Other endo 1

Question 1

What are the symptoms of high calcium?

Answer 1

Renal Stones
bone pain
psychic moans - depression
Groans - abdo pain, pancreatitis, Peptic ulcer disease
thrones - polyuria, polydipsia ( nephronic DI) and constipation

OTHER - high BP

Question 2

What are the causes of primary hyperparathyroidism ?

Answer 2

80% solitary adenoma
20% hyperplasia
0.5 parathyroid less than 0.5 %

Question 3

what investigations would do and what results would you see in a patient with primary hyperparathyroidism?

Answer 3

high CA
high or inappropriately normal PTH
high ALP
low PO4

ECG: short QT, bradycardia, 1st degree heart block

x-ray: Osteitis fibrosa cystica, phalangeal erosion

DEXA : osteoporosis

Question 4

What is Osteitis fibrosa cystica?

Answer 4

It is a skeletal disorder resulting in a loss of bone mass, a weakening of the bones as their calcified supporting structures are replaced with fibrous tissue (peritrabecular fibrosis), and the formation of cyst-like brown tumors in and around the bone

Question 5

What is the treatment for Primary hyperparathyroidism

Answer 5

General
increase fluids
avoid dietary CA and thiazides

surgery
The definitive management is total parathyroidectomy

conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage

calcimimetic agents such as cinacalcet are sometimes used in patients who are unsuitable for surgery

Question 6

What are the causes of secondary hyperparathyroidism ?

Answer 6

vitamin D deficiency

chonric renal disease

Question 7

What is the treatment for secondary hyperparathyroidism?

Answer 7

correct causes
give phosphate binder
VIT D calicitriol ( active)
cinacalcet

Question 8

What is pseudohypoparathyroidism ?

Answer 8

Failure of target organ response to PTH
symptoms of hypocalciumia
short 4th and 5th metacarpals, short stature
Ix low ca and high PTH

Question 9

What is pseudoppseudohypoparathyroidism

Answer 9

Normal receptor in kidney and normal biochem

abnormal paternal receptors in the body

Question 10

What are the symptoms of Cushing’s

Answer 10

Proximal myopathy
thin skin

striae 
bruising 
acne and hirsutism
Moon face 
Interscapular nad supraclavicular fat pads 
centripetal obesity

Question 11

What medical conditions are associated with Cushing’s

Answer 11

HTN
osteoporosis
DM
hypokalaemia ( NA can be normal or low )

Question 12

What are the ATCH independent causes of Cushing’s syndrome?

Answer 12

STERIODS: commonest cause
adrenal adenoma/CA
adrenal noduar hyperplasia

(ACTH will be low due to feedback)

Question 13

What are the ATCH-dependent cause of

Answer 13

Cushing disease - pityitary tumour
( corisol supression on high-dose dex)

ectopic ACTH
causes: SCLC, carninoid tumour

No suppression by any dose of dex

Question 14

what investigations would you do for a ptx with crushing’s?

Answer 14

1st 24 hour unrinary free cortisol
lat night serum or salivary corisol

dexamethasone suprression test
ACTH ( acth degrades very qucikly after venepunture

imaging: CT. MRI, chest x-ray

Question 15

What is the treatment for patients with Cushing’s?

Answer 15

cushing disease -trans-sphenoidale excision

adrenal adenoma/ca: adrenelectomy - hydrocortisone and fludrocortisone

Question 16

What is Nelson’s syndrome

Answer 16

rapid enlargement of pituitary adenoma following bilateral adrenalectomy for Cushing syndrome

presentation
mass effects: bitemporal heminaopia
hyperpigmentation

Question 17

what are the features Primary hyperaldosteronism

Answer 17

Hypokalemia: weakness, hypotonia, hyporeflexia, cramps

High BP

paresthesia

Question 18

what are the causes of primary hyperaldosteronism?

Answer 18

bilateral adrenal hyperplasia (70%)
adrenocortical adenoma ( 30%): Conn's syndrome

Question 19

What is the treatment for Conn’s ?

Answer 19

laparoscopic adrenalectomy

Question 20

What is the treatment for adrenal hyperplasia?

Answer 20

Spironolactone, plerenone and amiloride

Question 21

What are the investigations and results would you see in a patient with primary hyperaldosteronism?

Answer 21

U&Es normal or high NA, low K
aldosterone: renin ratio increased
ECG flat/ inverted T waves, U waves, depressed ST segments, pronged PR and Qt intervals

Question 22

what is the cause of secondary hyperaldosteronism?

Answer 22

due to increased renin from decreased renal perfusion

causes 
RAS
diurectics 
CCF 
hepatic failure 
ephrotic syndrome 

normal aldosterone:renin ratio

Question 23

Addison’s patient unwell what advice should they be given in regard to the dose of their hydrocortisone and fludrocortisone?

Answer 23

double the dose of hydrocortisone. keep the same does of fludrocortisone