Endocrine And Metabolic Diseases Short Essays

Question 1. Hypercalcemia

Answer:

Hypercalcemia Causes:

• Conditions associated with hypercalcemia and increased PTH levels
  • Hyperparathyroidism
  • Chronic renal failure
• Conditions associated with hypercalcemia and low PTH levels
  • Multiple myeloma
  • Sarcoidosis
  • Hyperthyroidism
  • Thiazide diuretics
  • Milk alkali syndrome
  • Familial

Hypercalcemia Clinical features

• Nausea, vomiting
• Pain in abdomen
• Dehydration
• Hypotension

Hypercalcemia Treatment:

• Avoid calcium-containing antacids
• Replacement of fluid and electrolytes by 4-6 l of normal saline
  • To correct dehydration, hypotension, and calcium levels
• Forced diuresis by saline and diuretic frusemide given 4 to depress tubular reabsorption of calcium
• Drugs given include a generation bis- phosphonate ex: pamidronate given as a single 4 dose of 15-60 mg in normal saline
• Calcitonin is used in emergency state
• Cinacalcet is used orally in hypercalcemia crisis

Question 2. Thyrotoxicosis

Answer:

Thyrotoxicosis

• It is a clinically toxic manifestation due to excess thyroid hormones

Thyrotoxicosis Causes:

• Common causes
• Grave’s disease
• Toxic nodular goitre
  • Multinodular
  • Solitary nodule
• Less common causes
  • Thyroiditis Drug-induced
  • Factitious
  • Iodine induced
• Rarely
  • Pituitary or ectopic TSH
  • Thyroid carcinoma

Thyrotoxicosis Clinical features:

• Goitre
• Weight loss, vomiting, diarrhea
• Increased pulse rate, dyspnea, arrhythmia
• Nervousness, restlessness, tremors, muscular weakness
• Perspiration, clubbing, loss of hair, pre-tibial myxoedema
• Amenorrhea, abortions, infertility, loss of libido
• Lid lag, exophthalmos, diplopia, watering of eyes
• Fatigue, heat intolerance, polydipsia

Question 3. Calcium homeostasis

Answer:

Regulation of Calcium/ Hemostasis:

• Calcium level is regulated by

Calcitriol

• It is the active form of vitamin D

Calcium homeostasis Mechanism:

• It also promotes calcification and remodeling of bone.

2. Parathyroid hormones

• Secreted by Parathyroid glands

Read And Learn More: General Medicine Question and Answers

Calcium Homeostasis Mechanism:

Question 4. Hypoglycemia-clinical features and management

Answer:

Hypoglycaemia

• It is defined as a fall in blood glucose concentration below 3.1 mmol/1

Hypoglycaemia Clinical Features:

1. CVS symptoms
   • Palpitation
   • Tachycardia
   • Anxiety
   • Cardiac arrhythmias
2. CNS symptoms
   • Tremors
   • Confusion
   • Headache
   • Tiredness
   • Difficulty in concentration
   • Slurred speech
   • Drowsiness
   • Convulsion
   • Coma
3. GIT symptoms
   • Nausea
   • Vomiting
4. Dermatological symptoms
   • Sweating
   • Hypothermia

Hypoglycaemia Management:

1. In unconscious patients
   • Stop anti-diabetic medication
   • Administer 50 ml of 50% intravenous glucose
   • Intramuscular injection of 1 ml of glucagon
2. Unconscious patients
   • Oral glucose intake
3. In severe cases
   • 1 mg glucagon subcutaneously or intramuscularly and repeated if necessary after 10 minutes

Question 5. Neurological complications of diabetes mellitus

Answer:

Neurological complications of diabetes mellitus

• Diabetes can involve any part of the nervous system except the brain
• Precipitating factors

1. Poor glycaemic control
2. Long control of diabetes

Pathological Changes:

• Axonal degeneration of myelinated and nonmyelinated fibers
• Patchy, segmental demyelination
• Vasculopathy

Question 6. Grave’s disease

Answer:

Grave’s disease

• Grave’s disease is a diffuse goiter affecting the whole functioning thyroid tissue causing hypertrophy and hyperplasia due to abnormal thyroid stimulants

Grave’s Disease Clinical Features

• It is a classical triad composed of

1. Goitre
   • Diffuse and symmetric enlargement of thyroid
   • The gland surface is smooth
   • Bruit is heard
2. Thyrotoxicosis
   • Excitability
   • Restlessness
   • Emotionally unstable
   • Insomnia
   • Muscle weakness
   • Fatigue
   • Myopathy
   • Heat intolerance
   • Increased sweating
   • Weight loss
   • Tachycardia
   • Palpitation
   • Increased cardiac output
   • Gynaecomastia
   • Increased libido
   • Pretibial myxoedema
3. Exophthalmos
   • Protrusion of eyeballs

Grave’s Disease Treatment:

1. Anti-thyroid drugs
   • To restore the patient to the euthyroid state
2. Radioactive iodine
   • It destroys thyroid cells and reduces the mass of thyroid-functioning tissue
3. Surgery
   • Reduce active thyroid mass

Question 7. Acromegaly- clinical features and complications

Answer:

Acromegaly:

• Acromegaly occurs due to excess secretion of GH later in life after epiphyseal closure

Acromegaly Clinical Features:

