Endocrine

Question 1

Cushing’s Syndrome

Answer 1

Sx: Wt gain, Truncal obesity, Moon facies, buffalo Hump, Abdominal striae, Easy cruising, DM, HTN, Hirsutism, Menstrual disorder.
PE: MRS testing
Labs: CBC, CMP, serum ACTH, serum cortisol, 24 urine cortisol, 6hr or overnight dexamethasone suppression test.
Ddx: PCOS, Metabolic Syndrome, Alcohol, Depression
Imx: CT to ro tumor.
Tx: Remove corticosteroids, Homeopathic (Calc cab, Thyroidinum, Ferrum metallicum)

Question 2

Hypothyroid

Answer 2

Sx: Cold, lateral eyebrow thinning, wt gain, slowed pulse/respiration, Muscle cramps, Constipation, Diminished DTR.
Labs: T4, TSH, rT3
Imx: US to view nodules
Ddx: Cretinism (insufficient thyroid through entire life), Iodine deficiency related hypothyroidism, Hashimotos, Acute thyroiditis
Tx: Bladderwrack, Armour, Hydrotx

Question 3

Diabetes

Answer 3

Sx: Diabetic ketoacidosis, polyphagia, polyuria, polydipsia.
PE: VHL, Eyes, Extremities (ulcers, decreased sensation, decreased circulation), Neuro (MRS)
Labs: Fasting glucose, BUN, creatinine, Serum albumin (increased in IDDM), UA (glucose >160)
Ddx: Metabolic syndrome, Pre-diabetes, Diabetic ketoacidosis, Hypoglycemia, Gestational Diabetes
Tx: Diet, EFA, Biotin, Zn (insulin synthesis)

Question 4

Hyperthyroidism

Answer 4

Sx: Enlarged non tender goiter, moist skin, tachycardia, tremor, wt loss
PE: Exopthalamos, eyelid retraction, pretibial myxedema, hyperactive DTS, muscle weakness
Labs: Increased free T3/T4, low TSH
Imx: US
Ddx: Goiter, Thyrotoxicosis, Graves, Plummer Vinson Syndrome
Tx: 50,000IU Vit A, Lemon balm/Lycopus/Lithospermum 2-6ml of tincture, stress mngmt, Cold compress,

Question 5

Hypoglycemia

Answer 5

Sx: Cold sweats, confusion, coma, HA, double vision, irritability, rapid HR, memory loss
PE: Neuro, mb Ophthalmoscopic depending on sx
Labs: Fasting glucose (<50), Glucose Insulin Tolerance Test (Glucose >50 after drink it indicates hypoglycemia)
Ddx: DM, Metabolic syndrome, Anxiety
Tx: Nutrition, 200-400mcg Chromium

Question 6

Metabolic Syndrome

Answer 6

Sx: BP >130/85, Fasting glucose >100, Waist circumference >40 for men >35 for women, Low HDL <40 for men <50 for women, TG >150, Elevated uric acid, Elevated insulin >22 (<5 ideal)
PE: BMI
Labs: CMP, lipids, serum insulin
Ddx: DM (pre, 1, 2)
Tx: Lifestyle

Question 7

Pre Diabetes (Impaired Glucose Tolerance or Impaired Fasting Glucose)

Answer 7

Sx: Adiposity, HTN sx
Labs: CMP, lipids, fasting glucose, oral glucose tolerance test
Ddx: Metabolic Syndrome, DM
Tx: Diet, weight loss