MT training: endocrine

A 24-year-old college student, known diabetic, was admitted for treatment of ketoacidosis. He had a several-year history of diabetes and had been taking insulin in the morning and in the evening. After the history was pieced together from the patient and his friends, it appeared that he had been getting progressively ill over several days following a flu-like episode and may well not have taken his insulin on the day of admission. He was found, slightly drowsy and confused, by classmates. His respirations were rapid, his pulse was 126 and he offered no sensible answer to questions. Blood sugar level was elevated at 728 mg/dl (100 mg/dl is normal) and blood ketones were positive. The patient was treated with insulin intravenously and over the course of the next 24 hours the ketoacidosis cleared.

Questions

1. Ketoacidosis is a complication of

a. Diabetes insipidus

b. Diabetes mellitus

c. Both a&b

2. A symptom of ketoacidosis is

a. Tachypnea

b. Bradycardia

c. Hypoglycemia

3. Ketoacidosis occurs when

a. Insulin blood levels are high

b. Sugar is not transported to cells and fats are burned improperly

c. Insulin is given intravenously.

Case Report 2.

A 42-year-old women presented with a 6 month history of progressive weakness. She had facial and central obesity with muscle wasting in the extremities. As an initial screening test, a 24-hour urine collection for cortisol determination revealed high levels. Her ACTH level was low. On CT Scan a 3 cm mass was found in the left adrenal. When the mass was resected, it proved to be 3 cm, smooth, yellow adrenocortical adenoma that secreted cortisol. The patient’s condition (cushing’s syndrome) normalized after surgery.

Questions

1. Symtoms of Cushing’s syndrome are

a) Hirsutism and hypergonadism

b) Palpitations.

c) Moon - like fullness of the face and deposition of fat.

2. What factors pointed to a diagnosis of Cushing’s syndrome?

a) pituitary gland tumor on CT scan

b) hypersecretion of ACTH

c) hypersecretion of cortisol and adrenal mass on CT scan.

3. Surgery performed to correct this condition was

a) Adrenocortical adenoma resection

b) Hypophysectomy

c) Both a and b

Case Report 3

Graves disease as characterized by exophathalmia and stare, was diagnosed in a 51-year-old man. Examination revealed a history of nervousness, palpitation, weight loss, diarrhea, dyspnea on exertion, insomnia, heat intolerance and fatigue. An ECG showed atrial fibrillation with a ventricular rate of about 180 beats per minute, which was treated with digoxin and propranolol. A chest X-ray film disclosed cardiomegaly. Thyroid function test showed T3 and T4 levels to be elevated and a thyroid scan showed diffuse enlargement of the gland. The patient was treated with radioactive iodine and is now euthyroid. The exophthalmia has not resolved, however.

Questions

1. Symptoms of grave’s disease are

a. Bulging eyeballs

b. Difficult breathing on exertion

c. Both a and b

2. Atrial fibrillation means that

a. The heart is enlarged

b. The heart rate is less than 180 beats per minute

c. The heart rate is rapid and irregular

3. Blood tests revealed that

a. The thyroid gland was hypersecretion

b. The thyroid gland was hyposecreting

c. Goiter was present

4. The patient was treated and

a. Exophthalmia has regressed

b. Is still having palpitations

c. His thyroid gland is functioning normally.