Endocrine

Question 1

What signs would you see in someone with hypothyroidism?

Answer 1

Weight gain
Cold intolerance
Brittle nails and skin
Slow reflexes
Reduced CO so: bradycardia/ oedema/ HTN

Question 2

What signs would you see in someone with hyperthyroidism?

Answer 2

Weight loss
Heat intolerance
Goitre
Exompthalmos
Increased CO: Tachycardia/AF

Question 3

What signs would you see in someone with graves disease?

Answer 3

Exompthalmos
Opthalmoplegia
Pretibial myoxedema: thick scaly skin on shins
Thyroid acropachy

Question 4

What is thyroid acropachy?

Answer 4

digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation

Question 5

What are the signs associated with Cushings?

Answer 5

• Moon face
• Buffalo hump
• Central obesity
• Thin skin/ Bruising
• Acne/hirtuism
• Striae
• Proximal muscle wasting
• HTN
• Polyuria/polydispsia associated with increased increased glucose production

Question 6

Explain what tests are used to test for high cortisol

Answer 6

First: 48hr low dose dexamethasone test
o Usually dexamethasone will suppress CRH and ACTH
o Give 1mg of Dexamethasone on going to bed at 23:00hrs
o Take cortisol plasma at 9:00am the next day
o If cortisol still high- indication of Cushing’s syndrome

Second : High dexamethasone test (8mg)
- If cortisol low: Cushing’s disease

Third: Test ACTH
- If ACTH low: Adrenal pathology
- If ACTH high: ectopic e.g. SCLC

Question 7

How do patients with Addisons disease present?

Answer 7

• Weight loss /malaise
• Loss of libido
• Fever/infection
• Pigmentation- especially of new scars/ palmar creases!!!!!!
• Postural hypotension due to hypovolemia and sodium loss.
• Loss of body hair
• Dehydration
• Hyponatremia
• Hyperkalemia
• Metabolic acidosis
• Hypoglycemia

Question 8

What test do you do to test for primary adrenal insuffciency?

Answer 8

ACTH stimulation test

Question 9

What tests do you do to test for bilateral adrenal hyperplasia?

Answer 9

• aldosterone: renin ratio
• check u&es for hypokalaemia
• CT/ MRI to distinguish between adenoma and bilateral hyperplasia

Question 10

When might you suspect primary hyperplasia

Answer 10

New patient< 35 without family history of HTN

Question 11

How might a phaechromocytoma present?

Answer 11

• HTN
• Tachycardia
• Bradycardia
• Orthostatic hypertension
• Pallor/flush
• Fever