Common Endocrine Diseases

Chapter 43 Common Endocrine Diseases




Clinical Case Problem 1 A 25-Year-Old Man with “Visual Problems,” Headaches, Weight Gain, Sweating, and “Hands and Feet That Are Changing”


A 25-year-old man comes to your office with his wife. He is very concerned about some “bizarre symptoms” that he has been experiencing. He is the chief executive officer of a family-owned manufacturing company and is “really embarrassed to go out in public any longer.” He tells you that approximately 6   months ago, he began to experience the following symptoms: headaches, visual spots or defects, weight gain, an appearance of his forehead growing, enlarging hands and feet (he could no longer get his gloves and shoes on), and increased sweating.


On examination, mental status is normal, and the apical impulse is felt in the fifth intercostal space, midclavicular line. His blood pressure is 170/105   mm Hg. He does have a protruding brow, and three discrete visual field defects are noted (two in the left eye and one in the right eye). His tongue appears enlarged, and he is sweating profusely.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. adrenocorticotropic hormone (ACTH) excess

b. acromegaly

c. prolactinoma

d. primary hypopituitarism

e. primary hyperparathyroidism

2. The pathophysiologic lesion resides in which of the following?


a. adrenal gland: adenoma

b. hyperparathyroid glands: adenoma in one or more of the four glands

c. pituitary gland: adenoma

d. gastrointestinal ectopic tumor: adenoma

e. none of the above

3. The treatment(s) for this patient may include which of the following?


a. microsurgery: transsphenoidal

b. stereotactic radiotherapy

c. cabergoline

d. growth hormone receptor antagonists

e. all of the above

f. none of the above


Clinical Case Problem 2: A 24-Year-Old Man with Weakness and Hyperpigmentation


A 24-year-old man comes to your office with the following symptoms: an extreme feeling of weakness, a 20-pound weight loss, a change in the color of his skin (his skin has become hyperpigmented), and lightheadedness and dizziness.


On examination, the patient has definite skin hyperpigmentation since you last saw him 9   months ago. His blood pressure is 90/70   mm Hg. He looks acutely ill.


On laboratory examination, his serum sodium is low (115   mEq/L), his serum potassium is high (6.2   mEq/L), his serum urea is elevated at 9   mg/dL, and his serum calcium is elevated (12   mg/dL).



4. On the basis of his history, physical examination, and laboratory findings, what is the most likely diagnosis of this patient?


a. Conn syndrome

b. Cushing syndrome

c. Addison syndrome

d. primary hyperparathyroidism

e. primary pituitary failure

5. What is the most likely cause of this patient’s symptoms?


a. overstimulation of the adrenal gland

b. an adrenal adenoma

c. autoimmune destruction of the hyperparathyroid glands

d. autoimmune destruction of the adrenal gland

e. a pituitary adenoma

6. What is the acute treatment of choice for this patient?


a. prednisone orally

b. dexamethasone orally

c. hydrocortisone intravenously

d. ACTH intravenously

e. Depo-Provera intramuscularly

7. This patient will need chronic treatment with which of the following?


a. hydrocortisone

b. fludrocortisone acetate

c. a or b

d. a and b

e. none of the above


Clinical Case Problem 3: A 25-Year-Old Woman with Increased Thirst and Urination


A 25-year-old woman presents with the sudden onset of increased thirst and increased urination. This began abruptly 1   week ago and has not abated since. She states that since then, she has been thirsty all the time. The only significant illness in her life has been the recent diagnosis of bipolar affective illness that was made 12   weeks ago. She started taking lithium carbonate and currently is taking 1200   mg/day. Her serum lithium levels have been normal since the beginning.


On examination, her blood pressure is 110/70   mm Hg. She has lost 5 pounds during the past week and looks somewhat dehydrated.



8. What is the most likely diagnosis in this patient?


a. psychogenic polydipsia

b. diabetes mellitus type 1

c. central diabetes insipidus

d. nephrogenic diabetes insipidus

e. adverse drug reaction to lithium

9. What is the treatment of choice in this patient?


a. hospitalization and complete psychiatric assessment

b. insulin: beginning at 10 to 20   units/day

c. glyburide

d. discontinuation of lithium carbonate

e. substitution of carbamazepine for lithium carbonate


Clinical Case Problem 4: An Overly Tired 37-Year-Old Woman with Hypertension


A 37-year-old woman comes to your office because she was found to be “hypertensive” by a nurse in a shopping mall screening program. She tells you that when she thinks about it, she really has not felt well for a couple of months. Her major complaint has been profound generalized fatigue and weakness. She has also been increasingly thirsty, urinating more frequently, and having to urinate frequently at night.


On physical examination, her blood pressure is 190/110   mm Hg. Laboratory abnormalities include mildly increased serum sodium (150   mEq/L), hypokalemic metabolic alkalosis, low renin level, and increased urine potassium.



10. What is the most likely diagnosis on the basis of the information presented?


a. Conn syndrome

b. Cushing syndrome

c. Addison syndrome

d. Bartter syndrome

e. diabetes insipidus

11. What is the most likely pathophysiologic cause of this syndrome?


a. benign adenoma of the adrenal gland

b. malignant adenoma of the adrenal gland

c. pituitary adenoma

d. bilateral hyperplasia of the adrenal gland

e. none of the above

12. What is the treatment of choice for the condition described here?


a. bromocriptine

b. transsphenoidal surgery

c. clomiphene

d. spironolactone

e. surgical removal of the adenoma


Clinical Case Problem 5: A 2-Year-Old Woman with Breast Secretions, Amenorrhea, and Decreased Libido


A 22-year-old woman, married for 18      months, has been trying to get pregnant without success. Approximately 9    months ago, she developed breast secretions, amenorrhea, and decreased libido. No other symptoms are present.


On examination, there is definite galactorrhea present. Her blood pressure is 140/80   mm Hg. No abnormalities are found on physical examination.



13. From the information provided, what is the most likely diagnosis?


a. anorexia nervosa

b. stress-induced amenorrhea

c. pregnancy

d. prolactinoma

e. hypopituitarism

14. If you could order only one test, what would that test be?


a. serum estrogen

b. serum progesterone

c. serum luteinizing hormone

d. serum follicle-stimulating hormone

e. serum prolactin

15. What is the treatment of choice for this condition?


a. transsphenoidal resection

b. bromocriptine

c. clomiphene

d. lithium carbonate

e. thyroxine


Clinical Case Problem 6: A 42-Year-Old Woman with Increased Body Hair and Purple Streaks on Her Abdomen


A 42-year-old woman comes to your office with the following signs and symptoms: obesity (she has gained 40 pounds in the past 6   months), elevated blood pressure at her last walk-in clinic visit, increased body hair, purple streaks on her abdomen, “a fat face” (her description), and pains in her bones and joints.


She is taking no medication at present, nor has she been taking any medication for the past year.


On examination, her body mass index is 35   kg/m2. Her blood pressure is 160/110   mm Hg; she has obvious hirsutism over her entire body, and her abdomen (which is obese) has purple striae. Her face not only is plethoric but also demonstrates a double chin. Her thoracic spine shows evidence of what is known as a buffalo hump.



16. On the basis of the information provided, what is the most likely diagnosis in this patient?


a. Conn syndrome

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Common Endocrine Diseases

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