Endocrinology Flashcards
A patient presents with exophthalmos and ophthalmoplegia. She has a known history of hyperthyroidism. Which of the following is the first most appropriate step in their management?
A ) Lateral tarsorraphy
B ) Normalisation of thyroid status
C ) Orbit irradiation
D ) Steroids
E ) Watchful waiting
B) Normalisation of thyroid status
A 40-year-old woman complains of weight loss and heat intolerance. Blood investigations confirm a diagnosis of Graves’ disease. Which of the following features are specific to this cause of thyrotoxicosis?
A ) Atrial fibrillation
B ) Goitre
C ) Ophthalmoplegia
D ) Proximal myopathy
E ) Tremor
= C) Ophthalmoplegia
Ophthalmoplegia is associated with Graves’ disease. Additional features include exophthalmos, thyroid acropachy and pretibial myxoedema. All the other features listed in the question can occur with any cause of thyrotoxicosis.
Your patient presents to her GP for a review of her blood pressure, which is proving difficult to control despite lifestyle measures and the combination of ramipril and amlodipine. No clinical features on exam. Urinalysis is normal.
The following blood tests show:
- Sodium 144 mmol/l (134-145 mmol/l)
- Potassium 3.1 mmol/l (3.5-5.0 mmol/l)
- Urea 4.1 mmol/l (2.0-7.0 mmol/l)
- Creatinine 75 μmol/l (55-120 μmol/l)
- eGFR >90 ml/min/1.73m2 (>90 ml/min/1.73m2)
Which secondary cause of hypertension is most likely for this patient?
A ) Cushing syndrome
B ) Diabetic nephropathy
C ) Glomerulonephritis
D ) Phaeochromocytoma
E ) Primary hyperaldosteronism
** = E) Primary hyperaldosteronism**
Primary hyperaldosteronism is the most common form of secondary hypertension. Primary hyperaldosteronism is commonly due to a solitary adrenal adenoma (Conn syndrome) or bilateral adrenal hyperplasia. There are rare familial forms of hyperaldosteronism, and adrenal carcinoma is also a rare cause. K+ depletion and Na+ retention, usually without edema but with weakness, hypertension, tetany, polyuria, and hypokalemic alkalosis
A 75-year-old woman is diagnosed with anaplastic thyroid cancer with pulmonary metastases. What is the next most appropriate step in management?
A ) Chemotherapy
B ) Palliative care
C ) Radioactive iodine treatment
D ) Subtotal thyroidectomy
E ) Total thyroidectomy
= B) Palliative care
Anaplastic cancers are extremely aggressive, with a disease-specific mortality approaching 100 percent. Given the very rapid course of disease progression and the poor treatment outcomes, end-of-life issues and plans for comfort care measures are an integral part of initial disease management planning. In patients with advanced disease, palliation of symptoms is a high priority.
A 21-year-old woman presents to the emergency room with palpitations. Physical examination reveals an anxious and highly energetic patient. Her heart rate is 120 beats/min. She has bilateral proptosis (exophthalmos), stare, and lid retraction. Thyroid examination reveals diffuse enlargement with an audible bruit. The thyroid gland is nontender. The patient has weakness of her quadriceps muscles (needs help to rise from a chair) and has fine tremors. Which of the following is the most likely diagnosis?
A ) Subacute thyroiditis
B ) Graves’ disease
C ) Hashimoto’s thyroiditis
D ) Plummer’s disease
E ) Struma ovarii
= B) Graves’ disease
Grave’s Disease is an autoimmune condition where TSH receptor antibodies cause a primary hyperthyroidism. These TSH receptor antibodies are abnormal antibodies produced by the immune system that mimic TSH and stimulate the TSH receptors on the thyroid. This is the most common cause of hyperthyroidism.
Answer: Cushing’s disease
= Answer: C-Peptide
Answer: Hashimoto’s thyroiditis
Hashimoto thyroiditis is the most common causes of hypothyroidism in the developed world. It is caused by autoimmune inflammation of the thyroid gland. It is associated with antithyroid peroxidase (anti-TPO) antibodies and antithyroglobulin antibodies. Initially it causes a goitre after which there is atrophy of the thyroid gland.
Answer: F, F, F, T, T
Answer: Autoimmune cause
Answer: Graves’ disease
** Answer: Thyroid stimulating hormone receptor antibodies**
Grave’s Disease is an autoimmune condition where TSH receptor antibodies cause a primary hyperthyroidism. These TSH receptor antibodies are abnormal antibodies produced by the immune system that mimic TSH and stimulate the TSH receptors on the thyroid. This is the most common cause of hyperthyroidism.
Answer: Symmetrical sensory neuropathy
Symmetrical sensory neuropathy is characterized by the early loss of vibration, pain and temperature sense in a glove and stocking pattern. In advanced disease, patients often lose their balance and complain of altered sensations.
Answer: Symmetrical sensory neuropathy
Symmetrical sensory neuropathy is characterized by the early loss of vibration, pain and temperature sense in a glove and stocking pattern. In advanced disease, patients often lose their balance and complain of altered sensations.
Answer: Parathyroid adenoma
Parathyroid adenoma is a benign neoplasm that typically involves one parathyroid gland. It is usually asymptomatic, but can present with the signs and symptoms of hypercalcaemia (nephrolithiasis, CNS disturbance, constipation, osteitis fibrosa, etc.).
What are the two most common causes of hypercalcaemia?
- A. Malignancy-induced hypercalcaemia and iatrogenic
- B. Myeloma and drug-induced
- C. Paget’s disease and excess vitamin-D
- D. Primary hyperparathyroidism and drug-induced
- E. Primary hyperparathyroidism and malignancy-induced hypercalcaemia
Answer: Primary hyperparathyroidism and malignancy-induced hypercalcaemia
What are the two most common causes of hypercalcaemia?
- A. Malignancy-induced hypercalcaemia and iatrogenic
- B. Myeloma and drug-induced
- C. Paget’s disease and excess vitamin-D
- D. Primary hyperparathyroidism and drug-induced
- E. Primary hyperparathyroidism and malignancy-induced hypercalcaemia
Answer: Primary hyperparathyroidism and malignancy-induced hypercalcaemia
Answer: Hypothyroidism
Answer: Medullary cell carcinoma of the thyroid
Which syndrome would be most likely to present with hypertension, hypokalaemia, and alkalosis?
A ) Acromegaly
B ) Hyperaldosteronism
C ) Hyperparathyroidism
D ) Hypoaldosteronism
E ) Hypothyroidism
Answer: Hyperaldosteronism
Answer: Propanolol
Carbimazole takes approximately 1–20 days to take effect. Propranolol will help to provide symptomatic control almost immediately.
Answer: Fluid resuscitation, propranolol and propylthiouracil are used in the management of a thyroid storm.
Answer: Radioiodine therapy
Answer: Acromegaly
Answer: Circulating lymphocytes
Cushing’s syndrome is associated with an increased predisposition to infection. High cortisol levels cause immune disruptions, with a decrease in lymphocyte levels and an increase in neutrophils. Cortisol inhibits the production of IL-2, TNF alpha, IFN alpha, and gamma. Decreased IL-2 levels prevent the proliferation of T-lymphocytes.
Answer: Exogenous steroid use
Answer: Options A, C and D are correct
Answer: Carbimazole 30 to 45 mg orally. Adjust the dose at 4- to 6-weekly intervals as required
Answer: Agranulocytosis and fulminant hepatitis - The most common side effect is a rash, but the most dangerous is agranulocytosis.
Answer: CT of the thorax
Answer: Graves’ disease
