Endocrine Case Studies

Question 1

22yo bought in a car accident –> trauma to left leg

blood pressure is 80/45

temperature 102.1

K+ high, Na Low super low

glucose low

upper WBC

what are the biggest problems for this person?

Answer 1

Hypotensive

Na/K/glucose

Question 2

Adrenal cortex does what?

what does the pt with low Na/high K, and low glucose mean?

Answer 2

retains sodium and blood glucose through glucocorticoids

so not enough glucocorticoids, not enough mineralocorticoids.

lack of steroids.

Question 3

Relative Adrenal Insufficiency or adrenal crisis?

Answer 3

inability of the adrenal gland to keep up.

inability of the HPA axis to keep up with the axis.

“Salt Wasting” –> insufficient

Question 4

two tests to prove that it is insufficiency is the problem?

what would you inject?

Answer 4

Aldosterone

Cortisol

Question 5

How would you know that it is a primary adrenal and not a secondary in the pituitary

Answer 5

ACTH

primary problem, ACTH is going to be high.

this is because the glucocorticoids and the aldosterone is low, so since cortisol is low, ACTH is going to be elevated

Question 6

How can you do another test that the adrenal glands have gone to sleep?

Answer 6

ACTH Stimulation Test

this is a more direct way to creating a false situation that seems if the serum cortisol responds.

there would be no response with elevated cortisol.

Question 7

Patient is tan and tired… what’s happening?

Answer 7

hyperpigmentation caused by Addison’s which is a chronic adrenocortical insufficiency.

Question 8

Primary adrenocorticol insufficiency –>

Answer 8

acute adrenal crisis superimposed on undiagnosed adrenal insufficiency –> Addison’s disease

Question 9

what do you give people with Addison’s disease?

Answer 9

corticosteroids

Question 10

end stage renal failure causing back and joint pain

osteoporosis

Answer 10

low ca, high phosphate.

high PTH

secondary hyperparathyroidism.

Question 11

why does someone with renal failure have bone pains during secondary hyperparathyroidism.

Answer 11

Renal Osteodystrophy in secondary hyperaprathyroidism

renal failure causes higher PTH, but it doesn’t work on kidney.. but it works on bones.. so you have high bone resorption to raise it.

“striped” appearance.

Question 12

how many parathyroid glands are affected for secondary parathyroid?

primary?

Answer 12

parathyroid glands are hyperfunctioning

all 4 parathyroid glands will perceive low calcium.

only one! that would be an adenoma.

Question 13

6y/o with n/v. 2 weeks has had fatigue, weak, missed school.

eating and drinking a ton, but getting thinner

peeing all the time and wet the bed.

blood glucose is super high.

Answer 13

diabetes.

ketoacidosis.

Question 14

4 Ts of T1DM?

Answer 14

Toilet –> a lot of peeing because of a ton of fluid
Thirsty –> excess sugar is pulling water from the cells to the bloodstream
Tired –>
Thinner

Question 15

Diabetes Mellitus meaning?

Answer 15

Passing through, Honey

Question 16

N/V and why someone has breath smells like fruit?

Answer 16

ketoacidosis –> can’t use glucose for fuel, so you use adipose tissue, which converts to FFAs, the liver makes ketoacids.

so your blood is acidotic, giving you labored breathing, N/V, and the fruity breath odor.

Question 17

52yo difficulty swallowing, can’t lay flat to sleep.

huge goiter.

not perspiring a lot, not weight loss, no diarrhea.

says not having sluggishness, no weight gain, cold intolerance, no cardiac problems.

Normal TSH, normal T4, normal T3.

Answer 17

Not hyperthyroidism, not Hypothyroidism

non-toxic goiter (euthyroid) –> enlarged thyroid but normal physiologically.

Question 18

What is the Pemberton’s sign?

Answer 18

facial flushing and venous dilation when arms are raised. (see that in goiters)

Question 19

adjacent structures to the thyroid?

Answer 19

sits on top of the trachea.

Question 20

hyperthyroidism and Cardiac is important because?

Answer 20

first thing the patient usually notices, and usually causes disease and death.

palpitations, tachycardia

Question 21

euthyroid why does it work the way it does?

Answer 21

thyroid is inefficient to make thyroid hormone so it has to grow to achieve a normal rate.

Question 22

why do we have to treat euthyroid people?

what do you do to treat?

Answer 22

physiological symptoms. –> obstructive

higher risk of malignancy.

surgery or radioactive iodine therapy.

Question 23

What is Bitemporal hemianopsia?

how is this happening?

Answer 23

nothing can be seen in the temporal fields but can see in the inside of that.

the temporal retinal fibers say on the side they emirate from, but the nasal fibers go to the opposite and cross at the optic chiasma.

the optic chiasm is above the sella turcica. anything swelling in the pituitary smashes the optic chiasm.

you knock out the nasal retinal fibers.

Question 24

blurred optic disk margins?

Answer 24

Papilledema –> finding that indicates elevated intracranial pressure.

Question 25

acromegaly have bad osteoarthritis.. how?

Answer 25

good luck