Endocrine SAQ Questions

Questions were made by students on behalf of The Peer Teaching Society. We hope there are no mistakes but are
not liable for any false or misleading information.

1. Ingrid, a 36-year-old woman with Crohn’s disease, went away on holiday for a few weeks, she had so much
fun that in the midst of it all she forgot to take her Crohn’s long-term medication. After a week, she started
feeling more tired, lost her appetite, and is dizzy upon standing.

What is the most likely cause of her symptoms? (1 mark)

2. State 3 types of cancers that can cause SIADH. (3 marks)

3. What ECG features would you expect to find in a patient with hyperkalaemia? (2 marks)

4. State 5 signs/ symptoms you might expect to see in a patient with hyperkalaemia? (5 marks)

5. Dave, a 50 year of male presents to clinic extremely worried about some bodily changes his wife noticed. His
hands have seemed to get larger as well has coarsening of his facial features.

a) What is the most likely cause of this condition? (2 marks)

b) On examination, you notice a loss of peripheral vision. What is this called and how is it caused? (2 marks)

c) Give 3 complications of this condition? (3 marks)

d) What is the first line investigation? (1 mark)

e) What is the first line treatment? (1 mark)

f) Give one other option of managing this condition. (1 mark)

6. A 30-year-old man presents with polyuria and polydipsia.

a) Give four differential diagnoses. (4 marks)

He has severe colicky right groin pain as well. A CTKUB shows a right sided renal calculus. His blood results
show:
eGFR >60 ml/min
Adjusted Ca2+ 3.1 mmol/l (2.1-2.6
mmol/l)
phosphate 0.6 mmol/l (0.8-1.4
mol/l)
PTH 5.9 pmol/l (1.6-6.9
pmol/l)
b) What is the most likely diagnosis? (1 mark)

c) What is the most likely cause of this diagnosis? (1 mark)

d) Give five more symptoms of this condition. (5 marks)

e) What is the definitive treatment? (1 mark)

7. A 43-year-old woman is referred to the endocrine clinic with symptoms of weight gain, fatigue and
headache. She was also recently diagnosed with type two diabetes.

a) Give 3 differential diagnoses (3 marks)

On examination, you note truncal obesity with proximal wasting of the arms and legs. Hirsutism is present,
and the skin appears thin with multiple striae and bruises.

b) What is your first line investigation? (1 mark)

c) What is the most common cause of Cushing’s Syndrome? (1 mark)

8. Fatima, a 30-year-old female, presents to clinic with generalised fatigue, headaches and paraesthesia. She
has been experiencing muscle cramps in her legs and has been too weak to go to her kickboxing practice.
She reports being constantly thirsty and constantly urinating.

a) Give 3 differential diagnoses (3 marks)

On examination, her BP is 158/110. She states that her father also had high blood pressure and passed away
from a stroke in his late 40s.

b) What is the main feature evident on a Urea and Electrolytes (U&E) blood test? (1 mark)

c) What is the first line investigation? (1 mark)

d) How do you distinguish between primary and secondary hyperaldosteronism? (2 marks)

9. A 55-year-old female presented to her GP with progressive abdominal pain and constipation. On further
questioning, the patient stated that she is not able to walk as far as she used to be able to due to bone pain.
The GP decided to take a sample of blood to test for urea & electrolytes, full blood count and thyroid
function tests as well as a bone profile. The blood results showed a high PTH and high serum calcium and
was subsequently diagnosed with primary hyperparathyroidism.

a) What ECG changes can be seen in hypercalcaemia? (1 mark)

b) Name two signs on clinical examination that can be seen on hypocalcaemia. (2 marks)

c) From which artery does the superior thyroid artery branch from? (1 mark)

d) Briefly outline the pathophysiology of malignancy. (1 mark)

10. Give 4 functions of parathyroid hormone. (4 marks)

 11. a) Give 3 generalised symptoms of a pituitary adenoma. (3 marks)

