Endocrinology Week 8 Summary

Question 36

How would you treat male hypogonadism? List three routes of administration for testosterone therapy, and give a sample of a prescription for each.

Oral: Andriol 40 mg bid po

Transdermal: Androgel 5 g topically daily

Intramuscular: Testosterone enanthate 200 mg i.m. q 2 weeks

Question 37

To make a diagnosis of central diabetes insipidus requires all of what 4 requirements to be met?

  • Polyuria: >3 liters a day
  • Inappropriately dilute urine: urine osmolality less than serum osmolality
  • Hypernatremia: obtained on water deprivation
  • Urine concentrates following DDAVP administration

Question 38

How do you treat DI?

  • If hypernatremic, administer free water to correct hypernatremia by 6-12 mmol/L/day (faster if hypernatremia happened quickly and patient is symptomatic)
  • DDAVP 1 ug sc or iv
    • OR 10 ug intranasal
    • OR 60-120 ug sublingual melt formulation daily to tid
    • OR 50 (1/2 of 0.1 mg tablet) ug bid po
  • Patient told to drink only when thirsty and to make sure they have breakthrough urination to avoid water intoxication
    • If there is no thirst mechanism, fluctuation in weight can be used to determine correct dose of DDAVP and intake of water

Question 39

Mrs. Drumkl is brought in emergency following loss of consciousness after behaving very oddly in the supermarket. Her capillary glucose level is 1.8 mmol/L. Her husband tells you she has been having similar episodes at home for about 3 months now, relieved by eating.

List 5 causes in your differential.

  • Drugs, including alcohol
  • Critical illness:
    • Hepatic
    • Renal or cardiac failure
    • Sepsis
    • Inanition
  • Cortisol/GH deficiency
  • Nonislet cell tumors producing IGF-1 or IGF-2
  • Endogenous hyperinsulinism:
    • Insulinoma
    • Nesidioblastosis
    • Noninsulinoma pancratogenous hypoglycemia
    • Post-gastric bypass surgery
  • Antibodies to insulin and insulin receptor
  • Accidental, surreptitious, or malicious hypoglycemia

Question 40

List five causes of gynecomastia and how you would investigate for them.

Diagnosis Investigation
Ideopathic, obesity, adolescent Diagnosis of exclusion
Primary hypogonadism Low testosterone
High LH, FSH
XYY karyotype
Liver cirrhosis AST
Testicular germ cell cancer b-HCG
Drugs: spironolactone, digitalis, cimetidine History
Hyperthyroidism sTSH
Free T4
Free T3
Rare: adrenal estrogen-producing tumour Estradiol level

Other rare causes:

  • Androgen insensitivity syndrome (partial)
  • Ectopic HCG
  • Excess aromatization
  • True hermaphrodite

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