Endocrinology

Question 1

The first step in the diagnosis of gigantism

Answer 1

Confirm elevated levels of IGF-1.
The next step is to perform an oral glucose suppression test to see if growth hormone remains elevated despite oral glucose. Normally, growth hormone decreases with elevated glucose.
Finally, MRI can be performed to look for a pituitary lesion.

Question 2

Adrenal insufficiency

Answer 2

Addison disease or autoimmune adrenalitis
Elevated plasma ACTH
Decreased aldosterone
possible hyponatremia
hyperkalemia
hypoglycemia
metabolic acidosis.
Clinical manifestations: skin hyperpigmentation, nausea/vomiting, fatigue, weight loss, orthostatic hypotension, fatigue, and myalgias/arthralgias.
Cosyntropin stimulation test may confirm the diagnosis of adrenal insufficiency.
Patients will often need lifelong glucocorticoid and mineralocorticoid replacement.

Question 3

Clinical symptoms associated with hypercalcemia

Answer 3

Bones (fractures and pain)
Stones (nephrolithiasis)/ Diabetes insipidus (Dehydrated patient but increase Urinary output)
Groans (vomiting and constipation)
Psychic overtones (altered mental status).

Question 4

Grave’s disease occurs due to?

Answer 4

Thyroid stimulating immunoglobulins (TSI’s) binding to TSH receptors causing excess thyroid hormone release.

Question 5

Subacute granulomatous thyroiditis

Answer 5

Also called de Quervain thyroiditis
The most common cause of thyroid pain The etiology is often post-infectious and viral in origin.
Early in the course of the disease, the patient may be hyperthyroid as follicular cells are damaged and release large amounts of T3/T4. This is often followed by a period of hypothyroidism as T3/T4 is depleted, and eventually euthyroidism within the oncoming months.
Enlarged and tender thyroid gland. Treatment is only NSAIDs and symptom control since this condition resolves on its own.