Blood tests show that there is increased circulating thyroid stimulating hormone (TSH) as a result of the
pituitary adenoma.

b) What specific signs or symptoms would you see? (3 marks)

12. a) What is carcinoid syndrome? (2 marks)

b) Give 3 signs or symptoms (3 marks)

13. a) What drug is commonly used to reduce thyroid hormone production? (1 mark)

b) Briefly outline the physiology of how this drug exerts its effects. (2 marks)

14. Provide 4 signs and/or symptoms of a patient experiencing DKA. (4 marks)

15. Phaeochromocytoma is a rare tumour of the adrenal medulla.

a) Of which cells is the tumour usually composed of? (1 mark)

b) Provide 3 symptoms someone with the tumour would experience. (3 marks)

Total Marks (76)

Endocrine SAQ Answers

Questio Answers
n
1. Secondary adrenal insufficiency due to corticosteroid withdrawal.

She would’ve been on a long-term corticosteroid (e.g. prednisone) for her Crohn’s disease which leads
to the suppression of the adrenal glands. With prolonged suppression, the adrenal glands atrophy,
which means that they can’t produce enough corticosteroids if exogenous corticosteroids are stopped
abruptly, leading to symptoms of adrenal insufficiency.

2. Small cell carcinoma (remember this one, comes up)

Prostate cancer
Pancreatic cancer
Lymphomas
Cancer of the thymus

3. Hyperkalaemia-associated ECG changes:

- Absent/flattened P waves
- Prolonged PR interval
- Tall-tented T waves
- Wide QRS complex
- Bradycardia

Hyperkalaemia is defined as plasma potassium ≥5.5

mmol/L. One of the most common causes is renal
impairment. It can be caused by many other things
such as: medications, DKA, Addison’s disease, trauma
and burns.

4. Muscle weakness/ Painful cramping / Paraesthesia

Neurological derangement/ irritability/ anxiety
Palpitations
Abdo cramping and diarrhoea
Dyspnoea
Hyperreflexia

https://geekymedics.com/hyperkalaemia/

5. a) GH secreting pituitary adenoma

b) Bitemporal hemianopia – pressure on the optic chiasm from a pituitary adenoma

 c) Obstructive sleep apnoea; IGT/T2DM; cardiomyopathy; hypertension; IHD/stroke; colorectal cancer

d) Serum IGF-1 raised (because GH release is pulsatile and IGF-1 levels increase with GH secretion -
the majority of GH biological consequences are due to IGF-1)

e) Transsphenoidal resection of the pituitary adenoma

f) Class, example
• SST analogues: octreotide
• GH antagonists: Pegvisomant
• DA agonists: bromocriptine, cabergoline
Stereotactic gamma knife

6. a) DM, DI, SIADH, primary polydipsia, hypercalcaemia

b) Primary hyperparathyroidism

c) Solitary adenoma (80%)

d)
• Bones: bone pain/facture
• Stones: renal/biliary stones
• Groans: constipation, abdo pain, PUD, pancreatitis
• Psychic moans: depression
• Thrones: polyuria, polydipsia

e) Total parathyroidectomy

7. a) Cushing’s syndrome, acromegaly, hypothyroidism

Diagnosis is Cushing’s disease.

b) Overnight dexamethasone suppression test

Cortisol following Cortisol following ACTH Interpretation

low-dose high-dose
dexamethasone dexamethasone
↓ ↓ No Normal
change
No change No change ↓ Cushing's syndrome (e.g. adrenal
adenomas)
No change ↓ ↑ Cushing's disease (i.e. pituitary adenoma
→ ACTH secretion)
No change No change ↑ ? ectopic ACTH syndrome

c) Most common cause of Cushing’s syndrome is from exogenous causes e.g. glucocorticoid use
(corticosteroids)

