Endocrine Flashcards
A 22yo presents with polyuria and polydipsia. Random blood glucose level was elevated
T1DM
A 45yo obese man presents with fatigue. Blood tests reveal an elevated Hba1c
T2DM
A known diabetic presents with altered consciousness, vomiting and acetone breath
Diabetic ketoacidosis
A known diabetic presents to the ED with altered mental status. Ketones are not elevated
Hyperosmolar coma
A female patient presents with fatigue, anorexia and weight loss. She also complains of palpitations and salt cravings. On examination, hyperpigmentation of the buccal mucosa is noted
Primary adrenal insufficiency (Addison’s disease)
Other causes: TB, malignancy, some drugs
A female patient presents with insidious onset weight gain and change in menstrual habits. On examination, a buffalo hump is noted as well as striae
Cushing’s syndrome
Causes: Cushing’s disease, ectopic ACTH-secreting tumours, ectopic CRF, exogenous corticosteroid exposure
A 30yo patient presents with lethargy, nocturia and polyuria. On examination, they are hypertensive
Conn’s syndrome
A 30yo patient presents to the ED in hypertensive crisis. They also complain of a headache and palpitations. The patient’s partner noted they have had a few similar episodes to this in the past involving headache, palpitations, sweating and pallor
Phaeochromocytoma
A 33yo female presents with weight loss despite increased appetite and menstrual irregularities. On further questioning she also admits to some palpitations. On examination, a lid lag is noticed
Hyperthyroidism (Graves’ disease)
Other causes: toxic multinodular goitre, iodine-induced, factitious, transient
A 40yo female with a history of coeliac disease presents with weight gain despite decreased appetite and constipation. On examination, reflexes are slowed
Hypothyroidism
Causes: autoimmune (Hashimoto’s), iatrogenic, drugs, congenital, iodine deficiency, infiltrative disorders
A 40yo female presents with a neck swelling. She has noted some hoarseness. She has no symptoms of hypo- or hyperthyroidism. US of the neck shows increased iodine uptake
Thyroid neoplasia
A 25yo female presents with a tremors and palpitations. On examination, a thyroid nodule is palpable
Toxic thyroid adenoma
A 22yo male presents with decreased libido. He has little body hair. On examination, his testicles are
Classical androgen deficiency
A 66yo overweight individual presents with inability to maintain an erection, fatigue and malaise. He has numerous CVD risk factors
Non-classical androgen deficiency
A patient presents with a headache associated with bitemporal hemianopia. The patient goes on to develop rhinorrhoea
Pituitary mass lesion (mass effect)
A 30yo female presents with amenorrhoea and galactorrhoea. FSH and LH levels are normal
Prolactinoma
A 45yo patient presents with carpal tunnel syndrome and fatigue. On examination, coarse facial features are noted
Acromegaly
Cold intolerance, weight gain, constipation, dry skin, slow reflexes Relevant pituitary hormone level?
Low TSH
- Weight loss with increased appetite
- Heat intolerance, sweating
- Tremulousness
- Tachycardia and palpitations (AF, SVT), cardiomegaly and CHF
- Anxiety, emotional lability
- Loss of hair
- Increased frequency of bowel movements or diarrhoea
- Menstrual irregularity
- Goitre
- Uncommonly: pretibial myxoedema, onycholysis
- Eye signs: redness and irritation, staring appearance, mild double vision on right extreme gaze
Relevant pituitary hormone level?
High TSH
Small stature in children, or central adiposity and reduced muscle mass in adults Relevant pituitary hormone level?
Low GHRH
- Coarsening of facial features: frontal bossing, enlarged nose, jaw enlargement, macroglossia
- Skin thickness and tags
- Increased sweating
- Carpal tunnel syndrome
- Joint pain and dysfunction
- Reduced libido, infertility, amenorrhoea, galactorrhoea, erectile dysfunction
- Fatigue
- Increased CV risk
- Organomegaly
Relevant pituitary hormone level?
High GHRH
Infertility, amenorrhoea/oligomenorrhoea, hot flushes, reduced bone and muscle mass, delayed puberty, erectile dysfunction, reduced libido failure to thrive or short stature in children
Relevant pituitary hormone level?
Low FSH/LH
Hypoglycaemia, hypotension, nausea and vomiting, fatigue, weakness and dizziness
Relevant pituitary hormone level?
Low ACTH
- Hypertension and water retention
- Ache and hirsutism
- Weight gain: central obesity, supraclavicular and dorsocervical (buffalo hump) fat pads, moon face
- Facial rounding and plethora
- Proximal muscle weakness and buttocks wasting
- Thinning of the skin, striae, plethoric face and bruising
- Psychiatric symptoms: depression, anxiety, (psychosis)
- Menstrual irregularities, decreased libido and inability to get pregnant
- Linear growth deceleration in children
- Metabolic complications including IGT/diabetes mellitus, dyslipidaemia, metabolic bone disease (osteopaenia), hypertension
Relevant pituitary hormone level?
High ACTH
Loss of lactation after delivery
Relevant pituitary hormone level?
Low prolactin
- Women: hypogonadism (infertility, amenorrhoea/oligomenorrhoea), galactorrhoea
- Men: hypogonadism (decreased libido, infertility, impotence, gynaecomastia), rarely galactorrhoea
Relevant pituitary hormone level?
High prolactin
- Euvolaemic hyponatraemia: anorexia, nausea, malaise
- Severe hyponatraemia may result in headache, muscle cramps, irritability, confusion, seizures, coma
- Severe hyponatraemia may result in headache, muscle cramps, irritability, confusion, seizures, coma
- High urine osmolarity
Relevant pituitary hormone level?
High ADH
A broad group of disorders characterised by thyroid inflammation. What are some types?
Thyroiditis
- Pain: subacute, infectious, radiation, trauma
- Painless: silent (post-partum, drugs), chronic lymphocytic, fibrous
A unilateral adrenal mass is found on CT as an incidental finding. The patient has no symptoms
Adrenocortical neoplasia: “incidentaloma”
