Endocrinology

Question 1

underlying pathology of Cushing’s syndrome

Answer 1

excessive cortisol

Question 2

causes of Cushing’s syndrome (4)

Answer 2

1- Exogenous steroids
2- Pituitary Adenoma
3- Adrenal Adenoma
4- Paraneoplastic (e.g. Small Cell Lung Cancer)

Question 3

Conditions that can be caused by Cushing’s syndrome (4)

Answer 3

1- Hypertension
2- T2DM
3- Depression
4- Osteoporosis

Question 4

Diagnostic test for Cushing’s syndrome

Answer 4

Dexamethasone Suppression Test

Question 5

Primary Adrenal Insufficiency- pathology

Answer 5

damaged adrenal glands cause decreased secretion of Cortisol and Aldosterone

Question 6

Secondary adrenal insufficiency- pathology

Answer 6

decreased ACTH from the pituitary causes decreased steroid secretion

Question 7

tertiary adrenal insufficiency

Answer 7

decreased CRH from the Hypothalamus causes decreased ACTH secretion from the pituitary which causes decreased steroid secretion from the adrenal glands

Question 8

clinical features specific to Grave’s disease (3)

Answer 8

1- Exopthalmos (pictured)
2- diffuse goitre (no nodules)
3- Pretibial Myxoedema

Question 9

Symptomatic treatment of Grave’s disease

Answer 9

Propranolol

Question 10

1. First line treatment option for Grave’s disease
2. Other treatment options

Answer 10

1. Carbimazole
2. Propylthiouracil
3. Radioactive Iodine
4. Surgery

Question 11

antibodies associated with Hashimoto’s Thyroiditis

Answer 11

Anti-TPO Antibodies (antithyroid peroxidase)
Antithyroglobulin antibodies

Question 12

medications that can cause hypothyroidism

Answer 12

Lithium
Amiodarone
Bromocriptine / Ocreotide

Question 13

treatment of hypothyroidism

Answer 13

Levothyroxine

Question 14

criteria for acute diagnosis of ketoacidosis

Answer 14

1- Ketones (<3)
2- hyperglycaemia (<11)
3- Acidosis (pH<7.3)

Question 15

Initial management of ketoacidosis

Answer 15

FIG PICK

Fluids
Insulin (fixed rate 0.1 units/kg/hr)
Glucose (monitor blood glucose and add dextrose if below certain level e.g. 14mmol/l)
Potassium (monitor 4hrly and correct as required)
Infection (treat underlying causes like infection)
Chart fluid balance
Ketone monitoring (monitor ketones or blood bicarbonate if ketones are unavailable)

Question 16

initial blood test for Acromegaly

Answer 16

Insulin-like growth factor (IGF-1)

Question 17

options for blocking growth hormone (in Acromegaly)

Answer 17

• GH antagonist (i.e. Pegvisomant)
• Somatostatin analogs (e.g. Ocreotide)
• Dopamine agonists (e.g. Bromocriptine)

Question 18

how does PTH increase serum calcium? (4)

Answer 18

1- increased osteoclast activity in bones
2- increased calcium absorption in Kidneys
3- increased vit D activity
4- increased gut absorption of calcium

Question 19

Primary Hyperparathyroidism:
1- PTH level
2 - Ca2+ level
3- Phosphate

Answer 19

1- PTH elevated
2- Ca2+ elevated
3- Phosphate low

Question 20

Secondary hyperparathyroidism:
1- PTH level
2- Ca2+ level
3- Phosphate level
4- Vit D level

Answer 20

1- PTH elevated
2- Ca2+ low or normal
3- Phosphate elevated
4- Vit D low

Question 21

tertiary hyperparathyroidism:
1- PTH level
2- Ca2+ level
3- Phosphate level
4- Vit D level
5- ALP level

Answer 21

1- PTH elevated
2- Ca2+ normal or high
3- phosphate decreased or normal
4- vit D normal or decreased
5- ALP elevated

Question 22

primary causes of Conn’s (primary hyperaldosteronism)

Answer 22

1- adrenal adenoma
2- bilateral adrenal hyperplasia

Question 23

secondary causes of hyperaldosteronism (3)

Answer 23

• renal artery stenosis
  2- renal artery obstruction
  3- heart failure

Question 24

test to distinguish primary and secondary hyperaldosteronism

Answer 24

Renin:
- Primary (Conn’s): decreased Renin
- Secondary hyperaldoseronism: increased Renin

Question 25

Findings in Conn's syndrome (3)

Answer 25

- Hypertension - Hypokalaemia - Alkalosis on ABG

Question 26

Treatment options for Conns if caused by: 1- adrenal adenoma 2- bilateral adrenocortical hyperplasia

Answer 26

1- Surgery 2- aldosterone antagonist e.g. Spironolactone or Eplerenone

Question 27

cancer associated with ectopic ADH

Answer 27

small cell lung cancer

Question 28

sodium level in SIADH

Answer 28

Hyponatraemia

Question 29

Treatment- SIADH

Answer 29

- Fluid restriction - ADH Receptor blockers (e.g. Tolvaptan)

Question 30

concern with rapid changes in blood sodium when correcting SIADH

Answer 30

Central Pontine Myelinolysis- In CPM, a rapid increase of sodium to correct low sodium levels (hyponatremia) damages nerve cells.

Question 31

Endocrine causes of hyponatraemia

Answer 31

- SIADH - Adrenal Insufficiency

Question 32

common medications that cause hyponatraemia (4)

Answer 32

1- Diuretics 2- SSRIs 3- NSAIDs 4- Carbemazepine

Question 33

Diabetes insipidus: 1- Serum osmolality 2- urine osmolality

Answer 33

1- serum osmolality high 2- urine osmolality low

Question 34

diabetes insipidus- diagnostic test

Answer 34

water deprivation test (no water for 8 hours + measure urine osmolality --> give desmopressin --> 8hrs later measure urine osmolality again)

Question 35

how to differentiate between cranial and nephrogenic diabetes insipidus?

Answer 35

water deprivation test: -Cranial: after deprivation: urine osmolality low after synthetic ADH (Desmopressin): urine osmolality high - Nephrogenic: after deprivation: urine osmolality low after synthetic ADH (Desmopressin): urine osmolality low

Question 36

medical treatment of diabetes insipidus

Answer 36

Desmopressin

Question 37

cells affected in phaechromocytoma

Answer 37

chromaffin cells in the adrenal medulla (which release adrenaline and noradrenaline)

Question 38

genetic condition associated with Phaechromocytoma

Answer 38

Multiple Endocrine Neoplasia Type 2 (MEN2)

Question 39

initial test options for Phaechromocytoma

Answer 39

1. Plasma free metanephrines 2. 24 hour urinary metanephrines

Question 40

management of phaechromocytoma

Answer 40

- Alpha blockers e.g. phenoxybenzamine - beta blockers (after alpha blockers) - adrenalectomy to remove the tumour