Endocrine

Question 1

How is SIADH diagnosed?

Answer 1

Diagnosis of exclusion
Low serum osmolality
High urine osmolality
High urinary sodium

Question 2

What is the treatment of SIADH?

Answer 2

Treatment of any underlying cause
Fluid restriction
Demeclocycline

Question 3

Associations with acromegaly?

Answer 3

HTN
DM
Colorectal Ca
OSA
Cardiomyopathy
OA

Question 4

Findings in acromegaly?

Answer 4

Big hands and feet
Prognathism
Scars ?OA/colorectal Ca
Signs of diabetes
Visual fields symptoms
Macroglossia
Loss of libido/lactation

Question 5

Investigation in ?Acromegaly?

Answer 5

BP/CBG/ECG
IFG1 ?raised
OGTT - failure of GH to suppress to <0.4
MRI ?pituitary tumour
Pituitary panel - TSH, LH, FSH, Testosterone/oestrogen, cortisol, short synacthen test and ACTH

Question 6

Management of acromegaly?

Answer 6

Surgery - transphenoidal resection
Radiotherapy if not fit enough for surgery
Drug therapy pre surgery or as adjunct - somatostatin analogues such as octreotide, or GH receptor antagonist such as Pegvisomant

Question 7

Causes of hypothyroidism?

Answer 7

• Autoimmune – Hashimotos Thyroiditis and goitre and atrophic hypothyroidism
• Iatrogenic – Radioodine, amiodarone, lithium, antithyroid drugs, surgery
• Iodine deficiency – dietary
• Genetic Pendreds syndrome with deafness
• Post partum thyroiditis

Question 8

What is a myxoedema coma?

Answer 8

• Severe hypothyroidism
• Altered mental stats, hypothermia, bradycardia, hyponatraemia
• Risk of cardiogenic shock

Question 9

What is the risk of hypothyroidism in pregnancy and how should this be managed?

Answer 9

• In first 12 weeks can cause problems with fetal neuropdevelopment
• Can need higher doses
• Need regular monitoring

Question 10

What is Hashimoto’s thyroiditis, what Ab are present and what are its associations?

Answer 10

• Progressive condition
• Lymphocytic deposition in thyroid gland causing destruction
• Autoimmune association – anti thyroglobulin and ant TPO Ab
• Associations:
  o Vitiligo
  o Addison’s – screen for this

Question 11

What is De Quervains thyroiditis?

Answer 11

• Period of hyperthyroidism where destruction of thyroid follicles
• Then period of hypothyroidism where the thyroid follicles regenerate
• Following that becomes euthyroid again

Question 12

Features of osteogenesis imperfecta?

Answer 12

Past history of fractures
Blue sclera
Small stature
Spinal scoliosis
Bowing of the long bones
Joint hypermobility and skin laxaity
Association with heart conditions – bicuspid aortic valve with AR
Discoloured translucent teeth
Hearing impairment (middle ear bones)

Question 13

Investigation for suspected osteogenesis imperfecta?

Answer 13

Bone profile and Vit D (replace if needed)
XRs
DEXA
Genetic testing

Question 14

Management of osteogenesis imperecta?

Answer 14

Bisphosphonates and surgery (often stabilising surgery)