• Thick bones-larger hands and feet
• Enlarged skull
• Increased intracranial pressure
• Headache
• Photophobia
• Visual disturbances
• Hepatomegaly
• Cardiomegaly
• Osteoporosis
• Arthralgia
• Excessive sweating
• Myalgia
• Bowing of legs
• Barrel shaped chest

Acromegaly Oral Manifestations:

• Enlarged mandible
• Class 3 malocclusion
• Macroglossia D Thick lips
• Proclination of teeth
• Hypercementosis
• Large nose, ears, and prominent eyebrows
• Periodontitis
• Enlargement of maxillary air sinuses

Acromegaly Complications:

• High blood pressure (hypertension)
• Cardiovascular disease, particularly enlargement of the heart (Cardiomyopathy)
• Osteoarthritis
• Diabetes mellitus
• Precancerous growths (polyps) on the lining of your colon
• Sleep apnea is a condition in which breathing repeatedly stops and starts during sleep
• Carpal tunnel syndrome
• Reduced secretion of other pituitary hormones (hypopituitarism)
• Uterine fibroids, benign tumors in the uterus
• Spinal cord compression
• Vision loss

Question 8. Addison’s disease

Answer:

Addison’s disease

• It is due to progressive destruction of the three zones of the adrenal cortex and medulla with lymphatic infiltration

Addison’s Disease Clinical Features:

1. Glucocorticoid insufficiency
   • Weight loss
   • Nausea and vomiting
   • Malaise
   • Weakness
   • Anorexia
   • Diarrhea
   • Constipation
   • Postural hypotension
   • Hypoglycaemia
2. Mineralocorticoid deficiency
   • Hypotension
3. Loss of androgens
   • Reduction of pubic and axillary hair in females
4. Increased ACTH secretion
   • Pigmentation of exposed areas, pressure areas, mucous membranes, conjunctivae, and recently acquired scars

Question 9. Diabetes and surgery

Answer:

Diabetes and surgery

• Patients with diabetes need to maintain very good oral hygiene as they are prone to odontogenic, periodontal, and other infections
• In well-controlled diabetics, dental procedures generally do not require any special precautions
• Antibiotic coverage may be required
• In uncontrolled diabetics, infections and wound healing may be a problem even after minor procedures
• If major dental procedures or surgery is to be undertaken, prior control of diabetes by the physician is needed
• If the patient is on only oral antihyperglycemic drugs, he should start insulin
• Dental procedures may often reduce food intake and diabetics may go to hypoglycemia
• Dose adjustments may be required

Question 10. Gestational diabetes mellitus

Answer:

Gestational diabetes mellitus

• It is defined as glucose intolerance that develops during pregnancy and usually cures after delivery
• Persons affected are

1. Older women
2. Obese/overweight women
3. Women with a history of delivering large babies
4. Women with a history of gestational diabetes

Gestational Diabetes Mellitus Diagnosis:

• All women during pregnane}7 should be screened based on random blood sugar tests in each trimester
• 50 mg oral glucose is administered and serum glucose is measured at 60 min
• If the glucose level is less than 140 mg, it is normal if not then the following step is taken
• 100 mg of glucose is administered and glucose in the fasting state is measured at 1,2 and 3 hours
• Deviation from normal levels indicates gestational diabetes

Normal Values:

Question 11. Cushing’s syndrome

Answer:

Cushing’s syndrome

• Cushing’s syndrome is caused by increased plasma glucocorticoid levels due to enhanced production of cortisol

Cushing’s Syndrome Clinical Features:

• Age- common in 3rd and 4th decades of life
• Females are more affected
• Obesity
• Truncal fullness
• Moon facies
• Buffalo hump
• Purple striae are seen on the abdomen
• Oligomenorrhoea and amenorrhoea
• Impotence in males
• Elevated blood pressure
• Muscle weakness
• Bone pain
• Decreased glucose tolerance

Cushing’s Syndrome Investigations:

• Screening test
• Determine free cortisol in urine
• Plasma ACTH measurement
• Plasma ACTH levels of more than 200-500 Pg per ml indicate Cushing’s syndrome
• Dexamethasone suppression test
• Plasma values above 5 microgram/100 ml suggest Cushing’s syndrome

Cushing’s Syndrome Treatment:

• Medical treatment
• Metyrapone- dose- 2-6 g per day in divided dose
• Aminoglutethimide-1-2 g per day
• Surgical treatment
• Pituitary irradiation
• Adrenalectomy

Question 12. Eye signs on thyrotoxicosis

Answer:

Eye signs on thyrotoxicosis

1. Exophthalmos
   • It means protrusion of the eyeball
2. Spasm of the upper eyelid with lid retraction
3. Proptosis with widening of the palpebral fissure
4. Supraorbital and infraorbital swelling
5. Congestion, edema, and chemosis of the conjunctiva
6. Papilloedema
7. Corneal ulceration
8. External ophthalmoplegia
9. Weakness of the extrinsic ocular muscles
10. Other signs
    • Von Giraffe’s sign
      • When the patient is asked to look down, his upper eyelid fails to follow the rotation of the eyeball and thus lags behind
    • Joffroy’s sign
      • When the patient is asked to look upwards with the head fixed, there will be the absence of wrinkling on the forehead
    • Moebius sign
      • Failure of convergence of eyeballs
    • Dalrymple’s sign
      • Upper sclera is seen due to retraction of the upper eyelid
    • Stellwag’s sign
      • Absence of normal blinking