Endocrine Pt II

8/12/2019 Endocrine Pt II

1/23

Endocrine Physical

Diagnosis

CasesGail Nunlee-Bland, M.D.


2/23

Case 1

A19-year-old man presents with excessive

thirst and urination. Laboratory evaluation

shows the following: serum glucose = 88

mg/dl, serum sodium = 146 mmol/L, serum

osmolality = 298 mOsm/kg and urine

volume 8800 ml/24 hour.


3/23

The most likely diagnosis is:

1. Diabetes Mellitus

2. Hypercalcemia

3. Hypokalemia

4. Diabetes Insipidus

5. Drug intoxication


4/23

What additional study would you like to

obtain?


5/23
http://www.endotext.org/neuroendo/neuroendo2/figures2/figure8.jpg


6/23

Case 2

A 32-year-old woman

presents with the recent

onset of fatigue, palpitations,

profuse sweating and

emotional liability. Her free

T4 is 3.8 ng/dl (nl 0.7-2.7 ) and

TSH is


7/23

The most likely cause for this clinical

presentation is:

A. Untreated Graves

B.Hashimotos thyroiditis

C. Antibodies directed against various

retroorbital tissue components

D. cocaine
http://images.google.com/imgres?imgurl=http://hubnet.buffalo.edu/ophthalmology/site/Home/Eye_Disorders/Double_Vision/Exophthalmos__Graves_disease_.jpg&imgrefurl=http://hubnet.buffalo.edu/ophthalmology/site/Home/Eye_Disorders/Double_Vision/double_vision.html&h=254&w=372&sz=26&tbnid=TZBi0X_B48iwSM:&tbnh=80&tbnw=118&hl=en&start=1&prev=/images%3Fq%3DGraves%2BDisease%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DRNWG,RNWG:2004-43,RNWG:enhttp://images.google.com/imgres?imgurl=http://hubnet.buffalo.edu/ophthalmology/site/Home/Eye_Disorders/Double_Vision/Exophthalmos__Graves_disease_.jpg&imgrefurl=http://hubnet.buffalo.edu/ophthalmology/site/Home/Eye_Disorders/Double_Vision/double_vision.html&h=254&w=372&sz=26&tbnid=TZBi0X_B48iwSM:&tbnh=80&tbnw=118&hl=en&start=1&prev=/images%3Fq%3DGraves%2BDisease%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DRNWG,RNWG:2004-43,RNWG:en


8/23

Which pathological specimen correlates with the patient?

A

B
http://images.google.com/imgres?imgurl=http://www.md.huji.ac.il/mirror/webpath/ENDO018.jpg&imgrefurl=http://www.md.huji.ac.il/mirror/webpath/ENDO.html&h=331&w=504&sz=182&tbnid=b9lz6ZSlOcKyVM:&tbnh=84&tbnw=128&hl=en&start=1&prev=/images%3Fq%3DHashimoto%2527s%2Bpathology%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DRNWG,RNWG:2004-43,RNWG:enhttp://www.lmp.ualberta.ca/resources/pathoimages/Images-G/000p043z.jpg


9/23

Treatment of this condition can include:

A. Antithyroid medication

B. Surgery

C. Radioactive iodine

D. Beta blocker

E. All of the above


10/23

Case 3

A 19-year-old man has experienced fatigue,

muscle weakness, and dizziness for the past 3

weeks. This morning, he fainted when he wentoutdoors to exercise. His blood pressure is

95/60 and his pulse is 110. His skin is cool, dry

and tanned. His thyroid feels normal.

Laboratory testing shows the following:

hematocrit =36%, glucose =62 mg/dl, sodium =120 meq/L, potassium =6.7 meq/L, creatinine =

1.4 mg/dl, BUN = 36 mg/dl.


11/23

Based on this

presentation, you

would give:

A. Hydrocortisone

B. Insulin

C. Dialysis

D. Beta blocker

E. Dopamine
http://www.emedicine.com/derm/images/1872der0761-03.jpg


12/23

Case 4

A 34-year-old woman presents withgalactorrhea, amenorrhea, headaches,

fatigue, and weight gain. Laboratory

evaluation reveals the following: prolactin

58 ng/ml (nl 2-25), free T4=0.2 ng/dl (nl, 4.5-

12) and TSH > 60 uU/ml (nl, 0.5-5.0). She hasan enlarged pituitary gland on MRI.


13/23

The most likely cause for this enlarged pituitarygland is:

A. Prolactinoma

B. Primary hypothyroidism

C. Secondary hypothyroidism

D. Craniopharyngioma


14/23

Case 5

A 25-year-old woman presents with fatigue, easy

bruising, elevated blood pressure, weight gain of50 pounds over a year, and increase in hair over

her face. She was hospitalized on a psychiatric

unit because of her irrational behavior.


15/23

Possible cause(s) for this is:

A. Exogenous steroids

B. Pituitary adenoma

C. Adrenal carcinoma

D. Adrenal adenoma
http://spiral.univ-lyon1.fr/polycops/Endocrinologie/Cushing.gif


16/23

Case 6

A 41-year-man is referred to your clinic for primary prevention.

He is a nonsmoker and does not have a family history of CHD,

but is hypertensive on treatment. On physical examination hisblood pressure is 140/80 Hg, his weight is 205 with a BMI of

30.0 and a waist circumference of 43 inches. Fasting blood

work demonstrates a total cholesterol of 223, an LDL of 148

mg/dl, and HDL of 33 mg/dl, triglycerides of 209 mg/dl, and a

glucose of 112 mg/dl.


17/23

What treatment would you give him:

A. Weight loss through diet and exercise

B. Start a statin

C. Start antihypertensive medicationD. All of the above


18/23

Case 7

A 70-year-old moderately obese gentleman with a

past history of mild hypertension presents with

polydipsia, polyuria and a 10 pound weight loss.His laboratory studies reveal the following fasting

values: plasma glucose 240 mg/dl, triglyceride of

450 mg/dl, HDL- cholesterol 25 mg/dl and a serum

creatinine of 2.3 mg/dl


19/23

Does he meet the criteria for having TheMetabolic Syndrome?


20/23

Which antidiabetic agent is contraindicated?

a. Rosiglitazone

b. Metforminc. Repaglinide

d. Acarbose

e. All of the above


21/23

If you elected to start him on rosiglitazone what

precautions should you take?

a. Start him on a low dose

b. Evaluate him for any evidence of borderline

congestive failure

c. Monitor his weight

d. Monitor him for fluid retentione. All of the above


22/23

Case 8

A 62-year-old woman presents for evaluation of recent

nephrolithiasis and low back pain. Her estimated

calcium intake is 800 mg/day, and she takes no vitamins.

Her physical examination is unremarkable. Spinal x-rays

reveal osteopenia and a compression fracture at L2.

Laboratory evaluation shows the following: serum

calcium 13.0 mg/dl (nl 8.5-10.5), phosphorus = 2.3 mg/dl

(nl 2.5-4.5), albumin = 4.4 g/dl (nl 3.2-5.5), intact PTH = 72

pg/ml (nl, 11-54), and 24 hour urine calcium = 92 (100-300)


23/23

Which laboratory study would not be consistent with a

diagnosis of primary hyperparathyroidism?

A. Serum calcium

B. Urine calcium

C. Intact PTHD. Phosphorus

E. Serum albumin

Endocrine Pt II

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