Endocrinology Pathologies

Question 1

Adrenal insufficiency (definition, signs and symptoms, tests, and management)

Answer 1

Definition: occurs when there is destruction of the adrenal cortex causing reduction of glucocorticoid production. Can be primary (Addison’s) or secondary (pituitary/hypothalamic insufficiency)

Signs and symptoms: hypotension, fatigue and weakness, GI symptoms, syncope, pigmentation (due to increase in ACTH precursors)

Tests: FBC, Us and Es (low Na, high K), cortisol test (low), adrenal autoantibody test, CT of adrenals

Management: replacement therapy (glucocorticoid replacement = hydrocortisone, mineralcorticoid = fludrocortisone)

Question 2

Cushing’s Syndrome (definition, causes, symptoms and signs, tests, management)

Answer 2

Definition: glucocorticoid excess

Causes: pituitary tumour, ectopic ACTH-producing tumour, adrenal adenoma/carcinoma

Symptoms and signs: bruising, osteoporosis, obesity, diabetes, moon face, acne and hirsutism, thin limbs and central obesity, psychological problems

Tests: urinary free cortisol, low dose dexamethasone suppression test, imaging if suspected tumour (MRI/CT)

Management: surgical resection of tumour or steroid synthesis blockers (eg. metyrapone)

Question 3

How would you treat a DKA patient?

Answer 3

• if patient is alert and able to: encourage oral intake and give SC insulin injection
• if patient is confused and vomiting: give IV fluids and insulin infusion
• if patient is in shock do ABCDE and prep for emergency resus

Question 4

Hyperparathyroidism (definition, causes, signs and treatment)

Answer 4

Definition: excessive secretion of PTH. Can be primary (excess production from gland), secondary (secretion in response to kidney/liver)

Causes: parathyroid adenoma/carcinoma, hyperplasia (primary). vit D deficiency, pancreatitis, chronic kidney disease (secondary)

Signs: painful bones, renal stones, GI symptoms and psychiatric problems (eg. depression, fatigue)

Treatment: calcimimetic drug cinacalcet, total or sub parathyroidectomy

Question 5

What are the signs of hyperthyroidism?

Answer 5

• tremor
• clubbing
• pretibial myxoedema
• thyroid bruit
• goitre
• eyelid retraction
• exopthalmos
• periorbital oedema
• muscle wasting
• AF

Question 6

What are the causes and treatment of hyperthyroidism?

Answer 6

Primary causes (thyroid dysfunction): Graves, multinodular goitre, De Quervain’s thyroiditis, radiation

Secondary causes: drugs (eg. amiodarone, lithium), TSH producing pituitary adenoma

Treatment: carbimazole (contraindicated in pregnancy), propylthiouracil, thyroidectomy (in cancer, recurrence, and obstruction)

Question 7

Hypothyroidism (signs and symptoms, causes, and treatment)

Answer 7

signs and symptoms: dry skin, britte hair, puffy face, goitre, bradycardia

Causes: Hashimoto’s thyroiditis (autoimmune), surgical, radiation, aplasia, iodine deficiency

Treatment: levothyroxine

Question 8

Describe patterns of visual field loss (lesions of optic nerve, chiasm, optic tract, temporal/parietal/occipital lobes)

Answer 8

• optic nerve: monocular visual loss
• chiasm: bitemporal hemianopia
• optic tract: contralateral homonymous hemianopia
• temporal lobe: homonymous superior quadrantanopia
• parietal lobe: contralateral homonymous inferior quadrantanopia
• occipital lobe: contralateral homonymous hemianopia