Endocrine

Question 1

Primary hyperparathyroidism

Answer 1

Cause: Tumour
PTH: High
Calcium: High
Tx: surgery

Question 2

Secondary hyperparathyroidism

Answer 2

Cause: Low vit D or CKD
PTH: high
Calcium: normal or low 
Tx: Increase Vitamin D Level
or renal transplant

Question 3

Tertiary hyperparathyroidism

Answer 3

Cause: hyperplasia after ssecondary
PTH: high
calcium: high
Tx: surgery

Question 4

Cushings: overnight suppression test

Normal

Answer 4

Cortisol after low dose dex = low

Cortisol after high dose dex = low

ACTH = normal

Question 5

Cushings: overnight suppression test

Cushings syndrome due to other cause e.g. adrenal adnenoma

Answer 5

Cortisol after low dose dex = normal

Cortisol after high dose dex = normal

ACTH = low

Question 6

Cushings: overnight suppression test

Cushings disease i.e. pituitary adenoma - ACTH secretion

Answer 6

Cortisol after low dose dex = normal

Cortisol after high dose dex = low

ACTH = high

Question 7

Cushings: overnight suppression test

Ectopic ACTH syndrome likely

Answer 7

Cortisol after low dose dex = normal

Cortisol after high dose dex = normal

ACTH = high

Question 8

Pendred’s syndrome

autosomal recessive genetic disorder (chromosome 7)

Answer 8

bilateral sensorineural deafness, with mild hypothyroidism and a goitre.

The patients tend to present with progressive hearing loss and delay in academic progression. Often head trauma tends to make the sensorineural deafness worse, leading to patients having to avoid contact sports.

Question 9

Hashimoto’s thyroiditis

autoimmune disorder of the thyroid gland. It is typically associated with hypothyroidism although there may be a transient thyrotoxicosis in the acute phase. It is 10 times more common in women

Answer 9

Features
features of hypothyroidism
goitre: firm, non-tender
anti-thyroid peroxidase (TPO) and also anti-thyroglobulin (Tg) antibodies

Associations
other autoimmune conditions e.g. coeliac disease, type 1 diabetes mellitus, vitiligo
Hashimoto’s thyroiditis is associated with the development of MALT lymphoma

Question 10

Complications of DKA and its treatment

Answer 10

• gastric stasis
• thromboembolism
• arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
• iatrogenic due to incorrect fluid therapy: cerebral oedema*,hypokalaemia, hypoglycaemia
  acute respiratory distress syndrome
  acute kidney injury
• children/young adults are particularly vulnerable to cerebral oedema following fluid resuscitation in DKA and often need 1:1 nursing to monitor neuro-observations

Question 11

• Minimal glucocorticoid activity

- Very high mineralocorticoid activity,

Answer 11

Fludrocortisone

Question 12

• Glucocorticoid activity,

- high mineralocorticoid activity,

Answer 12

Hydrocortisone

Question 13

• Predominant glucocorticoid activity,

- low mineralocorticoid activity

Answer 13

Prednisolone

Question 14

• Very high glucocorticoid activity

- minimal mineralocorticoid activity

Answer 14

Dexamethasone

Betmethasone

Question 15

Glucocorticoid side-effects

Answer 15

endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
Cushing’s syndrome: moon face, buffalo hump, striae
musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
psychiatric: insomnia, mania, depression, psychosis
gastrointestinal: peptic ulceration, acute pancreatitis
ophthalmic: glaucoma, cataracts
suppression of growth in children
intracranial hypertension
neutrophilia

Question 16

Mineralocorticoid side-effects

Answer 16

fluid retention

hypertension

Question 17

By increasing pancreatic insulin secretion and hence are only effective if functional B-cells are present. On a molecular level they bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.

Answer 17

Sulfonylureas e.g. gliclazide