Endocrinology Pathology

Question 1

Hyposecretion of Adrenal Gland

Answer 1

Weakness, fatigue, anorexia, weight loss  
Skin pigmentation or vitiligo 
Hypotension 
Unexplained vomiting or diarrhoea
Salt Craving                         
Postural symptoms

Question 2

Autoimmune Addison’s causes

Answer 2

adrenal failure
+ve adrenal autoantibodies
associated autoimmune diseases

Question 3

Possible clues to the diagnosis of adrenal failure

Answer 3

Disproportion bw severity of illness & circulatory collapse / hypotension / dehydration

Unexplained hypoglycaemia

Other endocrine features (hypothyroidism, body hair loss, amenorrhoea = absence of a menstrual period)

Previous depression or weight loss

Question 4

Adrenal Insufficiency Ix

Answer 4

Routine bloods: U&E, glucose, FBC

*Adrenal Antibodies
VLCFA if -ve for men
Adrenal Imaging for Women

Random cortisol
>700 nmol/l (not Addison’s)
<700 nmol/l (adrenal status uncertain)

Synacthen test (basal ACTH)
If suspicion high & patient unwell, treat with steroids and do Synacthen test later

Question 5

Adrenal Insufficiency Treatment

Answer 5

Glucocorticoid replacement
Hydrocortisone

Mineralocorticoid replacement
Fludrocortisone (Synthetic steroid)

Question 6

Cushing’s syndrome

Answer 6

Excess corticosteroids 
Cortisol is a catabolic hormone:
Tissue breakdown (skin, muscle, bone weakness)
Sodium retention (Hypertension & HF)
Insulin antagonism (DM)

Question 7

Cushing’s syndrome

Signs and Symptoms

Answer 7

Muscle atrophy
Thin hands and feet
Bruising
Thin skin ulcers
Odema
Diabetes
Cardiac failure
Buffalo hump
Moon Face

Question 8

Management of pituitary tumours

Hypersecretion

Hyposecretion (of the normal pituitary)

Tumour

Answer 8

dopamine agonists (prolactinoma)
somatostatin analogues (acromegaly)
GH receptor antagonist (acromegaly)

cortisol, T4, sex steroids, GH
desmopressin

surgery (mostly transsphenoidal), Radiotherapy