Maybe Pituitary
A female on no medications with no past medical history presents with chronic headaches, secondary menorrhea, galactorrhea, decreased FSH and LH
Prolactinoma
Healthy female presents with gradual onset of fatigue, weight gain, alopecia, constipation, a menorrhea, delayed reflexes, normocytic anemia, hyponatremia, hyperlipidemia. Next best test to order
TSH
35-year-old female with no past medical history, on no medications, develops hypertension, hypokalemia, decreased plasma renin activity, increased plasma aldosterone concentration
Adrenal tumor(Conn syndrome) or bilateral adrenal hyperplasia-primary hyperaldosteronism
Elderly patient has proximal muscle weakness, pain in the pelvic girdle, decreased calcium and phosphorus, increased alkaline phosphatase, increased PTH, decreased 25 hydroxy vitamin D and normal 1-25 hydroxy vitamin-D
Vitamin-D deficiency
Patient with a family history of MEN1 develops diabetes, weight loss, chronic diarrhea, a beefy red tongue, painful pruritic blistering rash
Glucagonoma
Postmenopausal female with gradual onset of headaches, mental fogginess, constipation and alopecia. Episodes of diaphoresis, pallor and tremors that improved with eating. Hyponatremia. Normocytic anemia. Hyperlipidemia. Decreased FSH and LH.
Hypopituitarism
Patient presents with gradual onset of tremulousness, anxiety, weight loss, diffuse muscle weakness, diarrhea, a menorrhea, hypertension, except almost. Increased calcium and alkaline phosphatase. Uptake and scan is diffusely increased
Graves disease
Healthy patient of 35 years presents with episodic headaches, palpitations, sweating and hypertension. What do you screen for?
24 hour urine fractionated metanephrines
A healthy patient with no symptoms. Screening lab work shows new onset hypercalcemia. Additional tests included normal albumin and a slightly increased PTH
Primary hyperparathyroidism
A known diabetic presents with confusion, fever, tachycardia, increased blood glucose, increased anion gap, decreased sodium, potassium and phosphorus
DKA
Postmenopausal female in no medications presents with headaches, loss of peripheral vision, weight gain and constipation. Delayed reflexes. Hyponatremia and decreased FSH and LH
Pituitary tumor causing hypogonadism and secondary hypothyroidism
Healthy patient presents with fatigue, painful swallowing, neck pain, tender goiter, decreased radioactive iodide uptake
Subacute thyroiditis caused by a virus or infectious thyroiditis
Patient presents with gradual onset of fevers and weakness, nausea and vomiting, sporadic abdominal pain, hypoglycemia, eosinophilia, normal bicarb and potassium. 60 minutes after cosyntropin, the serum cortisol is less than 20
Secondary adrenal insufficiency
Healthy patient presents with hypercalcemia on screening labs. Family history indicates relatives with hypercalcemia. Normal PTH. Urinary calcium is less than 100 mg per day
Familial hypocalciuric hypercalcemia
Patient presents with confusion or coma, plasma glucose is less than 55, consciousness and glucose improves after administration of IV glucose. During the episode, increased insulin level, proinsulin is 10 percent, undetectable C-peptide
Surreptitious use of insulin
Male with obstructive sleep apnea and extreme follow body odor presents with increasing ring in shoe sizes, frontal bossing, deepening of his voice, paresthesias in the ring and pinky fingers, tan-colored fleshy raw in the armpits. Increased plasma fasting glucose, hypertension, multiple adenomatous polyps
Acromegaly
Healthy patient presents with recent onset of anxiety and tremulousness that improves within days to weeks, decreased TSH and increased free T4. Decreased uptake on scan
painless thyroiditis
A type 1 diabetic develops gradual onset of fever, weakness, nausea, vomiting, sporadic abdominal pain and hand scan. Alopecia. Episodes of hypoglycemia on a previously stable insulin regimen. Hypotension. Delete reflexes. Hyponatremia. Increased TSH.
Hypothyroidism and adrenal insufficiency
Patient with advanced chronic kidney disease presents with hypocalcemia, increased phosphorus, increased alkaline phosphatase, increased PTH, normal 25 hydroxy vitamin-D
Secondary hyperparathyroidism due to chronic kidney disease
Patient presents with episodes of anxiety, diaphoresis, fogginess that occurs during fasting and resolves with eating. Plasma glucose is less than 55 during an episode. During hypoglycemia, normal insulin level. Proinsulin is 20 percent. Normal C-peptide.
Insulinoma
Premenopausal female presents with chronic malaise, constipation, alopecia, cold intolerance, galactorrhea, MRI indicates a modestly increased pituitary size, modestly elevated prolactin level
Hyperprolactinemia caused by hypothyroidism
Hospitalized patient in the ICU for ascending cholangitis presents with a decreased TSH, decreased free T4, decreased free T3
Euthyroid sick syndrome
Chronic alcoholic patient with hypertension and obesity presents with concentration of fat in the truncal region, small cervicodorsal fat pad, slightly increased urinary free cortisol also, a 1 mg overnight dexamethasone suppression test demonstrates suppression of the a.m. Cortisol production
Pseudo Cushing syndrome from alcoholism
Patient with lung cancer has increased calcium and normal phosphorus, increased alkaline phosphatase, decreased PTH. What is the treatment?
Treat the underlying malignancy, IV fluids, calcitonin, bisphosphonates
Patient with longstanding hypertension and diabetes mellitus, with uncontrolled blood sugars, microscopic proteinuria, develops hyperkalemia, progressive kidney disease, orthostatic hypotension, metabolic acidosis, normal anion gap
Secondary hypoaldosteronism caused by longstanding diabetes