Endocrinology Crash Course

Question 1

Most likely diagnosis?

Answer 1

Acromegaly - growth hormone secreting pituitary adenoma

Question 2

Mccune Albright syndrome?

Answer 2

Precocious puberty

Question 3

Acromegaly

Answer 3

Excess growth hormone, most commonly related to a pituitary adenoma

Question 4

Diagnosis?

Answer 4

Phaeochromocytoma

Question 5

Diagnosis? Test?
Low creatinine, Na and K+
CORTISOL ALSO LOW

Answer 5

Non specific GI sx, rule out addisons

Short synacthen test

Question 6

Diagnosis?

Answer 6

Pituitary apoplexy

Question 7

Pituitary apoplexy

Answer 7

Sudden Haemorrhage into pituitary gland that often occurs with an adenoma
Can be a life-threatening condition due to ACTH deficiency
Commonly causes headache, N+V, visual field defects, diplopia and endocrine dysfunction
Diagnose with imaging and manage the abnormalities

Question 8

Test to diagnose Cushing syndrome ?

Answer 8

Low dose dexamethasone suppression test

Question 9

Cushing syndrome - caused by prolonged exposure to an excess of…

Answer 9

Glucocorticoids

Classic signs - moon face, striae, buffalo hump

Question 10

Endogenous Cushing

Answer 10

Excess production of cortisol - rare

Question 11

Cushing diagnosis

Answer 11

Exclude exogenous cause (Steroids)
24hour urinary cortisol/ Midnight cortisol/ low dose dexamethasone suppression
Then serum ACTH as second line investigation

Question 12

Cushings - ACTH dependent/independent

Answer 12

Question 13

Diagnosis

Answer 13

DKA

Question 14

DKA treatment

Answer 14

Fixed rate IV insulin

Question 15

Suspect DKA - what tests (3)?

Answer 15

Glucose, ketones, VBG

Question 16

Severe HDU DKA

Answer 16

Ketones over 6 
Bicarbonate less than 5 
Ph under 7 
GCS under 12
Systolic BP under 90

Question 17

Treating DKA

Answer 17

Fluids, insulin fixed rate 0.1 unit per kg per hour, electrolytes ! Replace potassium

Question 18

Sitagliptin mechanism of action

Answer 18

Inhibits dipeptidyl peptidase (DDP-4)

Question 19

OVERVIEW of diabetes medications

Answer 19

Question 20

LOW TSH

Diagnosis?

Answer 20

Graves

Question 21

Most common cause of hyperthyroidism in the UK?

Answer 21

Graves
Caused by IgG antibodies to TSH receptors in the thyroid
TSH-ab mimic TSH action
Seen in 90% of patients with graves and considered diagnostic

Question 22

Thyroid function tests - interpretation

Primary hypo vs hyperthyroidism

Answer 22

Question 23

Thyroid function tests - interpretation

Secondary/tertiary hypo vs hyperthyroidism

Answer 23

Question 24

Diagnosis?

Answer 24

Diabetes insipidus !

Lithium association with diabetes insipidus

Question 25

Diabetes insipidus results from a deficiency or resistance to …

Answer 25

ADH

Divided into central (low adh) and nephrogenic (resistance to ADH)

Question 26

Diabetes insipidus characteristics

Answer 26

Polyuria and polydipsia

Compensate by drinking lots

Question 27

Diabetes insipidus and lithium

Answer 27

Chronic lithium use is a classic cause of nephrogenic diabetes insipidus (approx 20%)