endocrine

Question 1

parathyroid adenoma (ie primary hyperparathyroidism):

• risk factors? 4
• what electrolyte abnormality occurs
• four groups of symptoms?

Answer 1

• elderly
• female (post-menopausal)
• radiation to neck
• MEN syndromes
• hypercalcaemia

Bones:

• aches/pains in large joints/bones
• osteoporosis/fractures

Stones:
- kidney stones

Moans:

• lethargy/fatigue
• depression

Groans:

• non-specific abdo pain
• constipation
• ‘groan’ about going to the toilet at night (nocturia) - also polydipsia and polyuria

Question 2

parathyroid adenoma (ie primary hyperparathyroidism):

• blood tests? 2 (+ results)
• other investigation?
• treatment?

Answer 2

• U+E (high Ca)
• serum PTH (low PTH)
  nb this is if primary hyperparathyroidism
• radioisotope scanning (+/- USS) to localise adenoma
• surgical parathyroidectomy

nb can use drugs if surgery contraindicated but not as good/curative

Question 3

Addison’s disease

• commonest cause?
• other causes? 4
• risk factor?
• commonest cause of secondary adrenal insufficiency?

Answer 3

• autoimmune destruction of adrenal cortex (80%)
• TB (commonest cause worldwide)
• adrenal mets from elsewhere
• lymphoma
• adrenal haemorrhage
• other autoimmune conditions
• sudden withdrawal of long term steroid use (much more common that primary Addison’s disease)

Question 4

Addison’s disease signs + symptoms:

• systemic? 6
• GI? 4
• psychiatric? 3
• symptoms of addisonian crisis? 5
• commonest causes of addisonian crisis? 2
• treatment?

Answer 4

• anorexia
• weight loss
• hyperpigmentation (buccal mucosa, pressure points, skin creases, recent scars)
  (- vitiligo + hair loss)
• postural hypotension
• fatigue
• myalgia
• nausea
• vomiting
• abdo pain
• diarrhoea/vomiting
  (think Addison’s in any unexplained abdominal pain or vomiting)
• depression
• psychosis
• low self-esteem
• vomiting
• abdo pain
• profound weakness
• hypoglycaemia
• hypovolemic shock

nb if caused by withdrawal of exogenous steroids then won’t cause hyper pigmentation (as this is caused by raised ACTH reacting w melanocytes)

• someone forgetting to take steroids (on long course)
• someone with known Addison’s getting ill with other infection and their steroids not being increased
• lifelong steroid therapy (try to mimic natural cortisol cycle)

Question 5

dd for Addison’s disease?

Answer 5

• anorexia nervosa

nb in anorexia: K is low, K is high in Addison’s

• any malignancy

many other things as well….