Endocrine presentations Flashcards
A 12-year-old white girl is brought to the emergency department by her parents due to 12 hours of rapidly worsening nausea, vomiting, abdominal pain, and lethargy. Over the last week she has felt excessively thirsty and has been urinating a lot. Physical examination reveals a lean, dehydrated girl with deep rapid respirations, tachycardia, and no response to verbal commands.
T1DM
A 20-year-old man is brought to the accident and emergency department with abdominal pain, nausea, and vomiting with increasing polyuria, polydipsia, and drowsiness since the previous day. He was diagnosed with type 1 diabetes 2 years previously. He mentions that he ran out of insulin 2 days ago. Vital signs at admission are: BP 106/67 mmHg, heart rate 123 beats per minute, respiratory rate 32 breaths per minute, temperature 37.1°C (98.8°F). On mental status examination, he is drowsy.
Diabetic ketoacidosis
Physical examination reveals Kussmaul’s breathing with acetone odour and mild generalised abdominal tenderness without guarding and rebound tenderness.
A 45-year-old man with a history of type 2 diabetes is admitted directly from clinic for a serum glucose of 53.8 mmol/L (970 mg/dL). He was started recently on basal bolus insulin therapy after several years of treatment with oral hypoglycaemic agents. However, he reports not having followed his insulin prescription because he struggles to inject himself. For the past 2 weeks he has had polyuria and polydipsia, and has lost 5 kg in weight. He has also noted a progressively worsening cough for approximately 3 weeks that is productive of greenish-brown sputum.
Hyperosmolar hyperglycemic state
A 38-year-old woman, who in the past had tried to lose weight without success, is happy to see that in the last 2 months she has lost about 11 kg (25 pounds). She also has difficulty sleeping at night. Her husband complains that she is keeping the house very cool. She recently consulted her ophthalmologist because of redness and watering of the eyes. Eye drops were not helpful. She consults her doctor for fatigue and anxiety, palpitations, and easy fatigability.
Grave’s disease - hyperthyroidism
A 34-year-old woman presents with complaints of weight gain and irregular menses for the last several years. She has gained 20 kg over the past 3 years and feels that most of the weight gain is in her abdomen and face. She notes bruising without significant trauma, difficulty rising from a chair, and proximal muscle wasting.
Cushing’s syndrome
A 54-year-old man presents for evaluation of an incidentally discovered adrenal nodule. He underwent a computed tomography scan of the abdomen for evaluation of abdominal pain, which was negative except for a 2 cm well-circumscribed, low-density (2 Hounsfield units) nodule in the right adrenal gland. He reports weight gain of 15 kg over the past 4 years.
Cushing’s syndrome
A 47-year-old man presents with arthritic pain of the knees and hips, soft-tissue swelling, and excessive sweating. He also noticed progressive enlargement of the hands and feet. He has been taking antihypertensive medicine for the past 3 years. On physical examination, he has coarse facial features with prognathism and prominent supra-orbital ridges. The tongue is enlarged and the fingers are thickened. His wife says that he frequently snores.
Acromegaly
A 15-year-old girl presents with primary amenorrhoea and accelerated growth. On physical examination, her height is above the 90th percentile, her pubertal development is evaluated at Tanner stage 2, and she has soft-tissue swelling.
Acromegaly
A 27-year-old woman presents with amenorrhoea. She had been taking the combined oral contraceptive pill for the last 9 years, stopping this 11 months ago. She is otherwise healthy, but on physical examination she has bilateral galactorrhoea
Prolactinoma
A 45-year-old man presents with loss of libido and some erectile dysfunction. He is otherwise healthy. On physical examination he has mild bilateral gynaecomastia and normal testes. Visual assessment reveals bi-temporal hemianopia
Prolactinoma
A 54-year-old man presents with a 10-year history of hypertension that has been difficult to control with antihypertensive medicines. His symptoms include frequent headaches, nocturia (3-4 times per night), and lethargy. He has no other medical conditions or past medical history. Apart from a blood pressure (BP) of 160/96 mmHg, findings on physical examination are unremarkable. Plasma electrolytes are normal.
Primary hyperaldosteronism
A 36-year-old woman presents with increasing fatigue especially in the afternoon, 7 kg weight loss, decreased appetite, diminished libido, and decreased axillary and pubic hair over a 10-month period. Her skin seems more tanned despite lack of sun exposure. She is craving salty food and feels dizzy when standing up suddenly. She has been dying her hair as she started having grey hair when she was 17 years old. Her mother has Hashimoto’s thyroiditis and one of her sisters has type 1 diabetes. Her blood pressure is 102/66 mmHg with a heart rate of 86 beats/minute (supine) and 78/56 mmHg with a heart rate of 116 beats/minute (sitting). Hyperpigmentation is noted in the oral mucosa and also over a previous appendectomy scar.
Primary adrenal insufficiency
A 76-year-old homeless white man presents to the emergency department after police find him disoriented on the streets in late August. The patient gives little history, but admits to ongoing cough with productive sputum, night sweats/chills, and mild dyspnoea. He proceeds to suffer from a seizure. Vital signs demonstrate an elevated temperature at 38.7°C (101.7°F), a respiration rate of 26 breaths per minute, 94% oxygen saturation (on 3 L of O2), and pulse 87 bpm, with no evidence of orthostatic hypotension. Physical examination demonstrates a malnourished and dishevelled man in a postictal state. There is no sign of injury to the body. Crackles can be heard at the right lung base. Lab work demonstrates serum sodium of 120 mmol/L (120 mEq/L), serum creatinine of 88 micromol/L (1.0 mg/dL), and negative alcohol and toxicology screens. Chest x-ray demonstrates a large infiltrate in the right lower lung, consistent with pulmonary infection or abscess.
SIADH
Cough with productive sputum, night sweats/chills, and dyspnea, suggesting a pulmonary infection.
Hyponatremia can lead to seizures and neurological symptoms
Hyponatremia is secondary to SIADH, a condition often associated with pulmonary infections, malignancies, or central nervous system disorders.
A 42-year-old man undergoes trans-sphenoidal surgery for a large, non-functioning pituitary macro-adenoma. Preoperatively, dynamic pituitary hormone tests were normal, as was his fluid intake and output. Two days following surgery he developed acute polyuria, extreme thirst, and polydipsia. His urine output over the next 24 hours was 6 litres, with frequent nocturia.
Diabetes insipidus (Central)
A 75-year-old woman presents to her family physician with a 6-month history of progressive fatigue and malaise with polyuria, polydipsia, and nocturia. She has a long-standing history of bipolar affective disorder, and has been receiving lithium for the past 15 years.
Diabetes insipidus (nephrogenic)
