Presenting Complaints For Common Conditions

Question 1

What disease has these presenting complaints?

• lethargy, weakness, weight loss, nausea and vomiting
• hyperpigmentation (especially palmar creases), vitiligo, loss of pubic hair in women
• hypoglycaemia, hypotension
• hyponatraemia, hyperkalaemia, increased creatinine

Answer 1

Addison’s disease -hypoadrenalism → commonest cause of hypoadrenalism (80% of cases)
Autoimmune destruction of adrenal glands
Decreased cortisol and aldosterone and androgens

Question 2

Addison’s disease is the commonest cause of primary hypoadrenalism. What are the other causes?

Answer 2

• tuberculosis
• AIDS
• metastases ( bronchial, breast brain carcinoma)
• meningococcal scepticaemia
• antiphospholipd syndrome
• adrenal haemorrhage
• late onset congenital adrenal hyperplasia

Question 3

What diagnosis is most likely with the following symptoms?

• mania
• tachycardia
• sweaty hands
• recent history of diarrhoea

Answer 3

Grave’s disease —> hyperthyroidism

Question 4

Graves’ disease is the most common cause of thyrotoxicosis. In what demographic are you most likely to see it?

Answer 4

Women aged 30-50 years

Question 5

Specific signs limited to Graves’ disease?

Answer 5

• Graves ophthalmopathy (30% of patients) - exophthalmos, corneal ulceration
• pretibial myxoedema
• thyroid a acropachy, a triad of: digital clubbing, soft tissue swelling of hands and feet, periosteal new bone formation

Question 6

What would be an expected histological finding in a muscle biopsy in someone with muscle weakness related to thyroid disease?

Answer 6

Checkerboard pattern with necrosis and regeneration

• thyroid disease can result in myopathy. Muscle cells will be of different sizes due to necrosis and regeneration, giving rise to a checkerboard pattern.

Question 7

DKA Presentation

Answer 7

• abdominal pain
• nausea and vomiting
• polyuria, polydipsia, dehydration
• Kussmaul breathing (deep hyperventilation)
• pear drops breath
• weight loss

Question 8

Causes of DKA (5 I’s)

Answer 8

Infection
Inter current Illness
Inappropriate withdrawal of insulin
Intoxication
Infarction (MI)

Question 9

Why does DKA present with HYPOKALAEMIA?

Answer 9

• DKA is caused by increased insulin
• insulin increases the action of the Na/K/ATPase pump, which increases potassium uptake into the cells, leading to hypokalaemia in extra cellular fluid

Question 10

Cushing’s syndrome causes hyper or hypokalaemia? Why?

Answer 10

Hypokalaemia
Because in high concentrations cortisol can exhibit mineralocorticoid e.g. aldosterone activity by binding to and activating Na/k/ATPase. This causes movement of potassium into the cells and can result in hypokalaemia.

Question 11

What is the affect of cortisol on insulin release?

Answer 11

Cortisol inhibits insulin production in an attempt to prevent glucose from being stored.