Classic Presentations - Endocrine Flashcards
A diabetic patient complains of thirst, tiredness, blurred vision, weight loss, polyuria, nocturia and memory problems
Hyperglycaemia
A diabetic patient become pale and sweaty, with tremor and nausea
Hypoglycaemia
A type 1 diabetic patient begins vomiting, has abdominal pain and is confused
DKA
A type 2 diabetic patient presents with thirst, nausea, dry skin and disorientation. They have extremely high blood glucose and elevated serum osmolality (ie significant dehydration). They only have mild ketones/acidosis
Hyperglycaemic Hyperosmolar Syndrome
A patient who has recently been in a car crash that resulted in a skull fracture develops polyuria and polydipsia. They have very dilute urine (decreased urine osmolality) and increased serum osmolality
Cranial diabetes insipidus
A bipolar patient on lithium develops polyuria and polydipsia. They have very dilute urine (decreased urine osmolality) and increased serum osmolality
Nephrogenic diabetes insipidus
An obese patient’s test results indicate insulin resistance, raised plasma triglycerides, microalbuminuria (marker of kidney disease) and raised arterial BP
Metabolic syndrome
A patient is experiencing palpatations, tachycardia, intolerance to heat/excessive sweating, tremor, sleep disturbance and agitation. On examination you notice exophthalmos/proptosis of both eyes and a goitre
Tests show a high T4 and slightly elevated T3. TSH is suppressed. Anti-thyroid antibody tests are positive for TSH receptor antibody (TRAb).
Graves disease
A patient is experiencing palpatations, tachycardia, intolerance to heat/excessive sweating, tremor, sleep disturbance and agitation. On examination you find a goitre.
Tests show raised T4 and T3. TSH is low and the patient is antibody negative
Nodular thyroid disease/Toxic Multinodular Goitre (TMG)
A patient presents with osteoperosis, AF and a goitre. Their TSH is low but their T3&4 levels are normal
Subclinical hyperthyroidism
A hyperthyroid patient who has recently been unwell/undergone surgery developes hyperthermia, tachycardia, diarrhoea & vomiting and agitation. On examination they have exaggerated reflexes
Thyroid storm
A patient who has recently had a viral infection presents with fever, malaise and local tenderness around the thyroid gland. They also experience symptoms of hyperthyroidism for a few days. Examination shows slight thyroid enlargement and blood tests show raised T3&4 and suppressed TSH.
After a few days, the patient develops symptoms of hypothyroidism for a few weeks. Eventually they return to a euthyroid state
De Quervain’s Thyroiditis
A patient with a poor diet develops lethargy, weight gain, a puffy face, cold intolerance, poor memory and loss of appetite. On examination they have a goitre. Tests show increased TSH and decreased T4
Hypothyroidism caused by iodine deficiency
A patient with a poor diet develops lethargy, weight gain, a puffy face, cold intolerance, poor memory and loss of appetite. On examination they have a goitre and palpable lymph nodes.
Tests show T4 and T3 are suppressed while TSH is raised. Anti-thyroid antibody test shows presence of antibodies against thyroid peroxidase (TPO)
Hashimoto’s thyroiditis
A patient presents with classic hypothyroid symptoms and has high TSH but normal thyroid hormone levels
Subclinical hypothyroidism
A patient presents with classic hypothyroid symptoms but no goitre. Thyroid autoantibodies are present
Atrophic thyroiditis
An elderly woman presents with confusion, hypothermia and drowsiness. Tests show she has type 2 respiratory failure (hypoxia, hypercapnia & respiratory acidosis)
On ECG she has bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion and prolongation of the QT interval.
Myxoedema coma
A 70 year old woman with a PMH of autoimmune hypothyroidism experiences a rapid onset of mass in her thyroid
Thyroid lymphoma
A 40 year old woman presents with palpable nodules in her neck with no other symptoms. On examination, she is found to also have lymphadenopathy
Papillary thyroid cancer
A 40 year old woman presents with palpable nodules in her neck and no other symptoms. There is no lymphadenopathy
Follicular thyroid cancer
The blood results of a patient with a severe infection in hospital show suppressed TSH
Sick euthyroid syndrome/Non-thyroidal illness
A pregnant woman’s blood results show an increase in T4 and low TSH
Variant of normal thyroid in pregnancy
Increased demand on thyroid = raised T4. hCG acts like TSH = low TSH
A baby presents with delayed jaundice, poor feeding but normal weight gain, hypotonia, constipation, umbilical hernia and skin and hair changes
Congenital thyroid disease
A patient under 40 has hypertension and hypokalaemia. A CT scan shows a mass on one of the adrenals
Conn’s syndrome - primary aldosteronism caused by an adrenal adenoma
A patient with small cell lung carcinoma/Cushing’s disease etc has secondary hypertension
Acquired adrenal hyperplasia - primary aldosteronism caused by endogenous or ectopic ACTH production
A baby has adrenal insufficiency at 2-3 weeks old and poor weight gain. A female baby with this condition has genital ambiguity and a male has precocious puberty. What is the condition?
