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Clinical Endocrine Quiz

Clinical Endocrine Quiz. QUESTION 1. There are two sorts of tests available for people who are either hyposecreting or are hypersecreting . What are the tests? What are the principles behind the tests? Give examples of such tests to illustrate these principles. QUESTION 1 (cont.).

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Clinical Endocrine Quiz

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  1. Clinical Endocrine Quiz

  2. QUESTION 1 • There are two sorts of tests available for people who are either hyposecreting or are hypersecreting. • What are the tests? • What are the principles behind the tests? • Give examples of such tests to illustrate these principles

  3. QUESTION 1 (cont.)

  4. QUESTION 2 Ms W. Melons, a 38 year old woman, had bled heavily during labour. Two days after delivering the baby, Ms Melons suddenly complains of having a severe headache and feeling very tired. She begins vomiting as well. What would some expected long-term effects of this?

  5. QUESTION 2 (cont.) • The patient has Sheehan’s Syndrome. It’s a pituitary infarct that gets triggered by women who experience heavy bleeding during labour. It causes a severe hyposecretion of many pituitary hormones (PRL, TSH, GH, GnRH, ACTH) • She’s expect to see: agalactorrhoea, fatigue, cold intolerance, amenorrhoea, oligomenorrhoea, lower muscle mass etc

  6. QUESTION 3 Pituitary adenomas can often cause mass effects. What are the consequences of mass effects? • Suprasellarextension • Sellaturcica lesions • Visual abnormalities • Raised ICP • Hypopituitarism • Infiltration into ventricles  hydrocephalus due to obstruction • Extension into sphenoid sinus  CSF rhinorrhoea • Compression of neural contents of cavernous sinus

  7. QUESTION 4 Mr Y. Kameda presents to the clinic with nausea, vomiting and skin pigmentation. He also complains about feeling dizzy when standing up. You suspect he has Addison’s disease and you get his bloods tested. Fill out the table on the next page with the results you’d expect to see:

  8. QUESTION 4 (cont.)

  9. QUESTION 5 Miss I. Engel, a 15 year old girl, is rushed into the clinic and is complaining of headache, sweating and palpitations. You check her vitals and of note, her blood pressure is 160/100. Her urinary catecholamines are high. An abdominal CT is performed.

  10. QUESTION 5 (cont.) Which of these would be most likely? Phaeochromocytoma Renal artery stenosis Pituitary adenoma Conn’s syndrome Cushing’s syndrome

  11. QUESTION 6 Mr J. Hutt, aged 50, presents into the clinic because he’s been having difficulty with peripheral vision and headaches. Of particular note, Mr Hutt appears to have central obesity and a hump on the back of his neck. Mr Hutt says that he’s also feeling weak and has now broken out in acne. You suspect he’s got Cushing’s Syndrome. How would you confirm this?

  12. QUESTION 6 (cont.) • 48 hr low dose dexamethasone suppression • Shows ↑ cortisol production + failure to suppress cortisol secretion when dosed on dexamethasone • 24 hr urinary free cortisol (UFC) • Less reliable • Circadian rhythm • Take cortisol at 9am and 12am • CS: high midnight levels, 9am may be normal • Normal: high at 9am, low at night • Insuiln stress test • Induces hypoglycaemia  increased ACTH response • Look for blunted response

  13. QUESTION 7 You now want to find out the cause of Mr Hutt’s CS. What are some ways you could do this? • Plasma ACTH • Pituitary MRI (detects pituitary adenomas) • High dose dexamethasone suppression (see if ACTH comes from ectopic source or adrenal tumour) • Chest X-ray (look for paraneoplastic tumours e.g. lung cancers)

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