Endocrinology

Question 1

What is the most common cause of acromegaly

Answer 1

Pituitary macroadenoma

Question 2

Most common complaints of acromegaly patient

Answer 2

headache and sweating

Question 3

cause of excessive sweating in acromegaly

Answer 3

sweat gland hypertrophy

Question 4

Cause of headache in acromegaly

Answer 4

compression of diaphragmatica sella

Question 5

Clinical features of acromegaly

Answer 5

1) Headache
2) Increased sweating
3)Skull growth : prominent supraorbital ridge with large frontal sinuses
4)Enlargement of lips,nose,tongue
5)Prognathism
6)Enlargement of hands and feet (spade like)
7)Hypertension, Cardiomyopathy

Question 6

1st line investigation for acromegaly?

Answer 6

serum IGF-1 level

Question 7

Diagnostic test of acromegaly?

Answer 7

OGTT followed by serial measurements of GH and IGF-1 levels

Question 8

acromegaly patients should be screened for which malignancy

Answer 8

Colonic cancer

Question 9

acromegaly associated with which endocrine syndrome

Answer 9

MEN-1

Question 10

Treatment of choice in acromegaly

Answer 10

trans-sphenoidal surgery

Question 11

2nd line treatment of acromegaly

Answer 11

medical treatment

Question 12

which medical treatment is used prior to surgery in acromegaly

Answer 12

Somatostatin analogues because they shrink tumor size

Question 13

types of medical management in acromegaly

Answer 13

1) Somatostatin analogues-Octreotide,Lanreotide,Pasireotide

2) Dopamine Agonists-Bromocriptine,Cabergoline

3)GH receptor antagonist-Pegvisomant

Question 14

Mechanism of action of Pegvisomant

Answer 14

GH receptor antagonist

Question 15

Causes of Hypercalcemia:

Answer 15

Hypercalcemia with N/High PTH:
1) Primary or tertiary hyperparathyroidism
2) Lithium induced hyperparathyroidism
3) FHH
Hypercalcemia with low PTH:
1) Malignancy ( lungs,breasts,myeloma,kidney,lymphoma,thyroid)
2) Elevated vit D ( D intoxication, sarcoidosis, HIV, other granulomatous diseases)
3)Thyrotoxicosis
4)Paget’s disease with immobilisation
5)Milk Alkali Syndrome
6)Thiazide Diuretics
7)Glucocorticoid Deficiency

Question 16

Most common cause of Hypercalcemia with N/High parathyroid levels:

Answer 16

Primary hyperparathyroidism

Question 17

Most common cause of hypercalcemia with low PTH level:

Answer 17

Malignant hypercalcemia

Question 18

Hypercalcemia+ high phosphate level+ raised ALP in renal impairment =

Answer 18

Tertiary hyperparathyroidsm

Question 19

Cause of Hypercalcemia in malignancy

Answer 19

PTH related peptide

Question 20

How to differentiate between FHH and primary hyperparathyroidism-

Answer 20

24 hr urinary calcium levels

Question 21

Causes of hypocalcemia:

Answer 21

1) Hypoalbuminemia
2)Alkalosis
3)Vitamin D deficiency
4)Chronic renal disease
5)Hypoparathyroidsm
6)Pseudohypoparathyroidsm
7)Acute Pancreatitis
8)Hypomagnesaemia

Question 22

Most common cause of hypocalcemia:

Answer 22

Hypoalbuminemia

Question 23

Which is more specific to detect latent tetany?

Answer 23

Trousseau’s sign

Question 24

ECG features of hypocalcemia:

Answer 24

-Prolonged QT interval
-Ventricular arrhythmia

Question 25

Hypocalcemia+ hypophosphataemia+ bone pain and fracture=

Answer 25

Vitamin D deficiency

Question 26

Management of severe hypocalcemia:

Answer 26

-10-20 ml 10% calcium gluconate I/V over 10-20 minutes with cardiac monitoring

Question 27

Most common cause of primary hyperparathyroidsm:

Answer 27

Single parathyroid adenoma

Question 28

Hypocalcemia with hypomagnesemia. Which one needs correction first?

Answer 28

hypomagnesemia. Because low mg levels cause hypocalcemia. Rx: 50 mmol (1.23g) I/V magnesium chloride over 24 hours

Question 29

Treatment of choice for primary hyperparathyroidsm:

Answer 29

Surgical excision of adenoma

Question 30

Causes of secondary hyperparathyroidism:

Answer 30

1)Chronic kidney disease 2)Malabsorption 3)Vitamin D Deficiency (Osteomalacia and rickets)

Question 31

Indication of surgery for primary hyperparathyroidsm:

Answer 31

1) Individuals with clear cut symptoms: renal stones, renal impairment,osteoporosis 2)Asymptomatic patients with significant hypercalcemia ( >11.4 mg/dl or corrected level >2.85 mmol/l)

Question 32

Treatment of tertiary hyperparathyroidism-

Answer 32

Cinacalcet

Question 33

Mechanism of action of Cinacalcet:

Answer 33

Enhances the sensitivity of the calcium sensing receptor which reduces PTH levels

Question 34

2nd line Rx for primary hyperparathyroidsm-

Answer 34

Cinacalcet

Question 35

which type of genetic disorder is FHH?

Answer 35

Autosomal dominant

Question 36

Pathogenesis of FHH:

Answer 36

“Inactivating” mutation in calcium sensing receptor gene

Question 37

Level of Hypercalcemia in FHH?

Answer 37

Mild

Question 38

Most common cause of hypoparathyroidsm-

Answer 38

Damage to parathyroid glands during surgery

Question 39

Mirror image of FHH:

Answer 39

Autosomal dominant Hypoparathyroidsm ( due to activating mutation in calcium sensing receptor gene)

Question 40

Pseudohypoparathyroidsm:

Answer 40

Tissue resistance to PTH

Question 41

PTH levels in Pseudohypoparathyroidsm:

Answer 41

Markedly elevated

Question 42

In Pseudohypoparathyroidsm mutations occur in which gene?

Answer 42

GNAS1

Question 43

A short stature, round face obese patient. Lab shows hypocalcemia and hyperphosphatemia. You notice short 4th metacarpal and metatarsals. Dx?

Answer 43

Albright’s hereditary Osteodystrophy / Type 1a Pseudohypoparathyroidsm

Question 44

Pseudohypoparathyroidsm: mutation involves-

Answer 44

Maternal gene

Question 45

pseudopseudohypoparathyroidsm: mutation involves-

Answer 45

Paternal gene

Question 46

pseudopseudohypoparathyroidsm

Answer 46

Clinical features of AHO but normal serum calcium and PTH levels