endocrine pt ii
TRANSCRIPT
-
8/12/2019 Endocrine Pt II
1/23
Endocrine Physical
Diagnosis
CasesGail Nunlee-Bland, M.D.
-
8/12/2019 Endocrine Pt II
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.
-
8/12/2019 Endocrine Pt II
3/23
The most likely diagnosis is:
1. Diabetes Mellitus
2. Hypercalcemia
3. Hypokalemia
4. Diabetes Insipidus
5. Drug intoxication
-
8/12/2019 Endocrine Pt II
4/23
What additional study would you like to
obtain?
-
8/12/2019 Endocrine Pt II
5/23
http://www.endotext.org/neuroendo/neuroendo2/figures2/figure8.jpg -
8/12/2019 Endocrine Pt II
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
-
8/12/2019 Endocrine Pt II
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 -
8/12/2019 Endocrine Pt II
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 -
8/12/2019 Endocrine Pt II
9/23
Treatment of this condition can include:
A. Antithyroid medication
B. Surgery
C. Radioactive iodine
D. Beta blocker
E. All of the above
-
8/12/2019 Endocrine Pt II
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.
-
8/12/2019 Endocrine Pt II
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 -
8/12/2019 Endocrine Pt II
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.
-
8/12/2019 Endocrine Pt II
13/23
The most likely cause for this enlarged pituitarygland is:
A. Prolactinoma
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Craniopharyngioma
-
8/12/2019 Endocrine Pt II
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.
-
8/12/2019 Endocrine Pt II
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 -
8/12/2019 Endocrine Pt II
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.
-
8/12/2019 Endocrine Pt II
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
-
8/12/2019 Endocrine Pt II
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
-
8/12/2019 Endocrine Pt II
19/23
Does he meet the criteria for having TheMetabolic Syndrome?
-
8/12/2019 Endocrine Pt II
20/23
Which antidiabetic agent is contraindicated?
a. Rosiglitazone
b. Metforminc. Repaglinide
d. Acarbose
e. All of the above
-
8/12/2019 Endocrine Pt II
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
-
8/12/2019 Endocrine Pt II
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)
-
8/12/2019 Endocrine Pt II
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