Endocrine Physical

Diagnosis
Cases
Gail Nunlee-Bland, M.D.

Case 1
A19-year-old man presents with excessive
thirst and urination. Laboratory evaluation
shows the following: serum glucose = 88
mg/dl, serum sodium = 146 mmol/L, serum
osmolality = 298 mOsm/kg and urine
volume 8800 ml/24 hour.
The most likely diagnosis is:
1. Diabetes Mellitus
2. Hypercalcemia
3. Hypokalemia
4. Diabetes Insipidus
5. Drug intoxication
What additional study would you like to
obtain?
Case 2
A 32-year-old woman
presents with the recent
onset of fatigue, palpitations,
profuse sweating and
emotional liability. Her free
T4 is 3.8 ng/dl (nl 0.7-2.7 ) and
TSH is <0.03uU/ml (nl 0.5-5.0)
The most likely cause for this clinical
presentation is:
A. Untreated Graves
B. Hashimotos thyroiditis
C. Antibodies directed against various
retroorbital tissue components
D. cocaine
Which pathological specimen correlates with the patient?
A
B
Treatment of this condition can include:
A. Antithyroid medication
B. Surgery
C. Radioactive iodine
D. Beta blocker
E. All of the above

Case 3
A 19-year-old man has experienced fatigue,
muscle weakness, and dizziness for the past 3
weeks. This morning, he fainted when he went
outdoors to exercise. His blood pressure is
95/60 and his pulse is 110. His skin is cool, dry
and tanned. His thyroid feels normal.
Laboratory testing shows the following:
hematocrit =36%, glucose =62 mg/dl, sodium =
120 meq/L, potassium =6.7 meq/L, creatinine =
1.4 mg/dl, BUN = 36 mg/dl.
Based on this
presentation, you
would give:
A. Hydrocortisone
B. Insulin
C. Dialysis
D. Beta blocker
E. Dopamine


Case 4
A 34-year-old woman presents with
galactorrhea, amenorrhea, headaches,
fatigue, and weight gain. Laboratory
evaluation reveals the following: prolactin
58 ng/ml (nl 2-25), free T4=0.2 ng/dl (nl, 4.5-
12) and TSH > 60 uU/ml (nl, 0.5-5.0). She has
an enlarged pituitary gland on MRI.
The most likely cause for this enlarged pituitary
gland is:
A. Prolactinoma
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Craniopharyngioma
Case 5
A 25-year-old woman presents with fatigue, easy
bruising, elevated blood pressure, weight gain of
50 pounds over a year, and increase in hair over
her face. She was hospitalized on a psychiatric
unit because of her irrational behavior.
Possible cause(s) for this is:
A. Exogenous steroids
B. Pituitary adenoma
C. Adrenal carcinoma
D. Adrenal adenoma
E. All of the above
Case 6
A 41-year-man is referred to your clinic for primary prevention.
He is a nonsmoker and does not have a family history of CHD,
but is hypertensive on treatment. On physical examination his
blood pressure is 140/80 Hg, his weight is 205 with a BMI of
30.0 and a waist circumference of 43 inches. Fasting blood
work demonstrates a total cholesterol of 223, an LDL of 148
mg/dl, and HDL of 33 mg/dl, triglycerides of 209 mg/dl, and a
glucose of 112 mg/dl.
What treatment would you give him:
A. Weight loss through diet and exercise
B. Start a statin
C. Start antihypertensive medication
D. All of the above

Case 7
A 70-year-old moderately obese gentleman with a
past history of mild hypertension presents with
polydipsia, polyuria and a 10 pound weight loss.
His laboratory studies reveal the following fasting
values: plasma glucose 240 mg/dl, triglyceride of
450 mg/dl, HDL- cholesterol 25 mg/dl and a serum
creatinine of 2.3 mg/dl
Does he meet the criteria for having The
Metabolic Syndrome?
Which antidiabetic agent is contraindicated?
a. Rosiglitazone
b. Metformin
c. Repaglinide
d. Acarbose
e. All of the above
If you elected to start him on rosiglitazone what
precautions should you take?
a. Start him on a low dose
b. Evaluate him for any evidence of borderline
congestive failure
c. Monitor his weight
d. Monitor him for fluid retention
e. All of the above
Case 8
A 62-year-old woman presents for evaluation of recent
nephrolithiasis and low back pain. Her estimated
calcium intake is 800 mg/day, and she takes no vitamins.
Her physical examination is unremarkable. Spinal x-rays
reveal osteopenia and a compression fracture at L2.
Laboratory evaluation shows the following: serum
calcium 13.0 mg/dl (nl 8.5-10.5), phosphorus = 2.3 mg/dl
(nl 2.5-4.5), albumin = 4.4 g/dl (nl 3.2-5.5), intact PTH = 72
pg/ml (nl, 11-54), and 24 hour urine calcium = 92 (100-
300)
Which laboratory study would not be consistent with a
diagnosis of primary hyperparathyroidism?
A. Serum calcium
B. Urine calcium
C. Intact PTH
D. Phosphorus
E. Serum albumin