Objectives • Revise the pathways involved in Adrenal Function • Define the clinical features associated with common Adrenal Pathologies • Interpret the investigations used in Adrenocortical abnormalities • Outline the management of an Addisonian Crisis
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Objectives•Revise the pathways involved in
Adrenal Function•Define the clinical features
associated with common Adrenal Pathologies
•Interpret the investigations used in Adrenocortical abnormalities
•Outline the management of an Addisonian Crisis
Hypothalamus
CRF
Ant. Pituitary
ACTH
Adrenal Cortex
Cortisol
35 year old female.........
•feels like she has put on weight particularly on chest, stomach & face
•noticed bruising and “stretch marks”
•feels down and has no energy•periods have been quite irregular
3. A 36-year-old woman presents with feeling tired and cold all the time. On examination a firm, non-tender goitre is noted. Blood tests reveal the following:
TSH - 34.2 mU/lFree T4 - 5.4 pmol/l
What is the most likely diagnosis?A. Primary atrophic hypothyroidismB. Pituitary failureC. De Quervain's thyroiditisD. Iodine deficiencyE. Hashimoto's thyroiditis
A 34-year-old woman who takes hydrocortisone and fludrocortisone replacement therapy for Addison's disease presents for review. She has a three-day history of a productive cough associated with feeling hot. On examination the chest is clear, her pulse is 84 / min and temperature is 37.7ºC. You elect to prescribe an antibiotic given her medical history. What is the most appropriate advice with regard to her adrenal replacement therapy:
a)Keep the same hydrocortisone and fludrocortisone dose
b)Double both the hydrocortisone and fludrocortisone dose
c)Double the hydrocortisone dose, keep the same fludrocortisone dose
d)Convert her to prednisolone for the duration of the illness
e)Stop the hydrocortisone and fludrocortisone until the patient recovers
2. A 33-year-old female is referred by her GP with thyrotoxicosis. Following a discussion of management options she elects to have radioiodine therapy. Which one of the following is the most likely adverse effect?
A. HypothyroidismB. Thyroid malignancy C. AgranulocytosisD. OesophagitisE. Precipitation of thyroid eye disease
A 45-year-old woman is investigated for weight gain. She had had been unwell for around four months and described a combination of symptoms including depression, facial male-pattern hair growth and reduced libido. During the work-up she was found to be hypertensive with a blood pressure of 170/100 mmHg. Which one of the following tests is most likely to be diagnostic?
a)Renin:aldosterone levels
b)High-dose dexamethasone suppression test
c)Pelvic ultrasound
d)Overnight dexamethasone suppression test
e)24 hr urinary free cortisol
A 23-year-old woman presents with sweating and tremor. Her thyroid function tests are as follows:
TSH - <0.05 mU/lFree T4 - 25 pmol/l
What is the most common cause of this presentation?A. Hashimoto's thyroiditisB. Graves' disease C. Toxic nodular goitreD. De Quervain's thyroiditisE. Toxic adenoma
4. A 43-year-old woman presents for follow-up in clinic. She was diagnosed with Hashimoto's thyroiditis four months ago and is currently being treated with levothyroxine 75 mcg od. What is the single most important blood test to assess her response to treatment?
A. ESRB. TSHC. Free T4D. Total T4E. Free T3
Which one of the following is the cause of Cushing's disease?
a)Ectopic ACTH production
b)Adrenal adenoma
c)Micronodular adrenal dysplasia
d)Adrenal carcinoma
e)Pituitary tumour
5. A 40-year-old woman complains of feeling tired all the time and putting on weight. On examination a diffuse, non-tender goitre is noted. Blood tests are ordered:TSH - 15.1 mU/lFree T4 - 7.1 pmol/lESR - 14 mm/hrAnti-TSH receptor stimulating antibodies - NegativeAnti-thyroid peroxidase antibodies - Positive
What is the most likely diagnosis?A. Pituitary failureB. Primary atrophic hypothyroidismC. De Quervain's thyroiditisD. Hashimoto's thyroiditisE. Grave's disease
A 30 year old hypertensive man presents with the following blood results:
Na 147mmol/LK 2.8 mmol/LUr 4.0 mmol/LCr 50 micromol/LGlucose 4 mmol/L
What is the diagnosis?
a) Coarctation of the aorta
b) Conn’s syndrome
c) Cushing’s disease/syndrome
d) Polycystic kidney disease
e) Primary (essential) hypertension
6. A 52-year-old woman who was diagnosed as having primary atrophic hypothyroidism 12 months ago is reviewed following recent thyroid function tests (TFTs): TSH - 12.5 mU/lFree T4 - 14 pmol/l She is currently taking 75mcg of levothyroxine once a day. How should these results be interpreted? A. Poor compliance with medicationB. Taking extra thyroxineC. Evidence of recent systemic steroid therapyD. Keep on same dose E. T4 to T3 conversion disorder
A 30-year-old woman presents to the endocrinology clinic with bruising, striae, acne and hirsutism. On examination, the patient appears lethargic and depressed, with centripetal obesity and demonstrable proximal myopathy. Blood pressure is 165/106 mmHg and blood tests reveal Na+ 136 mmol/l, K+ 2.8 mmol/l and random glucose 8.2 mmol/l. A low-dose dexamethasone test and 24-hour urinary cortisol test are ordered.
What is the most common cause of Cushing’s syndrome?