SUM - CH4 - Endocrine

Question 1

Adrenal Insufficiency - Causes

Answer 1

Primary:
Autoimmune (idiopathic),
Infectious (TB, fungal)
Metastatic cancer

Secondary:
Pts on long term steroid therapy
Hypopituitarism

Question 2

Adrenal insufficiency - Clinical features:

Answer 2

Cortisol loss:

• GI: Nausua, vomiting, anorexia, abdominal pain, weight loss
• Mental: lethargy, confusion, psychosis
• Hypoglycemia
• Hyperpigmentation

Aldosterone loss:

• Hyponatremia, hypovolemia: shock, weakness, syncope
• Hyperkalemia

Question 3

Primary adrenal insufficiency - Treatment

Answer 3

Daily oral glucocorticoid and daily fludrocortisone

Question 4

SIADH: Source

Answer 4

Posterior pituitary or ectopic

Question 5

SIADH: Two major effects

Answer 5

Volume expansion, and Hyponatremia

Question 6

SIADH: Edema?

Answer 6

No, due to natriuresis (despite hyponatremia)

• ANP –> sodium excretion
• Volume expansion decreases tubular sodium absorption
• The renin-angiotensin-aldosterone system is inhibited

Question 7

SIADH: Diagnosis

Answer 7

Diagnosis of exclusion:

• Hyponatremia and conc. urine
• Low serum uric acid level
• Low BUN and creatinine
• Absence of significant hypervolemia

Question 8

SIADH: Treatment:

Answer 8

Asymptomatic: water restriction
- normal saline + loop diuretic if faster results required

Symptommatic: Restrict water intake
- Give isotonic saline, hypertonic saline may be indicated in severe cases