Congenital adrenal hyperplasia
A 30 year old woman presents with excessive bruising, proximal myopathy of upper and lower limbs, polydipsia and polyuria, back and bone pain, insomnia and lethergy.
On examination she has a moon face, central obesity, a buffalo hump in the supraclavicular fossa and male patterned baldness.
A high dose dexamethasone test shows ACTH levels <300 (suppressed by 50%)
Cushing’s disease - adenoma in the pituitary gland
A patient presents with Cushing’s symptoms. A high dose dexamethasone test shows ACTH levels <1 (suppressed by 0%)
ACTH independent Cushing’s - caused by adrenal adenoma/adrenal carcinoma/nodular hyperplasia/high dose steroid use
A patient presents with Cushing’s symptoms. A high dose dexamethasone test shows ACTH levels >300 (suppressed by 0%)
Cushing’s caused by ectopic cancer (lung, thymus or pancreas)
A patient presents with fatigue, weight loss, vomiting, diarrhoea and abdominal pain. On examination you find they are hypotensive and very tanned.
A synacthen test shows a basal cortisol level of <100 after 30 minutes
Addison’s disease (Primary adrenal insufficiency)
A young patient has hypertension, excessive sweating and headaches. Urinary catecholamines and metabolites are raised
Pheochromocytoma
A patient who has just been taken off long term high dose steroids presents with weight loss, tiredness, vomiting, diarrhoea, abdominal pain and hypotension
Secondary adrenal insufficiency
A patient is found to have a pituitary adenoma, parathyroid hyperplasia (hyperparathyroidism) and pancreatic tumours
MEN1
A patient is found to have medullary thyroid cancer, parathyroid tumors, and pheochromocytoma
MEN2
A patient with multiple hemangioblastomas is found to have a pheochromocytoma
Von Hippel-Lindau (VHL)
A patient with axillary freckling, café-au-lait patches and neurofibromas is found to have a pheochromocytoma
Neurofibromatosis type 1 (NF1)
A patient presents with excessive sweating, acne, joint pain and proximal muscle weakness, tireness, snoring and tingling sensations. They have been diagnosed with hypertension and diabetes. On examination you notice they have coarse facial features and large hands.
Tests show that IGF-1 is raised and an oral glucose tolerance test shows no suppression of growth hormone secretion
Acromegaly (mostly due to pituitary adenoma)
A patient presents with headaches and bitemporal hemianopia
Pituitary tumour - a micro or macroadenoma
A woman presents with galactorrhoea, infertility, amenorrhoea and lack of libido
Hyperprolactinaemia
A man presents with impotence, lack of libido, headache and bitemporal hemianopia
Prolactinoma
A patient presents with tiredness, confusion, sore bones, constipation, myopathy and thirst, with a PMH of kidney stones, osteoperosis and depression.
Serum calcium and serum PTH are raised but serum phosphate is normal. Urine calcium is high
Primary hyperparathyroidism - caused by a parathyroid adenoma
A patient with chronic kidney failure presents with bone and joint pain.
Serum calcium is low but PTH is raised
Secondary hyperparathyroidism
On routine tests, an asymptomatic patient is found to have raised blood calcium. Further tests show low urine calcium
Familial hypocalciuric hypocalcaemia
A patient presents with tiredness, confusion, sore bones, constipation, myopathy and thirst, with a PMH of kidney stones, osteoperosis and depression.
Serum calcium and serum phosphate are raised. Urine calcium is high
Hypercalcaemia due to high bone turnover (eg mets, bedridden, Pagets etc)
A patient complains of cramping muscles, pins and needles in the extremities and around the lips, muscle weakness, fatigue and breathing difficulty.
On examination you find Chvostek’s sign (twitching of facial muscle when gentle tapping is applied to the facial nerve) and Trousseau’s sign (inflation of the blood pressure cuff over systolic pressure for a period of time will result in tetany of the muscles in hand and wrist)
Hypocalcaemia
A patient presents with symptoms of hypercalcaemia. Tests show hypocalcaemia and hyperphosphatemia in the blood serum and decreased PTH. Parathyroid antibodies are present
Idiopathic hypoparathyroidism
A patient presents with symptoms of hypercalcaemia. Tests show hypocalcaemia and hyperphosphatemia in the blood serum and decreased PTH. Parathyroid antibodies are absent
Hypoparathyroidism caused by Di George syndrome / malignancies / autoimmune disease / hypomagnesaemia
A patient has bone abnormalities, obesity, subcut calcification, learning disability and brachdactyly (blunting of the 4th metacarpal) Blood tests show raised PTH, low Ca2+, raised PO4 3-
Pseudohypoparathyroidism
A patient with pathological fractures who is very pale has decreased calcium and phosphate and increased PTH
Vitamin D deficiency
A patient with pathological fractures has a DEXA scan that shows BMD ≥ 2.5
Osteoperosis
A sick patient presents confused and hyperventilating. Blood results show reduced bicarbonate, raised phosphate and a raised anion gap, with no ketonaemia
Lactic acidosis type A
A type 2 diabetic presents confused and hyperventilating. Blood results show reduced bicarbonate, raised phosphate and a raised anion gap, with no ketonaemia
Lactic acidosis type B