8. a) Primary hyperaldosteronism, SIADH, DM, renal artery stenosis

b) Hyperkalaemia

c) Aldosterone renin ratio (ARR)

d) High ratio = primary / low ratio = secondary

9. a) Shortening of the QT interval

b) Chvostek’s sign - tap over the facial nerve causes spasm of the facial muscles
Trousseau's sign - inflate the blood pressure cuff to 20mmHg above systolic for 5 minutes and the
hand should form a claw.

c) External carotid artery

Arterial supply to the thyroid gland arises from the external carotid artery and the thyrocervical
trunk. The superior thyroid artery is the first branch of the external carotid artery and the inferior
thyroid artery forms from the thyrocervical trunk which is the 3rd branch of the subclavian artery.
The branches of the subclavian artery are as follows in order - vertebral artery. Internal thoracic
artery, thyrocervical trunk, costocervical trunk.

d) Hypercalcaemia of malignancy is caused by excessive secretion of parathyroid hormone released

peptide (PTHrP)

10. • PTH increases bone remodelling and turnover. PTH stimulates osteoclasts to reabsorb bone mineral
which liberate calcium into blood (breaks down bone).
• PTH increases the amount of calcium reabsorbed in the kidney which means that less is excreted in
urine.
• PTH decreases phosphate reabsorption in the kidney.
• PTH decreases phosphate reabsorption in the kidney, increasing the amount excreted.
• PTH increases absorption of Ca2+ in the gut.
11. a)

• Headaches
• Vision problems (double vision, vision loss)
• Nausea or vomiting
• Changes in behavior, including hostility, depression and anxiety
• Changes in the sense of smell
• Nasal drainage
• Sexual dysfunction
• Infertility
• Fatigue (extreme tiredness)
• Unexplained weight gain or loss
• Achy joints or muscle weakness
• Early menopause
• Changes in your monthly periods (women)

B) Patients may present with symptoms of hyperthyroidism including sweating, heat intolerance, shaky
hands, palpitations, nervousness, increased stool frequency, weight loss, poor sleep quality, fatigue,
and irregular periods. They may also present with headache, visual disturbance, an enlarged thyroid
gland (goitre) and galactorrhoea (inappropriate milky discharge from the breasts)

https://www.yourhormones.info/endocrine-conditions/tsh-secreting-pituitary-
adenoma/#:~:text=What%20are%20the%20signs%20and,%2C%20fatigue%2C%20and%20irregular%20
periods.

12. • Symptoms
o common symptoms
§ cutaneous flushing
§ recurrent diarrhoea
• ↑ bowel motility
§ abdominal cramps
§ asthma-like wheezing
 • Physical exam
o erythema
o pellagra skin lesions
o wheezing
o hepatomegaly from metastases
o pulmonary systolic and diastolic heart murmur
§ cardiac involvement causes carcinoid heart disease
• primarily occurs on right side of the heart
o tricuspid valve most commonly affected

https://step2.medbullets.com/oncology/120477/carcinoid-syndrome

13. a) Carbimazole

b) Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, this
leads to decreased thyroid hormone production.

14. • Nausea/Vomiting
• Abdominal Pain
• Recued Conscious Levels
• Kussmauls Breathing
• Fruity Breath
• Polydipsia/Polyuria
• Hypotension
• Tachycardia
Absence of insulin leads to unrestrained hepatic gluconeogenesis and reduced peripheral uptake of
glucose. This results in the release of counterregulatory hormones such as adrenaline, noradrenaline,
glucagon, and cortisol. The actions of these hormones further include blood glucose levels. High
circulating levels of glucose leads to osmotic diuresis and dehydration, leading to symptoms of
polydipsia/polyuria. Loss of water from the body leads to hypotension and tachycardia. The presence of
ketones leads to fruity breath and Kussmauls breathing to maintain pH to a normal value.

15. a) Cells: Chromaffin Cells

b) Symptoms: Hypertension, Tachycardia/Palpitation, Diaphoresis, Hypertensive Retinopathy, Pallor

and Diabetes
The tumour is able to produce massive amounts of catecholamines, Metanephrine and
methoctramine. Which all cause the above symptoms.