Endocrine I

Question 1

Signs and sx of hypocalcemia

Answer 1

Hypoparathyroid/Hypocalcemia Signs & Symptoms:
Neuropsych: Seizures, dementia, anxiety, depression, ect

Neuromuscular: Paresthesia around mouth and fingers/toes, muscle stiffness, myalgia and spasms

CV: CHF, hypotension, prolongation of QT interval

Autonomic: Biliary colic, bronchospasm, diaphoresis

Other: Cataracts, dry coarse skin,

Question 2

what is chvostek’ sign?

Answer 2

tap onto the facial n anterior to the lip and you’ll get the spasming of lip

Question 3

what is trousseu’s sign?

Answer 3

put the bp cuff around the arm
hold it for a few min
get some spasming of the arm

Question 4

what is the most common cause of hypocalcemia?

Answer 4

hypoparathyroidism

Question 5

causes of hypoparathyroidism

Answer 5

-Surgical removal of glands during thyroidectomy, DiGeorge Syndrome, and hereditary autoimmunity syndrome.

Question 6

what is primary hyperparathyroidism predominantly caused by?

Answer 6

1° hyperparathyroidism(causes high PTH)
Adenomas (MC 80%) – may be associated with MEN 1
Multiple endocrine neoplasia (MEN)–endocrine gland(s) overactive or forms a tumor.

Question 7

what is secondary hyperparathyroidism predominantly caused by?

Answer 7

Renal failure, vit D def, malabsorption

low calcium causes high PTH

Question 8

Sx of hyperparathyroidism

Answer 8

Symptoms:
CNS: Lethargy, weakness, confusion, coma
Renal: Polyuria, dehydration, nocturia, renal stones, renal
failure
GI: Constipation, nausea, anorexia, gastric ulcer, pancreatitis
Cardiac: Syncope from arrhythmias

Stones (renal or biliary calculus)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (polyuria) resulting in dehydration.
Psychiatric overtones (Depression 30–40%, anxiety, cognitive dysfunction, insomnia, coma

Question 9

what is secreted by the thyroid? what is the active form?

Answer 9

Synthesizes, stores and secretes thyroid hormone
(T4 and T3)
• Thyroxine (T4 – contains four atoms of iodine) and
tri-iodothyronine (T3- contains three atoms of
iodine)
• T4 (inactive form) –> T3 (active form)

Question 10

what TSH levels expected to be in both hypo and hyper thyroidism?

Answer 10

Thyroid stimulating hormone (TSH) is secreted by
pituitary and in response the thyroid will secreted
T4 and T3
• Therefore there is a negative feedback
– Hypothyroidism (low thyroid) TSH is high in response to low T4,
low T3
– Hyperthyroidism (high thyroid) TSH is low in response to high
T4, high T3

Question 11

what causes hypothyroidism

Answer 11

Causes:
Hashimoto’s thyroiditis – Autoimmune (most common cause of hypothyroidism)

Medications (i.e. lithium) can sometimes cause hypothyroidism

Pregnancy (during or after) – can recur with subsequent pregnancies

Treatment for hyperthyroidism

Thyroidectomy

Question 12

Sx of hypothyroidism

Answer 12

Symptoms:
Constipation
Depression
Fatigue
Pale, dry skin
Sensitivity to cold
Elevated cholesterol levels
Dry, brittle nails and hair
Weight gain

Question 13

what causes hyperthyroidism

Answer 13

Causes:
Graves’ Disease – autoimmune (most common cause of hyperthyroidism)

Toxic nodular or multinodular goiter

Thyroiditis (autoimmune or viral)

Excessive consumption of iodine or meds (like amiodarone) that contain iodine

Pregnancy or first year after birth (some women)

Question 14

Sx of hyperthyroidism

Answer 14

Symptoms:
Fatigue or muscle weakness
Hand tremors
Mood swings
Nervousness or anxiety
Rapid heart rate
Heart palpitations or irregular heartbeat
Skin dryness
Trouble sleeping
Weight loss
Increased frequency of bowel movements
Light or missing periods
Irritability
Thinning of hair
Heat intolerance

Question 15

what are the causes of primary addison’s disease?

Answer 15

Adrenal Insufficiency
(Cortisol Underproduction)
Primary (account for 90% of cases)
About 70% are autoimmune
About 20% due to TB
Other causes: Chronic infections, surgical
removal, cancer cells affecting adrenals

Question 16

what are the causes of secondary addison’s disease?

Answer 16

Secondary due to lack of ACTH
Suddenly stopping exogenous glucocorticoids (like
prednisone)
Surgical removal of ACTH-producing tumors from
pituitary
Pituitary gland suddenly stops producing ACTH
(as in cancerous processes)

Question 17

Sx of addison’s disease

Answer 17

Symptoms:
Skin darkening, especially on scars, skin folds,
pressure points, mucus membranes
N/V/D in about 50% of cases
Salty food craving
Hypotension
Chronic worsening fatigue and muscle weakness
Weight loss, loss of appetite
Irritability
Hypoglycemia (uncommon in adults)
Menstrual irregularities

Addisonian Crisis/Acute Adrenal Insufficiency

• Usually appears at time of stress (illness, surgery, etc.)
• Sudden penetrating pain of back, extremities, vomiting, diarrhea
• If left untreated, could lead to death

Question 18

what is cushing’s syndrome?

Answer 18

Cushing Syndrome - (Adrenal (Cortisol) Overproduction)
Cushing’s disease is named after Henry Cushing, first described in 1932.

• Affects women more than men ( Female>Male)
• Cushing’s syndrome has both endogenous and exogenous causes
• Cushing’s disease is the most common cause of endogenous form

Question 19

Sx of cushing’s

Answer 19

Symptoms (how they feel):
Fatigue and sleeping problems
Headaches
Backaches
Swelling
Irritability
Repeated infections and poorly healing wounds
Acne
Hair loss

Question 20

signs of cushing’s

Answer 20

Signs (what you see):
-A round (moon-shaped) and/or red face
-Purplish streaks across the skin (“striae”)
-Unusual buildup of fatty tissue between the
shoulder blades (called “buffalo hump”)
-Unusual buildup of fatty tissue in the abdominal
area with thin arms and legs
-Easy bruising
-Excess facial/body hair growth (called
“hirsutism”) in women

Question 21

what is hyperprolactinemia? what are the clinical presentations?

Answer 21

Hyperprolactinemia
• Most common pituitary adenoma

• Common clinical presentation:
– Galactorrhea (milk discharge from breast), menstrual abnormalities,
hypogonadism, erectile dysfunction, infertility
– If mass is very large then vision issues and headaches