Endocrinology

Question 1

what is a simple colloid goitre a result of?

Answer 1

iodine deficiency

Question 2

what is the overall effect of PTH?

Answer 2

increases calcium and decreases phosphate
albumin is usually normal or low
as PTH increases bone turnover by stimulating osteoclast activity, ALP is usually elevated

Question 3

what symptoms does high calcium cause?

Answer 3

weak, tired, depressed

Question 4

what is secondary hyperparathyroidism caused by?

Answer 4

decreased vit D intake or chronic renal failure

the resulting reduction in calcitrol causes hypocalcaemia and raised PTH secondary to this

Question 5

what causes primary hyperparathyroidism?

Answer 5

parathyroid adenoma or MEN syndromes

Question 6

what are the results for bone metastases with regards to calcium and phosphate?

Answer 6

hypercalcaemia, normal or low albumin, and raised ALP, phosphate elevated or normal

Question 7

what are the results of vit D excess?

Answer 7

hypercalcaemia, hyperphosphataemia, ALP usually normal

Question 8

what are the results of myeloma with regards to calcium and phosphate and ALP?

Answer 8

hypercalcaemia, hyperphosphataemia, and normal ALP

Question 9

what is the classic triad of Grave’s disease?

Answer 9

pretibial myxoedema, thyroid ophthalmopathy, thyroid acropachy

Question 10

which variant of endocrine malignancy has the worst prognosis?

Answer 10

anaplastic thyroid cancer - 50% of thyroid cancer mortality

Question 11

which variant of endocrine malignancy carries a relationship with MEN?

Answer 11

medullary - they originate from parafollicular thyroid cells and secrete calcitonin

Question 12

which variant of endocrine malignancy mainly spread via blood?

Answer 12

follicular

Question 13

fine needle aspiration cytology does not suitably discern whether which endocrine variant malignancy is malignant or not?

Answer 13

follicular - excisional biopsy is required

Question 14

which variant of endocrine malignancy occurs in iodine-rich areas of the thyroid gland?

Answer 14

papillary

Question 15

what is the result of elevated cortisol levels with regards to calcium and phosphate and PTH?

Answer 15

hypocalcaemia and hyperphosphataemia and secondary hyperparathyroidism

Question 16

a 19 yea old man is brought to the ED unconscious. the patient’s breath smells of fruit punch. the patient was holding a glass containing clear liquid and the ambulance attendance had noted a syringe on the patient’s coffee table and a pool of vomit near the patient. what is the diagnosis?

Answer 16

diabetic ketoacidosis - acetone on the breath suggests ketoacidosis
excessive thirst explains the empty glass of water and the syringe is most likely insulin

Question 17

what is acromegaly and what are its 2 associations?

Answer 17

hypersecretion of growth hormone and a/w insulin resistance and diabetes

Question 18

what is psammoma calcification diagnostic for?

Answer 18

papillary thyroid cancer

Question 19

why is there hyperpigmentation in Addison’s?

Answer 19

there is an increase in ACTH which causes hyperpigmentation as it has the same precursor as melanocytes-stimulating hormone

Question 20

what is another name for primary hyperaldosteronism?

Answer 20

Conn’s syndrome

Question 21

what is the clinical presentation of Conn’s syndrome?

Answer 21

HARPS:

hypertension, aldosterone is raised, renin is lowered, potassium is decreased, sodium raised

Question 22

what is the most common cause of Addison’s disease?

Answer 22

autoimmune destruction

Question 23

how is the dose of levothyroxine changed in pregnaancy?

Answer 23

increase does of levothyroxine and refer to specialist

Question 24

which quadrants do craniopharyngiomas and pituitary adenomas affect?

Answer 24

cranio > inferior temporal

pituitary > superior temporal

Question 25

which test is used for Addison’s?

Answer 25

synacthen test - cortisol level is measured before and after ACTH admin - failure of cortisol to increase after admin suggests Addison’s

Question 26

what is the investigation for growth hormone deficiency?

Answer 26

insulin tolerance test