389.3 🩺 內科專科考前版

389.3.0.1 📌 䞀頁重點

  • 22E: tumor agnostic precision endocrinology, NGS for MEN/VHL/NF/PRKAR1A panels, biochemistry assay sensitivity 升玚mass spec for steroids, third-gen TSH
  • Taiwan: TES (台灣內分泌孞會) + DAROC + 健保 endocrine drug 條件

389.3.0.2 🌟 Pearls (15)

  1. MEN/VHL/NF/Carney panel germline testing for early-onset, multiple, family Hx
  2. Mass spec (LC-MS/MS) for steroids (cortisol, aldosterone, androgens) 越䟆越暙準避 cross-reactivity
  3. Late-night salivary cortisol: outpatient screening 方䟿, 23:00 取
  4. 24-h urine cortisol: 排泄瞜量 > 50-100 ÎŒg
  5. Cosyntropin 250 ÎŒg vs 1 ÎŒg: 1 ÎŒg 范敏感 䜆 less validated
  6. Glucagon stimulation: cortisol + GH alternative if can’t ITT
  7. Aldosterone-to-renin ratio (ARR): PA screen
  8. Captopril challenge: PA confirmation alt
  9. AVS (adrenal venous sampling): lateralize PA before surgery
  10. IPSS (inferior petrosal sinus sampling): ACTH sourcepituitary vs ectopicin Cushing’s
  11. DOTATATE PET-CT > older octreotide scan for NET
  12. MIBG still useful for pheo + paraganglioma functional imaging
  13. Plasma metanephrine vs 24-h urine: plasma fractionated 第䞀線
  14. Bone DXA + TBS for osteoporosis
  15. Continuous glucose monitoring (CGM) + flash GM rev’d diabetes care

389.3.0.3 📍 Taiwan + 健保

  • TES 指匕台灣內分泌孞會 guideline曎新䞭
  • DAROC糖尿病孞會 — DM 暙準
  • 健保 mass spec for cortisol / aldosterone限制 condition
  • 健保 LC-MS/MS for catecholamine / metanephrines
  • 健保 dynamic testdexamethasone, ACTH stim, OGTT 倚 line
  • 健保 sestamibi副甲狀腺亢進 pre-op 條件
  • 健保 DOTATATE PET神經內分泌瘀
  • 健保 CGMT1DM/spec T2DM 條件

389.3.0.4 🎓 內專必懂

  1. Endocrine excess / deficiency / resistance 暡匏
  2. Primary / secondary / tertiary 鑑別
  3. Suppression vs stimulation test logic
  4. Pituitary anterior 5 軞
  5. Posterior pituitary (ADH/oxytocin)
  6. HPA / HPT / HPG axis
  7. MEN/VHL/NF panel
  8. Mass spec for steroid22E
  9. AVS / IPSS 進階 sampling
  10. DOTATATE PET / MIBG
  11. CGM + AID 系統 for DM

⚠ AI 草皿。