Chapter Answers

1. Outline changes in endocrine control that occur throughout life. 

Answer: Growth and development regulated during two growth spurts: the infant growth spurt before and shortly after birth, and the adolescent growth spurt around puberty.

During the menopause, secretion of the ovarian hormones diminishes and leads to reduced activity of the female reproductive system. With ageing there is reduced growth hormone and other hormones involved in calcium metabolism and the person becomes frail and may develop osteoporosis. 

2. Explain the commonest cause of anterior hyperpituitarism? Outline the groups of signs and symptoms that occur.

Answer: Hyperpituitarism is mainly caused by secretions from a pituitary adenoma, which is a neoplasm (new growth) in the anterior pituitary. It does not form secondary growths.

There are two groups of signs and symptoms:

  1. Endocrine abnormalities: related to the different types of cell in the anterior pituitary gland secreting, e.g., growth hormone, ACTH, prolactin
  2. Effects of expansion of mass: pressure on surrounding tissues can lead to disturbances of vision, increased intracranial pressure, acute haemorrhage.

 

3. What are the groups of causes of short stature in children? Give at least one example in each group. Describe the main signs and symptoms of growth hormone deficiency in babies and children.

Answer: 

  • Endocrine disorders: growth hormone deficiency, hypothyroidism
  • Genetic factors: Down syndrome, Turner syndrome
  • Medical conditions and treatment: chronic illness, e.g. renal disease
  • Small at birth: familial small stature, retarded growth in utero
  • Psychosocial factors: early life deprivation, emotional deprivation

4.Name the condition that occurs with excess growth hormones in adults. Outline the main signs and symptoms of this condition.

Answer:  

The condition is acromegaly.

Signs and symptoms:

  • Tissue enlargement: soft tissues continue growth, causing swelling of small bones of hands and feet, development of characteristic facial features:

o deep voice and tendency to get bronchitis

o kyphosis, degenerative arthritis, arthralgia of spine, hips and knees

o most body organs grow and enlarged heart and atherosclerosis can result

  • Metabolic disturbances – altered fat and carbohydrate metabolism:

o increased free fatty acids released into body fluids

o decreased glucose uptake into muscle and adipose tissues, increased glucose release from the liver and increased insulin secretion

o insulin resistance causes impaired glucose tolerance and diabetes mellitus

  • Other changes:

o excessive sweating, moderate weight gain, muscle weakness and fatigue, menstrual irregularities, decreased libido, hypertension, sleep apnoea

o paraesthesias due to nerve entrapment

o headaches, hemianopia due to pressure on the optic chiasm/chiasma

5. What is Cushing’s syndrome? Describe the presentation of this condition.

Answer: 

  • Elevated levels of corticosteroid hormones
  • Altered fat metabolism: obesity/weight gain, protruding abdomen with stretch marks, buffalo hump on shoulders, rounded (moon) face
  • Increased protein breakdown: muscle weakness, thinning of limbs
  • Altered calcium metabolism and bone proteins: osteoporosis with back pain, compression of vertebrae, rib fractures. Renal calculi may develop
  • Disturbed glucose metabolism, sometimes causing diabetes mellitus
  • Increased gastric acid secretion, hirsutism, mild acne, menstrual irregularities, decreased libido
  • Inhibited inflammation and immune response
  • Mental health changes: mild euphoria to psychosis

6. What is hyperaldosteronism? How does it present?

Answer: 

  • Excess secretion of mineralocorticoids (aldosterone-secreting adenoma/hyperplasia)
  • Hypertension due to increased sodium and water reabsorption expanding ECF volume raising cardiac output. Hypokalaemia often occurs, leading to weakness, paraesthesia and visual disturbances

7. What are the three main causes of acute primary adrenal cortical insufficiency?

Answer: 

  1. Crisis: unable to respond to stressor due to chronic corticosteroid lack
  2. Exogenous corticosteroids rapidly withdrawn, adrenals unable to respond
  3. Massive adrenal haemorrhage damaging cortex. Due to: trauma and hypoxia, anticoagulants, disseminated intravascular coagulation, overwhelming bacterial infection

8. What is a phaeochromocytoma and how does it present?

Answer: 

Neoplasm of adrenal medulla: chromaffin cells secrete catecholamines.

Most have continually raised blood pressure with paroxysmal events with:

  • sudden, rapid rise in blood pressure
  • tachycardia, palpitations, headache, sweating, tremor, apprehension
  • possibly abdominal or chest pain, nausea and vomiting

May cause cardiac disturbances: myocardial infarction, congestive heart failure, or cerebrovascular accidents.