Endocrine Flashcards
A 45-year-old man presents with loss of libido and some erectile dysfunction. He is otherwise healthy. On physical examination he has mild bilateral gynaecomastia and normal testes.
Prolactinoma
Laboratory work-up reveals a highly elevated prolactin level of 46,000 mIU/L (2300 micrograms/L). Normal prolactin levels are up to 300 mIU/L (15 micrograms/L). He also has low testosterone, LH, and FSH levels. MRI examination of the pituitary sella depicts a large 32 mm pituitary macro-adenoma with suprasellar extension and optic chiasmal compression. Visual field assessment reveals bi-temporal hemianopia.
A 48-year-old man has a 4-month history of increasing fatigue and anorexia. He has lost 5.5 kg and noticed increased skin pigmentation. He has been otherwise healthy. His mother has Hashimoto’s thyroiditis and one of his sisters has type 1 diabetes. His blood pressure is 110/85 mmHg (supine) and 92/60 mmHg (sitting). His face shows signs of wasting and his skin has diffuse hyperpigmentation, which is more pronounced in the oral mucosa, palmar creases, and knuckles.
Addison’s disease (adrenal insufficiency)
A 27-year-old woman presents with amenorrhoea. She had been taking the combined oral contraceptive pill for the last 9 years, stopping this 11 months ago. She is otherwise healthy, but on physical examination she has bilateral galactorrhoea.
Prolactinoma
Laboratory work-up reveals an elevated prolactin level of 3000 mIU/L (150 micrograms/L). Normal prolactin levels are up to 500 mIU/L (25 micrograms/L). She also had low-normal gonadotrophin (LH, FSH) levels. MRI examination of the pituitary sellar region depicts a 6 mm right-sided pituitary mass, with no suprasellar or parasellar extension.
A 27-year-old man presents for evaluation of infertility. He had a normal birth and early development, but did not undergo puberty. He has developed none of the typical male secondary sexual characteristics. He reports diminished libido, although he occasionally gets early morning erections. He is able to get an erection during sexual activity, provided he is sufficiently aroused. He married 3 years ago, but attempts to father a child have been unsuccessful. His wife has normal menstrual cycles and her gynaecological examination is normal. On examination, the patient has sparse facial hair and low hair line. Minimal bilateral, non-tender gynaecomastia is present. The patient has a normal penis and scrotum, but the testes are small and firm with an estimated volume of 4 mL each.
Hypogonadism (male)
An overweight 55-year-old woman presents for preventative care. She notes that her mother died of diabetes, but reports no polyuria, polydipsia, or weight loss. BP is 144/92 mmHg, fasting blood sugar 8.2 mmol/L (148 mg/dL) (on 2 occasions), HbA1c 65 mmol/mol (8.1%), LDL-cholesterol 5.18 mmol/L (200 mg/dL), HDL-cholesterol 0.8 mmol/L (30 mg/dL), and triglycerides 6.53 mmol/L (252 mg/dL).
T2DM
A 20-year-old man is brought to the accident and emergency department with abdominal pain, nausea, and vomiting with increasing polyuria, polydipsia, and drowsiness since the previous day.
Diabetic ketoacidosis
He was diagnosed with type 1 diabetes 2 years previously. He mentions that he ran out of insulin 2 days ago. Vital signs at admission are: BP 106/67 mmHg, heart rate 123 beats per minute, respiratory rate 32 breaths per minute, temperature 37.1°C (98.8°F). On mental status examination, he is drowsy. Physical examination reveals Kussmaul breathing (deep and rapid respiration due to ketoacidosis) with acetone odour and mild generalised abdominal tenderness without guarding and rebound tenderness.
