ENDOCRINOLOGY AND MENTAL HE z z z
ALTH MED CHALLENGER TEST BAN
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LectStephen
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Endocrinology and Mental Health Med-
ENDOCRINOLOGYAND
Challenger Chapter Exam_Complete study
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MENTAL HEALTH MED C
guide/test bank
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HALLENGER TEST BAN written by
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K dennys
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Stem & Answers z z
A 35-year-
z
old man presents with fatigue, loss of libido, and lethargy for the last 3 year
z z z z z z z z z z z z z z
s. He has no medical history. He takes a multivitamin but no other medicati
z z z z z z z z z z z z z
ons. He smokes 1 pack of cigarettes every week and drinks 1 glass of wine
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each night. He does not use drugs. He is the manager at a retail clothing st
z z z z z z z z z z z z z z z z
ore.
His review of symptoms is notable for a 15-
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pound weight loss since his last visit 3 years ago. Vital signs are: temperat
z z z z z z z z z z z z z
ure 37.4 °C, heart rate 95 beats/minute, blood pressure 110/65 mm Hg, re
z z z z z z z z z z z z
spiratory rate 14 breaths/minute, and oxygen saturation 99% on room air.
z z z z z z z z z z z
Findings on his head, ears, eyes, nose, and throat examination, as well as
z z z z z z z z z z z z z
examinations of his neck, heart, lungs, abdomen, and neurologic statusarz z z z z z z z z
e all normal. His skin appears tanned, even under his clothes.
z z z z z z z z z z
You order laboratory studies that show a normal complete blood count, so
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dium level of 130, potassium level of 5.1, chloride level of 110, bicarbonat
z z z z z z z z z z z z
e level of 25, blood urea nitrogen level of 13, creatinine level of 0.8, and gl
z z z z z z z z z z z z z z z
ucose level of 90. You suspect adrenal insufficiency.
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What is the next test to order to confirm this diagnosis?
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•
randomzserumzcortisolzandzadrenocorticotropiczhormonez(ACTH)zlevels
•
antiadrenalzantibodies
•
low-dosezcorticotrophinzstimulationztest
•
24-hourzurinezcortisolzexcretion
•
Plasmazcortisolzlevelzafterzinfusionzofzadrenocorticotropiczhormonez(ACTH)
Remediation
EducationalzObjective:
Diagnosezadrenalzinsufficiency.
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:z tdeepnhneynsz|zsetm
epphireencm
ybuekru1h@
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omail.com
Distributionzofzthiszdocumentziszillegal
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KeyzPoint:
Increaseszinzcortisolzlevelszabovez20zmcg/mLzafterzACTHzstimulationzexcludeszadrenalzinsuffici
ency.
Explanation:
Anzincreasezinzcortisolzlevelszofzmorezthanz20zmcg/dLzfollowingzACTHzstimulationzexcludesza
drenalzinsufficiency.zThezlow-zandzhigh-
dosezACTHzstimulationztestszhavezsimilarzrateszofzsensitivityzandzspecificity.zSomezadvocatez
azmorningzcortisolzlevelzaszanzinitialzscreeningztestzforzadrenalzinsufficiencyzinzambulatoryzpati
ents.zAzmorningzcortisolzlevelzbelowz3zmcg/dLziszspecificzforzadrenalzinsufficiency,zandzazmorn
ingzcortisolzlevelzhigherzthanz20zmcg/dLzexcludeszallzbutzthezearliestzcaseszofzadrenalzinsuffici
ency.
Oncezthezdiagnosiszofzadrenalzinsufficiencyziszconfirmed,zanzACTHzlevelzshouldzbezdrawnztozlo
calizezthezdefectztozthezadrenalzglandzorzthezhypothalamic-
pituitaryzaxis.zInzprimaryzadrenalzinsufficiency,zACTHzlevelszarezmostzoftenzaboveznormalzandzh
yperkalemiaziszcommon.zInzsecondaryzadrenalzinsufficiency,zACTHzlevelszarezlowzorzinappropri
atelyznormal.
References:
BleickenzB,zHahnerzS,zVentzzM,zQuinklerzM.zDelayedzdiagnosiszofzadrenalzinsufficiencyziszcom
mon:zazcross-sectionalzstudyzinz216zpatients.zAmzJzMedzSci.z2010;339(6):525-531.
Nieman,zLK.zAdrenalzcortex.zIn:zGoldmanzL,zSchaferzAI.zGoldman-
CecilzMedicine.z25thzed.,z2016:1514-1521
Question 2 z
Edited:zOctz7,z2016
ReportzQuestion
Stem & Answers
z z
In which of the following patients with adrenal insufficiency is therapy with
z z z z z z z z z z z z
fludrocortisones necessary? z
•
42-year-oldzmanzwhozunderwentzpituitaryzsurgeryzforzCushingzdisease
•
27-year-oldzmanzrecentlyzdiagnosedzwithzemptyzSellazsyndrome
•
31-year-oldzwomanzwithzSheehanzsyndrome
•
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il.gcm
omail.com
Distributionzofzthiszdocumentziszillegal
ALTH MED CHALLENGER TEST BAN
z z z z
K
written by z
LectStephen
www.stuvia.com
Downloadedzby:zLectStephenz|
onzofzthiszdocumentziszillegal
, Stuvia.comz-
zThezMarketplaceztozBuyzandzSellzyourzStudyzMaterial
Endocrinology and Mental Health Med-
ENDOCRINOLOGYAND
Challenger Chapter Exam_Complete study
z
z
z
z z
z
z
z
z
z
MENTAL HEALTH MED C
guide/test bank
z
z
z z
HALLENGER TEST BAN written by
z
z
z
K dennys
www.stuvia.com
DownlD
oo
aw
dendlob
ayd:eLdebcytS
:ztdeepnhneynsz|zsetm
epphireencm
ybuekru1h@
a5g6m7a@
il.gcm
omail.comzDistributi
onzofzthiszdocumentziszillegal
, Stuvia.comz-
zThezMarketplaceztozBuyzandzSellzyourzStudyzMaterial
Stem & Answers z z
A 35-year-
z
old man presents with fatigue, loss of libido, and lethargy for the last 3 year
z z z z z z z z z z z z z z
s. He has no medical history. He takes a multivitamin but no other medicati
z z z z z z z z z z z z z
ons. He smokes 1 pack of cigarettes every week and drinks 1 glass of wine
z z z z z z z z z z z z z z
each night. He does not use drugs. He is the manager at a retail clothing st
z z z z z z z z z z z z z z z z
ore.
