Endocrinology

• A 15-year-old boy of 7 ft in height complains of constant headache,

weakness and increase sweating.
• He also had blurred vision and diplopia.
• On examination, he is found to have coarse facial features, large hands
and feet.
• He has not yet attained puberty.
• Investigation reveals high growth hormone level and increased blood
glucose level

1. What is the probable diagnosis?

2. What is the most likely cause for his symptoms?
3. How is the condition treated?
4. How does this condition differ from similar condition seen in adults?
2. A 45-year-old male comes to the hospital with complaints of headache, diplopia
and giddiness.
• He also complains that his face is gradually changing leading to protrusion of
lower jaw.
• He has observed that his hands and feet have become large in recent months.
• On examination, his blood pressure is found to be 150/100 mm Hg and chest X-
ray reveals cardiomegaly.
• On ultrasound examination of abdomen, he is found to have
hepatosplenomegaly.
• What is the probable diagnosis?
• What is the most likely cause for his symptoms?
• How is the condition treated?
• How does this condition differ from similar conditions seen in children?
3. A 25-year-old male who has recently had a head injury complained of sudden
increase in urine output. He also has immense thirst, nocturia and generalized
weakness. Blood and urine analysis showed the following results:
Fasting blood sugar – 95mg/dL
Serum osmolarity – 305 mosm/kg of water
Specific gravity of urine - <1.005
Urine volume – 10L/day
Urine glucose - Nil
• What is the probable diagnosis?
• What is the cause for his symptoms?
• How do you explain the values obtained during blood and urine examination?
• How is the condition treated?
4. A 45-year-old female complained of puffiness of face, swelling around the
eyes, dry scaly skin and generalized weakness.
• Examination showed bradycardia and hypotension.
• Blood examination showed elevated levels of serum TSH and decreased level of
plasma T3 and T4.
• Which hormone is involved in this condition?
• What are the other signs and symptoms of this disease?
• How is this condition treated?
• A 41-year-old woman presents to her primary care physician with weight and
hair loss, diarrhea, nervousness, and eye pressure. She has no medical
problems, but some of her family members have similar symptoms and
require medication. On examination, she is noted to have exophthalmos, an
enlarged nontender goiter, hyperreflexia, and a tremor when her arms are
outstretched.
• The patient has a decreased thyroid-stimulating hormone (TSH) level and an
increased free thyroxine (T4) level.
• What is probable diagnosis.
• What is the physiological basis of symptoms.
• What is the mechanism by which high levels of iodine inhibit thyroid
production?
• What is the treatment?
5. A 60-year-old male underwent a total thyroidectomy for thyroid malignancy.
He was given thyroid hormone replacement therapy. 48 hours later he
developed cramps in the muscles of the hand. He also showed signs of
continuous twitching of the muscles. A few hours later he developed laryngeal
spasm. Investigation showed the following values:
Urine calcium – 25 mg/dL Urine Phosphorus – 0.1 g/day
Plasma Calcium – 6 mg/ d/L Plasma phosphorus 0 5 mg/dL
Administration of oral vitamin D and calcium gluconate reduced the
symptoms.
What is the cause for this condition?
What are the hormones regulating serum calcium? Discuss their mode of action.
What is the cause for symptoms seen in this case?
Comment on the values obtained during blood and urine tests.
What are the tests done to detect this condition in its latent phase?
6. A 40-year-old male presented with symptoms of weakness, fatigue, weight
loss and anorexia. Examination revealed increased pigmentation of skin and
mucous membranes. Blood investigations revealed the following:
Fasting blood glucose – 60 mg/dL
Serum sodium – 125 Meq/L
Serum Chloride – 95 Meq/L
Serum potassium – 6.5 Meq/L
Hematocrit – 50%
Plasma cortisol was low. ACTH levels were high. There was no significant rise in
plasma cortisol after administration of ACTH.
• What is the cause for this condition?
• What is the cause for symptoms seen in this case?
• Comment on the values obtained during blood test.
• How is this condition treated?
7. A 20-year-old male with history of type 1 diabetes mellitus on
irregular treatment was brought to the hospital.
• His blood glucose was very high, urine glucose, ketones and serum
ketone levels were increased.
• Serum bicarbonate was <11 Meq/L. His respiratory rate and depth was
increased. His breath had acetone odor.
• Blood pressure was 90/60 mm Hg. Pulse was rapid and weak.

• What is the cause for this condition?

• What is the cause for symptoms seen in this case?
• How is this condition treated?
8. A middle aged man complains of weakness, polyuria, polydypsia &
increased appetite.
• He also has poor wound healing.
• Investigations revealed:
• Fasting blood sugar: 160mg/100ml,
• Postprandial blood sugar: 260mg/100ml.

• QUESTIONS:
• a)What is your diagnosis?
• b)Explain the cause of polyuria and polydipsia.
• c)Give the reason for poor wound healing?
• A 36-year-old woman presents to her gynecologist with complaints of
amenorrhea and hirsutism. She has also noticed an increase in her weight
(especially in the trunk region) and easy fatigability. She denies any medical
problems. Her periods were always normal until 6 months ago, and her
hirsutism has been gradual in onset. On examination, she has a very rounded
hirsute face with centripetal obesity. Her blood pressure is elevated, as is her
weight compared with previous visits. On abdominal examination, she is noted
to have striae and a male-like distribution of hair on the lower abdomen. The
patient then undergoes studies that demonstrate increased cortisol production
and failure to suppress cortisol secretion normally when dexamethasone is
administered.
• what is the provisional diagnosis.
• Why is there moon face and buffalo hump?
• Why is hyperpigmentation not found in patients with secondary
adrenocortical insufficiency?
• What is the basis of hypertension?
• A 70-year-old woman is brought to the emergency department with
right flank pain, nausea, vomiting, and blood in her urine. She has no
fever or urinary tract symptoms. She has recurrent kidney stones,
vague abdominal pain, muscle weakness, and atrophy. On
examination, she is in moderate distress secondary to her flank pain.
She appears thin and fragile. Other than right back pain, her physical
examination is normal. Urinalysis reveals large amounts of blood but
no signs of infection. An intravenous pyelogram (IVP) is performed
and reveals numerous kidney stones. A metabolic panel shows an
extremely elevated calcium level and PTH.
• What is the provisional diagnosis?
• Which is the regulation of the hormone involved?
• What are the other signs and symptoms seen in the condition?
Give the physiological basis for the following questions

1. Exophthalmos Is a feature of graves disease

2. Lack of Iodine In the diet leads to goiter
3. There is increased risk of osteoporosis and fracture after Menopause
4. tetany occurs in hyperventilation
5. Carpopedal spasm occur in tetany
6. Patient with alkalosis are more susceptible to hypo calcemic tetany
7. Moon face and buffalo Hump are features of glucocorticoid excess
8. About 85% of patients with Cushing syndrome are hypertensive
9. Eosinopenia is seen in glucocorticoid excess
10. Absence of edema in primary hyperaldosteronism or conn syndrome
11. Hyper pigmentation of skin and mucosa occurs in primary adrenal
insufficiency
12. in diabetes mellitus there will be muscle wasting and weight loss even if
there is increased food in take
13. polyuria polydipsia and polyphagia occur Current Diabetes mellitus
14. Diabetic patients are more prone for infections
15. ketoacidosis and Kussmaul breathing are features of severe Diabetes
mellitus