A 55-year-old man complains of persistently aching legs. He is initially diagnosed with fibromyalgia. However, his blood tests reveal an elevated serum alkaline phosphatase. Subsequent x-ray of the tibia/fibia shows defects in the cortical and cancellous bone, with some degree of tibial bowing
Paget’s disease of bone
A 38-year-old woman, who in the past had tried to lose weight without success, is happy to see that in the last 2 months she has lost about 11 kg (25 pounds). She also has difficulty sleeping at night. Her husband complains that she is keeping the house very cool. She recently consulted her ophthalmologist because of redness and watering of the eyes. Eye drops were not helpful. She consults her doctor for fatigue and anxiety, palpitations, and easy fatigability. On physical examination, her pulse rate is 100 bpm and her thyroid is slightly enlarged. Conjunctivae are red and she has a stare.
Graves’ disease
A 42-year-old man presents with a 4-month history of frontal headaches and decreased libido. The symptoms started gradually. In addition to decreased libido, the patient also complains of gradual loss of early morning erections. He has been married for 12 years and has 3 children. He denies any head or testicular injury. He also denies gynaecomastia or galactorrhoea. The only abnormality on his physical examination is bitemporal hemianopia on visual field testing.
Hypogonadism (male)
A 28-year-old woman presents with a 2-year history of hypertension, associated with nocturia (4-5 times per night), polyuria, palpitations, limb paraesthesias, lethargy, and generalised muscle weakness. There is no other past medical history. Physical examination is unremarkable apart from a blood pressure (BP) of 160/100 mmHg, global hyporeflexia, and weak muscles. Plasma potassium is 2.2 mmol/L (2.2 mEq/L), bicarbonate is 34 mmol/L (34 mEq/L), and serum creatinine is normal.
Primary hyperaldosteronism
Not Pheochromocytoma as it wouldn’t cause altered blood potassium (only secretes noradrenaline and adrenaline)
A 40-year-old man has a 12-month history of progressive headaches, weight loss, poor appetite, lethargy, cold intolerance, and erectile dysfunction. He has difficulty seeing the periphery when driving his car. Physical examination is remarkable for bradycardia, gynecomastia, scant body hair, delayed relaxation of his reflexes, and bitemporal haemianopia.
Hypopituitarism
An 18-year-old woman presents with a chief complaint of hirsutism. She needs to wax her upper lip and chin twice a week. This has been a problem for 4 years. She also has excess hairs on her upper back and lower abdomen. Her periods are irregular, occurring every 2 to 3 months. Embarrassment about the facial hirsutism has affected her social life, and she is finding she feels depressed much of the time.
PCOS
A 35-year-old woman has not resumed menses since stopping oral contraceptives 1 year ago. She reports normal puberty and regular menses both before and during her use of oral contraceptives. She had one normal pregnancy with a spontaneous vaginal delivery 3 years ago. She has no significant medical history except for mild hypothyroidism. She has noted occasional episodes of vaginal dryness and irritation and feels occasionally as if someone has turned the temperature up in the room. Sexual intercourse has become increasingly uncomfortable. A physical examination demonstrates atrophic changes in the vagina. A pregnancy test is negative.
Premature ovarian failure
A 15-year-old girl presents with primary amenorrhoea and accelerated growth. On physical examination, her height is above the 90th percentile, her pubertal development is evaluated at Tanner stage 2, and she has soft-tissue swelling. Pituitary MRI shows a 15 mm pituitary mass without parasellar extension.
Acromegaly
Laboratory work-up reveals a moderately elevated serum prolactin and an elevated IGF-1.
A late middle-aged woman presents with chronic right hip and anterior thigh pain, with increased localised temperature. Lately she has needed a walking stick. During the last 6 months her relatives have noticed a progressive hearing loss on her left side, as well as some facial changes - mostly enlargement of her mandible.
Paget’s disease of bone
A 42-year-old man undergoes trans-sphenoidal surgery for a large, non-functioning pituitary macro-adenoma. Preoperatively, dynamic pituitary hormone tests were normal, as was his fluid intake and output. Two days following surgery he developed acute polyuria, extreme thirst, and polydipsia. His urine output over the next 24 hours was 6 litres, with frequent nocturia.
Diabetes insipidus
