Cushing’s Syndrome
Results Normal range 24 h urinary free cortisol 564 nmol/day (vol 1.62 L) <147 nmol/day 24 h urinary free cortisol 489 nmol/day (vol 1.93 L) <147 nmol/day 1 mg…
Diagnosis and Management of Hypocalcaemia in Adults
Low PTH High PTH Others Destruction of parathyroid glands by surgery or radioactive iodine Vitamin D deficiency or resistance Hypomagnesaemia Autoimmune destruction of parathyroid glands Chronic kidney disease Drugs Irradiation…
A 25-Year-Old Woman with Headache and Joint Pain
Fig. 8.1 Pre-operative MRI pituitary. Pre-contrast T1 weighted images in the coronal (a) and sagittal (b) plain show a homogenous mass arising from the pituitary fossa and invading the left…
Hypothyroidism Complicated by Hypothyroid Coma
Fig. 2.1 Chest x-ray on admission to accident and emergency ECG: rate 50/min regular, flat T waves in III, AVF, V4–6. Urgent CT-head, no abnormality detected. Comment on Her FBC…
Salt-Wasting Crisis in a Newborn
Fig. 14.1 Pathways of steroid metabolism. A block due to deficiency of 21-hydroxylase causes accumulation of precursors (17-hydroxyprogesterone, androstenedione, testosterone) and deficiency of glucocorticoids (cortisol) and mineralocorticoids (aldosterone) Classical 21-Hydroxylase…
Diagnosis and Management of Polycystic Ovary Syndrome (PCOS)
Differential diagnoses Hirsutism and/or hyperandrogenaemia Oligomenorrhea or amenorrhea Distinctive characteristics Clinical features Laboratory tests Hyperprolactinaemia; prolactinoma Mild or absent Present Galactorrhoea; macroprolactinomas may cause visual disturbances headache, cranial nerve palsies…
Hyperthyroidism in Pregnancy
Test, units Result Reference range TSH, mIU/l <0.02 0.27–4.2 FreeT4, pmol/l 48 12–22 FreeT3, pmol/l 12.6 3.1–6.8 TRAb, IU/l 7.2 ≤0.9 How would you manage this case? She wants to…
Weight Loss and Dizziness: Adrenal Failure
Features due to glucocorticoid insufficiency Weakness Malaise Weight loss Nausea and vomiting Hypoglycaemia Myalgia Anaemia Features due to mineralocorticoid insufficiency Hypotension Dehydration Hyponatraemia Features due to reduced adrenal androgens Decreased…
Polyuria and Polydipsia
Serum/plasma Spot urine 24-h urine Osmolality (mOsmol/kg) 298 86 – Sodium (mmol/L) 147 16 114 Potassium (mmol/L) 4.1 3 21 Urea (mmol/L) 2.5 30 215 Creatinine (μmol/L) 58 1.9…
Hypertension in Patients with Cushing’s Syndrome
Fig. 3.1 Diagnostic workup for patients with Cushing’s syndrome. Modified from Melcescu, Koch. Testing for endocrine hypertension, Chapter 7, In: Leslie De Groot, editor, online http:// www.endotext.org; 2012 Ectopic ACTH…
