389.2 📚 國考版（醫師國考 / PGY OSCE）

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389.2.0.1 📌 Cram Sheet

389.2.0.1.1 🔥 高 yield 12

1. 3 大模式: excess / deficiency / resistance
2. Primary vs central：trophic hormone (TSH/ACTH/LH/FSH) high → primary; low → central
3. Suspect excess → suppress test
4. Suspect deficiency → stimulate test
5. Anterior pituitary 5: GH/PRL/ACTH/TSH/LH-FSH
6. Posterior pituitary: ADH + oxytocin
7. Hypothalamic releasing: TRH/CRH/GnRH/GHRH/Somatostatin/Dopamine（PRL inhibitor）
8. Pituitary MRI for sellar lesion
9. Adrenal CT washout for adrenal mass
10. Sestamibi for parathyroid
11. DOTATATE PET for NET
12. MIBG for pheo

389.2.0.1.2 🔢 必背

項目	數字
ACTH stim cortisol cutoff	< 18 (older) / < 14 (newer assay)
Low-dose dex Cushing screen	1 mg overnight
OGTT GH suppress	< 1 ng/mL
Cortisol AM normal	5-25 μg/dL

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389.2.0.2 ⭐ 高 yield

389.2.0.2.1 Hormone Receptor Class

Receptor	Hormone
GPCR	TSH, LH, FSH, ACTH, PTH, glucagon, GHRH
RTK	Insulin, IGF-1
JAK/STAT	GH, prolactin, leptin
Nuclear	Steroid, thyroid, Vit D

389.2.0.2.2 Pituitary Cell Types + Hormone

Cell	%	Hormone
Somatotroph	50%	GH
Lactotroph	15-20%	PRL
Corticotroph	15-20%	ACTH
Thyrotroph	5%	TSH
Gonadotroph	10-15%	LH/FSH

389.2.0.2.3 MEN Quick

	Pit	PT	Pancreas	MTC	Pheo	Mucosa
MEN1	+	+	+	−	−	−
MEN2A	−	+	−	+	+	−
MEN2B	−	−	−	+	+	+
VHL	−	−	+ (NET)	−	+	−

389.2.0.2.4 Imaging Quick

Gland	Imaging
Pituitary	MRI sella (dynamic)
Thyroid	US, FNA
Parathyroid	Sestamibi + US ± 4D-CT
Adrenal	CT washout
Pheo	MIBG; metanephrines
NET	DOTATATE PET

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389.2.0.3 🎯 自我檢測

1. 3 大模式? → Excess / deficiency / resistance
2. Trophic hormone high → primary or central? → Primary
3. ACTH stim cortisol cutoff? → < 18 (老 cutoff)
4. Low-dose dex screen Cushing? → 1 mg overnight
5. Pituitary 5 cell types? → Somato/lacto/cortico/thyro/gonado
6. Dopamine 對 PRL? → 抑制
7. MEN1 3P? → Pit/parathyroid/pancreas
8. MEN2 gene? → RET
9. VHL pheo? → Yes, hemangioblastoma + RCC + pheo + pancreas NET
10. Pituitary imaging? → MRI sella
11. Pheo functional imaging? → MIBG
12. NET imaging? → DOTATATE PET

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