Endocrine

Question 1

Name 5 essential components to clinically assess, investigate & manage in order to treat & prevent recurrence of diabetic foot complications.

Answer 1

1. Peripheral neuropathy
2. Peripheral vascular disease
3. Ulceration
4. Infection
5. Maximise diabetes control

Question 2

At what toe pressure is an ulcer unlikely to heal?

Question 3

How do you diagnose infection of an ulcer?

Answer 3

1. Purulent discharge
   OR
2. Two or more of: pain, swelling, redness, warmth

Question 4

What are serological markers of osteomyelitis from a foot ulcer?

Answer 4

• Elevated WCC, CRP/ESR

- Elevated ALP

Question 5

What serum test is most diagnostic of prolactinoma?

Answer 5

Elevated serum prolactin

Question 6

What are the clinical features of prolactinoma in women & in men?

Answer 6

Women: galactorrhoea, oligomenorrhoea, amenorrhoea, infertility

Men: decreased libido, infertility, impotence, gynaecomastia (rarely galactorrhoea)

Question 7

What is the usual treatment for prolactinoma?

Answer 7

Dopamine agonists (cabergoline, bromocriptine)

Question 8

What common test is useful for the diagnosis of acromegaly?

Answer 8

Oral glucose tolerance test - failure to suppress GH release is diagnostic

Question 9

Pituitary macroadenoma =

Answer 9

GH-secreting

Question 10

Pituitary microadenoma =

Answer 10

Prolactinoma

Question 11

What is the first-line treatment of acromegaly?

Answer 11

Transphenoidal-hypophysectomy

Question 12

What blood test results could you expect in Cushing’s syndrome?

Answer 12

FBE: high-normal Hb, high WCC with low neutrophils
Glucose: elevated
Electrolytes: hypokalaemia & metabolic acidosis in ectopic ACTH
Hypercalciuria (urine test)

Question 13

What tests are used to diagnose Cushing’s syndrome?

Answer 13

• 24-hour urine free cortisol

- Dexamethasone suppression test (lack of suppression is diagnostic)

Question 14

What blood test results could you expect in Addison’s disease?

Answer 14

• Electrolytes: hyponatremia, hyperkalaemia, moderate acidosis, increased urea
• Hypoglycaemia

Question 15

What are some clinical features of Addison’s disease?

Answer 15

• Postural hypotension
• Fatigue
• Unintentional weight loss
• Hypoglycaemia
• Hyperpigmentation
• Unexplained hyperkalaemia

Question 16

What test is diagnostic of Addison’s disease?

Answer 16

Synacthen test (ACTH infusion test) - shows whether the adrenals can respond to an appropriate stimulus or not

Question 17

What is the management of an Addisonian crisis?

Answer 17

• Hydrocortisone 100mg IV 6 hrly
• Fluid replacement: IV N saline
• Glucose if hypoglycaemic

Question 18

What is the clinical triad of Conn’s syndrome?

Answer 18

• Hypertension
• Hypokalaemia
• Metabolic alkalosis

Question 19

What is diagnostic of primary hyperaldosteronism?

Answer 19

High aldosterone/renin ratio

Question 20

What are the treatment options in primary hyperaldosteronism (Conn’s syndrome)?

Answer 20

• Adrenal adenoma removal
• Aldactone (aldosterone antagonist)
• Amiloride (decreases potassium excretion)