Endo Conditions

Question 1

Case: A 32 yo F PTC with galactorrhea. Her hCG test was negative. Her medical history includes hypothyroidism. Labs indicated elevated prolactin, and decreased FSH, LH, and GnRH. What do you suspect? Tx?

Answer 1

Hyperprolactinemia

Tx: Dopamine agonist (Bromocriptine)

Question 2

Labs:
Lack of ADH leads to?
Decreased response to ADHD leads to?

How do you differentiate the two conditions?

Answer 2

Lack → central diabetes insidious
Decreased response → nephrogenic DI

To differentiate: Look at ADH levels!

1. Blood osmolality test: >290 mosm/kg in both
2. Urinalysis: Urine-specific Gravity <1.006
3. Water deprivation test

Question 3

Pharm Match:

1. Central Diabetes Insipidus
2. Nephrogenic Diabetes Insipidus
3. SIADH

a. HCTZ
b. Desmopressin
c. Furosemide

Answer 3

1. Central Diabetes Insipidus - Desmopressin
2. Nephrogenic Diabetes Insipidus - HCTZ
3. SIADH - Furosemide

Question 4

Pharm: Hyperprolactinemia Tx

Answer 4

Dopamine agonist Bromocriptine

Question 5

Pharm: Gigantism & acromegaly Tx

Answer 5

Dopamine agonist Bromocriptine

Question 6

HLA-B8 HLADR3

Answer 6

Grave’s

Question 7

Case: A 35 yo F PTC with exophthalmos, diffuse, symmetric enlargement of the gland (goiter), thickening of dermis (pretibial myxedema) and clubbing of fingers and some nails separated from nail bed.

Lab value:
Low TSH
Increased free T4 (and/or increased T3)
Increased radioactive iodine (I-131) uptake
Positive for thyroid-stimulating immunoglobulin.

What do you suspect? Tx?

Answer 7

Grave’s

Thionamides: Propylthiouracil and Beta-blockers for symptomatic treatment

Question 8

Case: A 35 yo F PTC with goiter, weight loss without anorexia, fine tremor of the hands, heat intolerance, diarrhea, anxiety, oligomenorrhea, and lid stare. PE was negative for exophthalmos and pretibial myxedema. Cardiac findings include 102 BPM, afib, and 150/78.

Lab value:
Low TSH
Increased T3 and T4 (T3>T4)

What do you suspect? Next step? Tx?

Answer 8

Plummer’s disease (toxic adenoma/toxic multinodular goitre)

different from Grave’s by LACK of exophthalmos and pretibial myxedema.

Thyroid scan: increased uptake/hot in nodules with I^123

Tx:

1. Benign therapy with Propylthiouracil to attain euthyroid state to prevent radiation thyroiditis.
2. Use radioactive iodine (I-131) to ablate hyperfunctioning nodules
3. Beta-blocker for symptomatic tx prior to definitive therapy

Question 9

Triple Bolus Test

Answer 9

Stimulation test for Hypopituitarism: Rapid IV infusion of insulin, GnRH, ACTH/cortisol, TRH

• Insulin bolus leads to hypoglycemia which increases GH and ACTH/cortisol
• GnRH IV push increases LH and FSH
• TRH IV push increases TSH and PRL