic tachycardia syndrome, the resting supine heart rate is greater than the normal control population and an increase of more than 30 beats per minute or a heart rate of more than 130 beats per minute takes place between 1–10 minutes at a 70-degree head uplift.

Answer 52

This person has biochemical results suggestive of subclinical hypothyroidism (TSH above the normal reference range but T4 within normal range). However, she is symptomatic. The current recommendation is to start treatment for hypothyroidism if the TSH is greater than 10 mU/l even if free T4 is within the normal range and even if this person was asymptomatic. However, a watch and wait approach may be more suitable in older patients of 80 years and older. If a decision is made to treat such patients, prescribe levothyroxine and recheck the TSH two months after starting and adjust the dose accordingly.

Answer 53

69mmol/mol The aim should be to control glycaemic control to less than 69mmol/mol within 3 months of referral if practical and safe. Suboptimal preoperative glycaemic management (defined as HbA1c >69mmol/mol) is associated with both hypoglycaemia and hyperglycaemia during and after surgery, a risk factor for infections, poor wound healing and increased length of stay.

Answer 54

Features are typically episodic hypertension (around 90% of cases, may be sustained) - headaches - palpitations - sweating - anxiety Tests: 24 hr urinary collection of metanephrines (sensitivity 97%) Presence of vanillylmandelic acid (VMA) in a 24-hour urine sample is diagnostic.

Endocrinology Flashcards

(80 cards)