Endocrine

Question 1

Symptoms and RF for adrenal failure

Answer 1

Tired, uninfentional weight loss, dizziness, postural hypotension, amenorrheoa
RF: type 1dm, hashimoto thyroiditis

Question 2

Why postural hypotension in adrenal failure

Answer 2

Seen in GP

lack of mineralcorticosteroids (aldosterone) and glucocorticoid leads fo volume contraction

Question 3

Tx for Postural hypotension

Answer 3

Hydrocortisone and fludrocortisone

Question 4

Common pigmentation in addisons dx

Answer 4

Buccal and skin pigmentation 
Lack of glucocorticoids
Increased ACTH
Increases MSH
Increases pigmentation 
NO ULCERATION

Question 5

Secondary sexual Hair loss

Answer 5

Caused by reduced GnRH which leads to hypothlamic induced hypogonadism

Question 6

Features of hypogonadism

Answer 6

Lack of body hair
Amenorrhea
Failure of secondary sexual development

Question 7

Causes and feathres of ACTH deficiency

Answer 7

Secondary cause of adrenal failure
Problem with the hypothalamus
No acth, no MSH- no pigmentation- PALLOR
Pallor also due to normocytic, normochronic anemia

Question 8

Pcos

Answer 8

Prevalence: 8-22
Causes: unknown, sodium valproate long term
Anovulatory Infertility, oligo/amenorrhe, hirsutism, high BMI, acne
Patho: high insulin, low SHBG, increased testosterone and androgens, prevent ovarian follicles development
Weight gain worsens hyperinsulinemia
Labs:
Insulin resistant causes low SHBG: cause n/h testosterone
HIGH LH:NORMAL/LOWFSH- usually 3:1
DHEA and Androgens- elevated
Normal TSH
Normal or high prolactin
High HBA1c
USS: 12+ follicles
RF: IGGT, T2DM, hyperlipidemia, increased CVD, OSA, endometrial cancer,
Tx: weight loss, metformin, clomiphene, OCPS, spirinolactone

Question 9

Pcos tx

Answer 9

Weightloss 
Metformin
Clomiphene 
Ocp/IUD/cyclical progesterone to bleed ever 3-4 months
Laparoscopic drilling

Question 10

Why TVUS in Pcos

Answer 10

Ovarian follicles

Or less fhan 1 period every 3 months- cyclical progesterone- bleed, assess endometrial thickness, R/O endometrial cancer

Question 11

DDX for oligomenorrheo

Answer 11

Pcos 
Hypothyroidism 
Premature ovarian failure
Obesity 
Hyperprolactinoma

Question 12

Ddx gor infertility

Answer 12

Pcos 
Premature ovarian failure 
Obesity 
Endometriosis 
Pid 
Anatomical defect

Question 13

Increased androgen

Answer 13

Pcos
Cushing syndrome
CAH-congenital adrenal hyperplasia

Question 14

Osteomalacia

Answer 14

Proximal myopathy
South asian woman on a veg diet high in phytates
Limited sun exposure

Question 15

Acromegaly causes

Answer 15

excessive growth hormone AFER fusion of epiphysis
due to pituitary adenoma
ectopic secretion of GHRH via a carcinoid
McCune Albright Syndrome
Neurofibromatosis
MEN
FIPA==> familial isolated pituitary adenoma with mutation of the AIP gene

Question 16

Acromegaly diagnosis

Answer 16

IGF-1 ==>Insulin Growth like Factor-1 levels
confirmed by OGTT==> proves failure to supress GH to below 0.3 ug/L
MRI for pituitary tumours
Visual acuity
ECG + ECHO

Question 17

Acromegaly Clinical presentation

Answer 17

Increased food and hand enlargement 
coarse facial features
overbite of lower jaw due to lower jaw enlargement 
diabetics
arthropathy 
headache
OSA
Carpel tunnel syndrome 
increased COLIC POLYPS--> CANCER 
cardiomyopathy 
LVH
renal stones
Biochem: raised phosphate, prolactin, raised triglycerides

Question 18

Acromegaly management:

Answer 18

pituitary adenoma: transphenoidal surgery/radiotherapy
dopamine agonist==> bromocriptine/cabergoline/quinagolide –> reduce GH secretion
somastatin analogues ==> octreotide
GH antagonist ==> pegvisamant

Question 19

Diabetes associated gastroparesis

Answer 19

dx with gamma scintigraphy, gastric emptying studies

tx: prokinetics like domperidone, eythromycin, gastric pacing