LECT Approach to Endocrine Disorders II

Question 1

Primary disease

Answer 1

inhibits the action of downstream glands

Question 2

Secondary disease

Answer 2

indicative of a problem with the pituitary gland

Question 3

Tertiary disease

Answer 3

associated with dysfunction of the hypothalamus and its releasing hormones

Question 4

Causes of Endocrine Dysfunction

Answer 4

Hormone Excess: neoplastic growth of endocrine cells, autoimmune, excess hormone administration
Hormone Deficiency: autoimmune destruction, tumor infiltration, surgery, infection, inflammation, hemorrhage
Hormone Resistance: inherited, immunologic

Question 5

Hyperthyroidism and the HPI

Answer 5

Wight loss, anxiety, diaphoresis, heat intolerance, palpitations, amenorrhea, tremor, increased appetite, frequent bowel movements, proximal muscle weakness

Question 6

Causes of Hyperthyroidism

Answer 6

Graves’ disease, toxic multinodular goiter, toxic adenoma, de Quervain’s thyroiditis, Hashimoto’s thyroiditis, Jod-Basedow phenomenon, Amiodarone-induced thyroiditis, “subclinical hyperthyroid” (lowered TSH, euthyroid, normal T4, common in elderly)

Question 7

Hypothyroidism and the HPI

Answer 7

Fatigue, weight gain, anorexia, dry skin, cold intolerance, weakness, muscle cramps, impaired memory, depressed, hearing change, diminished sweating, voice hoarseness, brittle hair

Question 8

Hypothyroidism and potential causes

Answer 8

Hashimoto, iodine deficiency, subacute (de Quervain’s) thyroiditis after hyper phase, severe illness, drugs (lithium, amiodarone, propylthiouracil, methimazole, sulfonamides), deficient pituitary TSH, riedel’s

Question 9

Parathyroid: classic primary hyperparathyroidism

Answer 9

Increased calcium “bones, stones, and groans”

Question 10

PTH and Calcium

Answer 10

Kidney: 1-alpha hydroxylase converts active vitamin D, 25-hydroxy vit D
Intestine: Vitamin D helps intestines absorb calcium after it is activated by PTH

Question 11

Hypocalcemia

Answer 11

Trosseau’s Sign: carpopedal spasm when a blood pressure cuff is inflated
Chvostek’s Sign: contraction of the ipsilateral facial muscle elicited by tapping the facial nerve anterior to the ear (face twitches)

Question 12

Primary Hyperparathyroidism

Answer 12

Directly associated with hyperparathyroidism: nephrolithiasis and bone disease due to prolonged PTH exposure
Symptoms include to hypercalcemia include anorexia, nausea, constipation, polydipsia, and polyuria

Question 13

Adrenal Gland

Answer 13

Cushing’s Syndrome (cortisol excess), Cushing’s disease (secondary to pituitary ACTH hypersecretion), Adrenal insufficiency

Question 14

Cushing’s syndrome

Answer 14

Caused by overproduction of ACTH by pituitary or ingestion of exogenous corticosteroids
Presents with hypertension, central obesity, weakness, ecchymosis, hirsutism, depression, striae

Question 15

Adrenal insufficiency

Answer 15

Primary (Addison’s): autoimmune, removal or trauma, etc.

Secondary: pituitary failure, exogenous steroids

Question 16

Clinical manifestations of adrenal insufficiency

Answer 16

hyperpigmentation, weakness, fatigue, anorexia, nausea, vomiting, hypotension, salt craving, syncope

Question 17

Anterior Pituitary

Answer 17

ACTH, GH, TSH, FSH, LH, MSH, PRL

Question 18

Posterior pituitary

Answer 18

ADH, oxytocin