393.2 📚 國考版醫垫國考 / PGY OSCE

393.2.0.1 📌 Cram Sheet

393.2.0.1.1 🔥 高 yield 18
  1. 5 functional adenomas: prolactin (40-50%) / GH (10-15%) / ACTH (5-10%) / TSH (< 1%) / gonadotroph
  2. Microadenoma < 10 mm; macroadenoma ≥ 10 mm
  3. Prolactinoma → cabergoline 1st line (NOT surgery)
  4. PRL > 200 + adenoma → prolactinoma 高床可胜
  5. PRL < 100 + macroadenoma → likely stalk effect (NFPA)
  6. Hook effect: 極高 PRL → assay false low → dilute
  7. Macroprolactinemia: PRL-IgG complex, false high, asymptomatic
  8. Acromegaly screen: IGF-1; confirm: OGTT GH 䞍 suppress < 1
  9. Acromegaly TSS 1st line; SSA → pegvisomant/pasireotide → RT
  10. Cushing’s 3 tests: 24h urine / late-night salivary / 1mg dex
  11. High-dose dex 區分 CD vs ectopic
  12. IPSS = gold for ACTH source
  13. TSH-oma: TSH ↑ + T4 ↑ + α-subunit ↑
  14. NFPA: silent gonadotroph 倚
  15. Craniopharyngioma: bimodal, BRAF V600E in papillary
  16. Bitemporal hemianopsia = chiasm compression
  17. Pituitary apoplexy: thunderclap + visual + steroid IV stat
  18. Replacement order: cortisol always first
393.2.0.1.2 🔢 必背
項目 æ•žå­—
Microadenoma < 10 mm
Macroadenoma ≥ 10 mm
PRL prolactinoma > 200 ng/mL
PRL stalk effect < 100, often < 200
OGTT GH suppress < 1 ng/mL (post)
1-mg dex suppress < 1.8 ÎŒg/dL
Late-night salivary cutoff > 0.15 ÎŒg/dL
24h urine cortisol > 3-4× upper normal
IPSS central:peripheral > 2 basal, > 3 post-CRH
MRI microadenoma sensitivity 60-70% in CD

393.2.0.2 ⭐ 高 yield

393.2.0.2.1 Pituitary Adenoma % Quick
Type % Treatment
Prolactinoma 40-50% Cabergoline
Nonfunctional 25-30% Observation / TSS
GH-secreting 10-15% TSS → SSA → pegvisomant
ACTH-secreting 5-10% TSS
TSH-secreting < 1% TSS
Gonadotroph (silent) rare functional TSS if mass
393.2.0.2.2 Acromegaly Comorbidities
  • DM (~25-50%)
  • HTN
  • Cardiomyopathy (䞻死因)
  • Sleep apnea
  • Colon polyps + cancer ↑
  • Thyroid nodules
  • Carpal tunnel
  • Hypogonadism
393.2.0.2.3 Cushing’s Workflow
1. Screen: 24h urine OR salivary OR 1mg dex (≥ 2 abnormal)
2. ACTH:
   - High → ACTH-dependent (CD or ectopic)
   - Low → ACTH-independent (adrenal)
3. ACTH-dependent localize:
   - MRI sella
   - High-dose dex (suppress in CD, not ectopic)
   - CRH stim
   - IPSS (gold)
393.2.0.2.4 Drug Quick by Syndrome
Disease Drug
Prolactinoma Cabergoline > bromocriptine
Acromegaly SSA Octreotide LAR, lanreotide depot
Acromegaly broader Pasireotide LAR
Acromegaly GH-R block Pegvisomant
Cushing’s steroidogenesis Ketoconazole, metyrapone, osilodrostat, levoketoconazole, etomidate
Cushing’s pituitary Pasireotide, cabergoline
Cushing’s GR antagonist Mifepristone, relacorilant
TSH-oma SSA
Craniopharyngioma BRAF V600E Vemurafenib + cobimetinib
393.2.0.2.5 Pregnancy + Pituitary
  • Microprolactinoma: stop dopamine agonist when pregnant; visual fields
  • Macroprolactinoma: continue; risk expansion
  • Bromocriptine has more pregnancy data than cabergoline

393.2.0.3 🎯 自我檢枬

  1. 5 functional adenomas? → Prolactin/GH/ACTH/TSH/gonadotroph
  2. Most common functional? → Prolactinoma
  3. Prolactinoma 1st line? → Cabergoline
  4. PRL prolactinoma threshold? → > 200
  5. Stalk effect PRL? → < 100, often < 200
  6. Hook effect? → Extreme high PRL → false low → dilute
  7. Macroprolactinemia? → PRL-IgG complex, asymptomatic
  8. Acromegaly screen? → IGF-1
  9. Acromegaly confirm? → OGTT GH 侍 suppress < 1
  10. Acromegaly TSS cure rate? → Micro ~80%, macro ~50%
  11. Cushing’s screen 3? → 24h urine / salivary / 1mg dex
  12. CD vs ectopic high-dose dex? → CD suppresses; ectopic doesn’t
  13. IPSS central:peripheral cutoff? → > 2 basal, > 3 post-CRH
  14. TSH-oma labs? → TSH ↑ + T4 ↑ + α-sub ↑
  15. NFPA most? → Silent gonadotroph
  16. Craniopharyngioma papillary mutation? → BRAF V600E
  17. Macroadenoma threshold? → ≥ 10 mm
  18. Apoplexy treatment? → IV HC 100 mg + IV NS

⚠ AI 草皿。