His review of symptoms is notable for a 15-
z z z z z z z z
pound weight loss since his last visit 3 years ago. Vital signs are: temperat
z z z z z z z z z z z z z
ure 37.4 °C, heart rate 95 beats/minute, blood pressure 110/65 mm Hg, re
z z z z z z z z z z z z
spiratory rate 14 breaths/minute, and oxygen saturation 99% on room air.
z z z z z z z z z z z
Findings on his head, ears, eyes, nose, and throat examination, as well as
z z z z z z z z z z z z z
examinations of his neck, heart, lungs, abdomen, and neurologic statusarz z z z z z z z z
e all normal. His skin appears tanned, even under his clothes.
z z z z z z z z z z
You order laboratory studies that show a normal complete blood count, so
z z z z z z z z z z z
dium level of 130, potassium level of 5.1, chloride level of 110, bicarbonat
z z z z z z z z z z z z
e level of 25, blood urea nitrogen level of 13, creatinine level of 0.8, and gl
z z z z z z z z z z z z z z z
ucose level of 90. You suspect adrenal insufficiency.
z z z z z z z
What is the next test to order to confirm this diagnosis?
z z z z z z z z z z
•
randomzserumzcortisolzandzadrenocorticotropiczhormonez(ACTH)zlevels
•
antiadrenalzantibodies
•
low-dosezcorticotrophinzstimulationztest
•
24-hourzurinezcortisolzexcretion
•
Plasmazcortisolzlevelzafterzinfusionzofzadrenocorticotropiczhormonez(ACTH)
Remediation
EducationalzObjective:
Diagnosezadrenalzinsufficiency.
DownlD
oo
aw
dendlob
ayd:eLdebcytS
:z tdeepnhneynsz|zsetm
epphireencm
ybuekru1h@
a5g6m7a@
il.gcm
omail.com
Distributionzofzthiszdocumentziszillegal
, Stuvia.comz-
zThezMarketplaceztozBuyzandzSellzyourzStudyzMaterial
KeyzPoint:
Increaseszinzcortisolzlevelszabovez20zmcg/mLzafterzACTHzstimulationzexcludeszadrenalzinsuffici
ency.
Explanation:
Anzincreasezinzcortisolzlevelszofzmorezthanz20zmcg/dLzfollowingzACTHzstimulationzexcludesza
drenalzinsufficiency.zThezlow-zandzhigh-
dosezACTHzstimulationztestszhavezsimilarzrateszofzsensitivityzandzspecificity.zSomezadvocatez
azmorningzcortisolzlevelzaszanzinitialzscreeningztestzforzadrenalzinsufficiencyzinzambulatoryzpati
ents.zAzmorningzcortisolzlevelzbelowz3zmcg/dLziszspecificzforzadrenalzinsufficiency,zandzazmorn
ingzcortisolzlevelzhigherzthanz20zmcg/dLzexcludeszallzbutzthezearliestzcaseszofzadrenalzinsuffici
ency.
Oncezthezdiagnosiszofzadrenalzinsufficiencyziszconfirmed,zanzACTHzlevelzshouldzbezdrawnztozlo
calizezthezdefectztozthezadrenalzglandzorzthezhypothalamic-
pituitaryzaxis.zInzprimaryzadrenalzinsufficiency,zACTHzlevelszarezmostzoftenzaboveznormalzandzh
yperkalemiaziszcommon.zInzsecondaryzadrenalzinsufficiency,zACTHzlevelszarezlowzorzinappropri
atelyznormal.
References:
BleickenzB,zHahnerzS,zVentzzM,zQuinklerzM.zDelayedzdiagnosiszofzadrenalzinsufficiencyziszcom
mon:zazcross-sectionalzstudyzinz216zpatients.zAmzJzMedzSci.z2010;339(6):525-531.
Nieman,zLK.zAdrenalzcortex.zIn:zGoldmanzL,zSchaferzAI.zGoldman-
CecilzMedicine.z25thzed.,z2016:1514-1521
Question 2 z
Edited:zOctz7,z2016
ReportzQuestion
Stem & Answers
z z
In which of the following patients with adrenal insufficiency is therapy with
z z z z z z z z z z z z
fludrocortisones necessary? z
•
42-year-oldzmanzwhozunderwentzpituitaryzsurgeryzforzCushingzdisease
•
27-year-oldzmanzrecentlyzdiagnosedzwithzemptyzSellazsyndrome
•
31-year-oldzwomanzwithzSheehanzsyndrome
•
DownlD
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ayd:eLdebcytS
:z tdeepnhneynsz|zsetm
epphireencm
ybuekru1h@
a5g6m7a@
il.gcm
omail.com
Distributionzofzthiszdocumentziszillegal
