p.

196 - Case 1
1) B - HCG
2) E - panhypopituitarism
3) C - pituitary adenoma
4) B - Sheehan syndrome
5) D - sarcoidosis
6) acute hemorrhagic necrosis of pituitary
7) A - histiocytosis X
Case 2:
1) acromegaly
2) B - IGF1
3) 2 hr glucose tolerance test
4) TSH
5) after biochemical confirmation
6) osteoarthritis, HTN, DM, 2x mortality
7) surgical resection
8) B - lanreotide
9) Add on (adjuvant) to somatostatin analogue
10) 3rd line agent
Case 3:
1. Kallman's syndrome (hypogonadotropic hypogonadism)
2) Testosterone. If fertility is a concern, replace LH/FSH
Case 4:
1) Prolactinoma
2) Serum prolactin level
3) D - MRI
4)
5) Visual field deficit, osteoporosis, reproductive concerns, and
macroadenoma
6) B - Cabergoline
7) Rarely; in the case of resistance to meds
8) A - repeat prolactin with hemodilution
Case 5:
1) Serum GGT level
2) Paget's disease
3) Bone survey
4) A - Bone scan
5) Bisphosphonates
6) Almost never (used for bone pain)
7) C - bone biopsy
Case 6:
1) osteoporosis
2) C - vit D and TSH
3) steroids, thyroid, vit D def
4) DEXA scan - most accurate test
5) bisphosphonates

6) Never alone for OA, can be used within 7 yrs of menopause

7) bisphosphonates
8) SERM - 2nd line agent
9) A - calcitonin (best tx for pain)
10) D - calcium and vit D
11) C - HRT increases fibroid size
12) C - testosterone
13) A - alendronate
14) E - d/c alendronate and start PTH
15) D - Raloxifene
Case 7:
1) E - calcium gluconate
2) calcium, PTH, vitamin D
3) QT prolongation
4) activated vitamin D
5) loop diuretics
6) A - TSH
Case 8:
1) hyperparathyroid, malignancy
2) stones, moans, groans, psychic overtones (renal stones,
hypertension, polyuria, fatigue, mental status changes, bone pain,
osteoporosis, and pathologic fractures.)
3) B - normal saline
4) 24-48 hrs
5) granulomatous disease
6) parathyroid adenoma and hyperplasia, most common complication
of surgery is hypoparathyroidism
7) C - calcitonin
8) D - check sister's calcium
Case 9:
1) Cushings syndrome
2) ACTH
3) ACTH - to distinguish central vs adrenal vs. extra-adrenal
4) E - serum and urinary cortisol
5) if adenoma
6) adrenal cancer or resistant cushings
Case 10:
1) B - hyperaldosteronism
2) D - renin and aldo
3) C - aldo supp test
4) CT (if adenoma --> take it out, if bilateral --> no surgery)
5) A - increased plasma renin activity
6) adrenal vein sampling
7) adenoma only, NOT hyperplasia
8) C - spironolactone
Case 11:

1) pheochromocytoma
2) D - urina metanephrines
3) adrenal CT
4) always!
5) preop - to prepare for surgery
6) B - after phenoxybenzamine
7) A - thyroid sonogram
Case 12:
1) A - 24 hr urinary cortisol
2) skip - cut out if functional
3) A - ACTH level
Case 13:
1) primary adrenal insufficiency
2) B - AM cortisol
3) if low AM cortisol
4) when primary insufficiency (tell if it's atrophy or hemorrhage)
5) secondary adrenal insufficiency
6) hydrocortisone. prednisone
7) E - anti-CYP21 antibodies