2 December

Question 1

How can you differentiate between Cushing’s disease and Cushing’s syndrome?

Answer 1

High dose dexamethasone test causes suppression of cortisol in Cushing Disease
Cushing Syndrome- can not be suppressed due to ectopic ACTH production or adrenal abnormalities

Question 2

What are features of hypercalcaemia?

Answer 2

Polyuria
Polydipsia
Depression
Constipation
Peptic ulceration
Bone pain/fracture
Renal stones
HTN

Question 3

What is Zollinger Ellison Syndrome?

Answer 3

Endocrinopathy resulting in gastrin secreting tumours can lead to multiple peptic ulcers in duodenum and jejunum

Question 4

What are features of hyperaldosteronism?

Answer 4

HTN
Hypokalaemia- muscle weakness
Metabolic alkalosis

Question 5

What are investigation findings of hyperaldosteronism?

Answer 5

Hypertension with hypokalaemia
Treatment resistant HTN
Plasma aldosterone/renin ration=1st line (high aldosterone with low renin)
2nd line= CT abdomen if normal then adrenal venous sampling to differentiate between unilateral and bilateral

Question 6

What are sick day rules in Addison disease?

Answer 6

Continue hydrocortisone

In Addisonian crises A-e, IV fluids, IV hydrocortisone 100mg IV 6 hourly

Question 7

What are features of Addison disease?

Answer 7

Lethargy
Hyperpigmentation- palmar creases
Nausea and Vomiting
Weight loss
Vitiligo
Loss of pubic hair in women
Hypotension
Hyponatraemia

Question 8

What are investigations in Addison disease?

Answer 8

ACTH simulation test (short synacthen)
Measure plasma cortisol before then give 250ug synacthen IM

OR measure serum 9am cortisol
<100 abnormal
100-500 prompt ACTH stimulation
>500 normal

Question 9

What are ocular symptoms of hyperthyroidism?

Answer 9

Proptosis
Reduced visual acuity
RAPD
Reduced colour vision
Swollen optic nerve head

Graves disease
exopthalmos
opthalmoplegia

Question 10

What are side effects of acarbose?

Answer 10

Flatulence
Diarrhoea

Question 11

What are side effects of propranolol?

Answer 11

Tiredness
Cold fingers and toes
Disturbed sleep
Stomach upset

Question 12

What are features of graves opthalmopathy and how is it managed?

Answer 12

Inflammation leading to exopthalmos, pressure or pain in eyes, light sensitivity and double vision

Treat with high dose steroids to prevent optic nerve compression and blindness

Question 13

What is diagnostic criteria for HHS?

Answer 13

Hypovolaemia
Osmolality >320
Hyperglycaemia >30

Question 14

What are features of ADH secreting adenoma?

Answer 14

SIADH- excessive reabsorption of water from renal tubules causing low sodium
Risk of cerebral oedema