Endo medicine

Question 1

chronic autoimmune thyroiditis = hypothyroid, TPO antibiodies, goitre

painless/silent thyroiditis = brief hyperthyroid phase, goitre, recovery. TPO antibodies. low iodine uptake

Question 2

hypopituitarism signs

Answer 2

1. hypothyroidism
2. low lh fsh = low libido, erectile dysfunction, testicular atrophy!! - soft and small testes
3. adrenal insufficiency = fatigue, hypoglycemia

T4 will be low, cortisol low and aldosterone normal!!!

Question 3

35 yo man. poor exercise tolerance and muscle weakness.
HTN!, hypokalemia!!
3cm mass on left adrenal gland

what levels of renin, aldosterone and bicarbonate are expected?

Answer 3

High aldosterone!
compensatory low renin!
bicarbonate high!!!

patient has primary hyperaldosteronism or conns syndrome!!!!

reabsorbtion of sodium and wasting of potassium (hypokalemia)

triad = hypertension, hypokalmia and metabolic alkalosis

Question 4

man with recurrent falls. sensation of imbalance that is worse at night. T2DM. decreased proprioception and vibration sensation in feet. ankle jerk reflexes absent. patient sways and tends to fall when eyes are closed (loss of proprioception). what process is responsible for neurological symptoms.

Answer 4

axonopathy of large nerve fibres!!!! - numbness and poor balance key

if it was small nerve fibres = positive symptoms!! = pain, paresthesia, allodynia - pain and sensation key, burning ans stabbing pain may occur

patient has peripheral neuropathy

Question 5

thyroid nodule on woman. no signs of hyper or hypothyroidism. first step in work up?

Answer 5

SERUM TSH!!! AND US neck -> follow up with FNA biopsy based on findings eg size, non cystic

Radionuclide thyroid scan is only done after TSH if TSH is low

Question 6

on bisphosphonates for osteoporosis but developed heartburn so started over the counter antacids.

now has an AKI with associated hypercalcemia and metabolic alkalosis (increased serum bicarb)

most likely cause of patients hypercalcemia?

Answer 6

excessive calcium carbonate (antacids) intake!! - patient has milk alkali sydrome.

= hypercalcemia, aki + metabolic alkalosis!

additional findings = hypophosphatemia and hypomagnesemiw.

evaluation = measurement of PTH which would be suppressed.

symptoms that may be present = nausea vomiting constipation, polyuria polydipsia, neuropsychiatric symptoms.

discontinue agent.

Question 7

hypercalcemia + elevated PTH -> primary hyperparathyroidism. clues include kidney stones, osteoporosis, constipation.
note: also finding in tertiary hyperparathyrodism but also history of CKD.

CKD causing secondary hyperparathyroidism -> LOW calcium!! elevated pth

= high high, 1&3, High low, 2

even if patient has a history of CKD and lupus, doesnt mean its secondary HPThyroidism. might still have primary coincidentally