Endocrine + Immunology

Question 1

A patient is reviewed at the chest clinic. He was treated over 1 year ago for pulmonary TB. He now complains of lethargy. Clinical examination reveals no chest abnormalities, but he has significant postural hypotension. A U&E is sent and the following test is arranged:
Time 0mins cortisol 140nmol/l. Time 30mins cortisol 150nmol/l.

1. What is the test and what does it demonstrate?
2. What would you expect of the U+Es?
3. What is the diagnosis?

Answer 1

1. Short Synacthen test. If cortisol levels don’t rise on administration of the synacthen (such as here), indicated primary hypoadrenalism.
2. Low sodium and raised potassium, probably low BM too.
3. TB induced hypoadrenalism (like Addison’s but not autoimmune).

Question 2

Man is investigated for HTN.
First test = urine metanephrines. His were 2.1umol/days (normal)
1) what is the test for?
Then given dexamethasone 11pm and cortisol measured in the morning.
2) What is the test for?
3) What is the diagnostic result of it?

Answer 2

1. Pheochromocytoma. Suspicious is metanephrine are greater than 5.5.
2. Cushings
3. A positive test is defined as morning cortisol >50 nanomol/L.

Question 3

Autoantibody in Addison’s

Answer 3

Anti-21 hydroxylase

Question 4

Autoantibody in anti-phospholipid syndrome

Answer 4

Anti-cardiolipin
Lupus anticoagulant antobodies
anti-beta2 glycoprotein 1 antibodies.

Question 5

Autoantibody in type 1 and 2 autoimmune hepatits

Answer 5

1 anti smooth muscle, antinuclear

2 antiliver/kidney microsomal1 (anti-LKM1)

Question 6

Autoantibody in Goodpasture’s

Answer 6

anti-glomerular basement membrane

Question 7

Autoantibody in diffuse and limited scleroderma

Answer 7

diffuse = anti-RNA polymerase
limited = anti-centromere

Question 8

Autoantibody in myositis

Answer 8

anti-Jo1

Question 9

Autoantibody in Sjogren syndrome

Answer 9

anti-Ro and anti-La