PSS Endocrine 2 Dr Naguib Salleh (Thyroid, Ca2+ homeostasis, Pancreas, Adrenal)

1. a. Explain the following signs and symptoms seen in hyperparathyroidism: i. hypercalciuria. ii. nocturia b. Severe hyperparathyroidism may cause the heart to stop beating. Explain.

2. i. Explain whether a person with panhypopituitarism would have goitre ii. Explain the importance of thyroid hormone in children.

3. A 28-year old woman began to note nervousness, tremor, weight loss with a vor acious appetite, thirst, sweating, heat intolerance and a rapid heart rate.

a. What is the most likely diagnosis? b. Discuss the steps involved in the synthesis of the hormones directly involved ? c. How is the release of the hormone normally controlled? d. How may control have been altered in this patient? e. Explain the changes in the patient on the basis of the physiological actions of the hormones.

4. Mrs Connell, a 66 year old widow, complained that she had experienced difficu lty listening over the telephone for at least a year. She gained 3 kg in weight and had become increasingly depressed and weepy. Her daughter had noticed that her mother had s lowed up so that her home was relatively unkempt. The heating was also turned up. On examination there was no cerumen in the auditory canals, the tympanic membranes were

normal and the Weber test showed that hearing was equal on both sides. However, she did not hear the ticking of a watch held against either pinna. She had coarse fe atures; oedema around her eyes and her skin was dry. Her scalp hair was coarse and britt le and her voice was husky and her speech slow. No motor or sensory deficits were found , but the relaxation phase of the ankle jerk was considerably delayed.

1. What is the most likely diagnosis and why? 2. What tests could be performed to confirm this diagnosis? 3. Explain the changes underlying the signs and symptoms. 4. Describe the possible mental changes that may occur with this disorder? 5. How would you manage this patient?

5. Tessa, 25 years old, suffers from hyperthyroidism. She was treated with thiou racil and propranolol. After 4 months of treatment, she complained of being easily tired an d cannot stand cold temperature. She had also gained weight and her heart rate was 54 bpm .

a) Explain the basis of the treatment with thiouracil and propranolol. b) Explain what was causing her to experience those symptoms after 4 months eatment.

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6. In conditions of pheochromocytoma, patients may suffer from episodic or conti nuous hypertension or orthostatic hypertension. Based on your knowledge in Physiology, explain the mechanisms that may lead to orthostatic hypertension.

7. Give physiological explanation for the following signs and symptoms seen in p atients with uncontrolled diabetes mellitus: (i) high plasma osmolarity (ii) hypovolemia (iii) Kussmaul breathing

8. a. Mr Hasan has a tumor that secretes aldosterone excessively. Explain the ch anges observed in the following parameters: (i) blood pressure (ii) plasma potassium concentration (iii) arterial blood pH (iv) plasma renin concentration

b. Right heart failure also increases aldosterone secretion and ECF volume. Exp lain why Mr Hasan does not suffer from edema whereas a patient with right heart failure wou ld have oedema.

9. Give physiological explanations for these signs & symptoms observed in diabet es mellitus as follows:

a. Genital infection

b. c. d. e.

Polydipsia Tingling & numbness Blurred vision Seizures and CNS symptoms

10. Explain the pathophysiological basis of the signs & symptoms that occur in o verdosage of insulin injection.

11. Explain the basis of these conditions:

a. b. c. d.

hyperpigmentation in Cushing s Disease Fat redistribution in Cushing s. Hirsuitism in Cushing s Syndrome Hypertension in Cushing s.

e. Secondary hyperaldosteronism. f. Steroid applications in eczema.

12. Madam Khoo, 43 years old was found to show signs and symptoms of Cushing syn drome. ACTH level was found to be very low whereas the cortisol level was high when det ermined in the morning as well as at night. a. Would Madam Khoo have hyperpigmentation? Explain your answer. b. Explain why her plasma ACTH level was low. c. State one exogenous cause for Cushing syndrome. d. State the normal pattern for plasma cortisol level and compare it with that for Madam Khoo. e. State whether the plasma Na+ concentration in Madam Khoo is normal and expla in your answer. f. Explain why Madam Khoo may have a high risk for osteoporosis.