Endocrine

Question 1

Describe two potential etiologies of Addison disease

Answer 1

Autoimmune (polyglandular syndrome) and genetic abnormalities (congenital adrenal hyperplasia)

Question 2

Describe symptoms of Addison’s disease

Answer 2

Fatigue, weight loss, fever, anemia, hypoglycemia, low blood pressure, hyponatremia

Question 3

How should Addison’s disease be treated?

Answer 3

Oral hydrocortisone (replace cortisol) or mineralocorticoid (replace aldosterone), or corticosteroid injections

Question 4

Why can Addison’s disease lead to hyperkalemia and hyponatremia?

Answer 4

The adrenal gland is also responsible for aldosterone secretion which controls urinary output of sodium via the RAS system

Question 5

What tests should be ordered to diagnose Addison’s disease?

Answer 5

Plasma cortisol, plasma ACTH, plasma renin activity, serum aldosterone, adrenal antibodies

Question 6

What is Cushing’s disease?

Answer 6

Hypercortisolism due to excessive ACTH secretion (by pituitary adenoma)

Question 7

What are two etiologies of Cushing’s disease?

Answer 7

Pituitary adenoma or ectopic ACTH secreting tumor (as in small cell lung cancer)

Question 8

Addison’s disease results in deficiency of which three biological chemicals?

Answer 8

Glucocorticoids, mineralcorticoids, androgens

Question 9

What are symptoms of Cushing’s disease?

Answer 9

Weight gain, truncal obesity, striae, hypertension, glucose intolerance, infections, moon face, acne, buffalo hump

Question 10

What tests should be used to diagnose Cushing’s disease?

Answer 10

24 hour urine test, dexamethasone suppression test, salivary cortisol, blood glucose

Question 11

How is Cushing’s disease treated?

Answer 11

Surgical excision of adenoma, ketoconazole, cortisol replacement therapy post surgery

Question 12

What is prolactinoma?

Answer 12

Benign pituitary tumor that causes overproduction of prolactin

Question 13

What is the etiology of prolactinoma?

Answer 13

Genetic disorder, secondary to certain drugs, sporadic

Question 14

List clinical findings of prolactinoma

Answer 14

Daily headaches, visual changes, breast enlargement, galactorrhea, decreased libido, irregular menstrual cycle, decreased fertility

Question 15

How is prolactinoma diagnosed?

Answer 15

Prolactin level greater than 200 mcg/L, T4 less than 4.5, TSH greater than 6, MRI shows pituitary adenoma

Question 16

How is prolactinoma treated?

Answer 16

Dopamine agonist, surgery if dopamine intolerance

Question 17

Why do thyroid nodules develop?

Answer 17

Most are idiopathic, but can also be caused by iodine deficiency, Hashimoto’s thyroiditis, cyst, goiter, cancer, inflammation, neck radiation

Question 18

What are some symptoms of thyroid nodules?

Answer 18

Most are asymptomatic but Macy weight loss, tremors, SOB, Nick tenderness, change in temperature tolerance, tachycardia

Question 19

Differentiate between appearance of benign and malignant thyroid nodules

Answer 19

Benign – movable, soft, nontender Malignant – fixed, hard, tender

Question 20

How are thyroid nodules diagnosed?

Answer 20

Ultrasound, fine needle aspiration, nuclear scan, T4 and TSH levels

Question 21

How are thyroid nodules managed/treated?

Answer 21

Hormone replacement, radioactive iodine, thyroidectomy

Question 22

If a patient is hypertensive, Hypokalemic, and not on a diuretic what should you suspect?

Answer 22

Cushing’s (Hyperaldosteronism)

Question 23

How do you treat acute Addisons crisis?

Answer 23

Inject hydrocortisone, saline, and dextrose