Chart- 1

A female patient has the following features: Moon face, buffalo

hump, truncal obesity, striae in the abdomen, osteoporosis.

Questions:

1. What is your diagnosis? (1)

2. What endocrine abnormality is the cause for the above

condition? (1)

3. What is the cardiovascular complication and metabolic

abnormality in the above condition? (1)

4. What happens to sodium and potassium levels in this

condition? (1)

5. What is the treatment of the above condition? (1)

1. What is your diagnosis?
Cushing’s syndrome

2. What endocrine abnormality is the cause for the above

condition
Increase in plasma glucocorticoids or hypercortisolism

3. What is the cardiovascular complication and metabolic

abnormality in the above condition?
 Cardiovascular complication – Hypertension
 Metabolic abnormality – Diabetes Mellitus
(Insulin – resistant)

4. What happens to sodium and potassium levels in this

condition?
 Retention of sodium ions.
 Depletion of potassium ions.

5. What is the treatment of the above condition?

Surgical resection of adrenal or pituitary tumor. Medical

adrenalectomy with high doses of drugs like ketoconazole,
metyrapone or amino glutethimide that inhibit cortisol
synthesis.
 Chart- 2

A 14 year old boy came with complaints of polyuria, polydipsia

and polyphagia.

On investigation: Blood sugar level – 350 mg/dl.

Questions:

1. What is the probable diagnosis? (1)

2.What are the reasons for Polyuria, polydipsia

and polyphagia (3)

3. How will you treat this condition? (1)

1. What is the probable diagnosis?
Diabetes mellitus –type1( since the patient s age is less than
15)

2. What are the reasons for Polyuria, polydipsia and

polyphagia?
Reason for Polyuria – When blood sugar crosses renal threshold
(180mg/dl), complete glucose reabsorption is not possible 
Glycosuria glucose decreases water re-absorption in PCT &
LOH  increased osmotic diuresis
Reasons for Polydipsia- Osmotic dieresis & Hyperglycemia 
increased osmolality of blood which act on thirst center (pre-
optic area) and causes polydipsia.
Reasons for polyphagia - Normally VM nucleus of
hypothalamus (Satiety center) is stimulated by entry of
glucose which is insulin dependent. The VM nucleus of
hypothalamus normally inhibit the feeding center ie., Lateral
nucleus of hypothalamus  results in Satiety.
In DM, absence of insulin though blood sugar level is more,
glucose entry to VM nucleus is decreased. This leads to
unopposed (increased) action of feeding center leads to
polyphagia.

3. How will you treat this condition?

Insulin – Subcutaneously
 Chart- 3

A 50 year old man with sedentary lifestyle came with

complaints of polyuria, polydipsia and polyphagia. On
investigation: Blood sugar level – 480 mg/dl.

Questions:

1. What is the probable diagnosis? (2)

2. What are the types of this disease? (2)

3. How will you treat this disease? (1)

 1. What is the probable diagnosis?
Diabetes mellitus –type II (since the patient s age is more
than 40 years)

2. What are the types of this disease?

Types:
 Juvenile diabetes mellitus(type-1/ Insulin dependent DM)-
less than 15 years
 MODY- MATURITY ONSET DIABETES of YOUNG .
 Diabetes mellitus(type-2/ Insulin Independent DM) – more
than 40 years
 Gestational DM.

3. How will you treat this disease?

Intravenous (i.v) insulin
 Chart- 4

A middle-aged woman came to OPD with complaints of loss of

weight, heat intolerance, irregular periods, tremors and
swelling in the neck.

On Investigation: T3&T4 were raised, TSH decreased.

Questions:

1. What is the probable diagnosis? (3)

2. How it is treated? (2)

1. What is the probable diagnosis?

HYPERTHYROIDISM- Since T3, T4 Elevated. TSH-

decreased. Symptoms are also suggestive of it.

2. How it is treated?
Treatment
a) Antithyroid drugs-Propyl thiouracil, methimazole,
carbimazole
b) Radioactive iodine
c) Surgery- Total/ subtotal Thyroidectomy
 Chart- 5

An adult female patient presents with the following features:

Cold intolerance, swollen face, edematous hands and feet, dry
& yellow skin, husky voice, constipation and extreme
somnolence.

Questions:

1. What is your diagnosis? What endocrine abnormality is the

cause for above condition? (1)

2. What happens to BMR & plasma cholesterol levels in this

patient? (1)

3. Write 3 blood investigations that can give the diagnosis? (1)

4. What type of edema is present in this patient? Why? (1)

5. What is the treatment for the condition? (1)

Answer:

1. What is your diagnosis?

Myxedema

2. What endocrine abnormality is the cause for above

condition?
Hypothyroidism in adults

3. What happens to BMR & plasma cholesterol levels in this

patient?
BMR decreases (to about -40) and plasma cholesterol is
usually elevated.

4. Write 3 blood investigations that can give the diagnosis?

Estimation of T3, T4 and TSH.

5. What type of edema is present in this patient? Why?

Non-pitting edema. Because of the deposition of
myxedematous tissue under the skin. (collection of
protein, hyaluronic acid & chondroitin sulfate in
interstitial spaces retains water and cause edematous
look).

6. What is the treatment for the condition?

Thyroxine tablets replacement.
 Chart- 6
Mrs. X underwent total thyroidectomy 6 months back. Her
serum Sodium, Potassium and Calcium levels were 142m Eq/L,
4 mEq/L, 7 mg/dl respectively. She used to get paresthesia and
numbness at the finger tips and perioral areas with
spontaneous muscle cramps.

Questions:

1. What is the clinical diagnosis? (1)

2. Write down the normal serum calcium levels (1)

3. Name 2 relevant clinical signs to demonstrate (2)

4. How will you treat this condition? (1)

1. What is the clinical diagnosis?
Hypoparathyroidism

2. Write down the normal serum calcium levels

9 to 11 mg/dl

3. Name 2 relevant clinical signs to demonstrate

This condition.
1. Trousseau’s sign
2. Chvostek’s sign

4. How will you treat this condition?

Calcium supplementation
 Chart- 7

A patient has the following features: Headache, Visual

disturbances, enlargement of hands and feet, protrusion of
lower jaw, increase in size of nose and tongue, kyphosis.

Questions:
1. What is your diagnosis?
2. What is the cause for the abnormality? What could be the
age of the above patient?
3. What metabolic abnormality is usually present in the
above condition?
4. Hyper secretion of which other hormone is associated with
the above condition?
5. Will there be increase in height in the above patient?
6. What is the cause for the visual defects in the above
patient?
1. What is your diagnosis?
Acromegaly.

2. What is the cause for the abnormality? What could be the

age of the above patient?
Tumor of the anterior pituitary (acidophilic) producing
excessive growth hormone after adolescence. The age of
the above patient will be after puberty.

3. What metabolic abnormality is usually present in the

above condition?
Impaired glucose tolerance (or) diabetes mellitus.

4. Hyper secretion of which other hormone is associated with

the above condition?
Prolactin (in 20-40% of patients).

5. Will there be increase in height in the above patient?

No, there won’t be increase in height in this patient
because the epiphysis of long bones would have been fused
at puberty.

6. What is the cause for the visual defects in the above

patient?
Local pressure effects of the pituitary tumor on the optic
pathway.
 Chart- 8

A child presents with the following features: Stunted growth,

infantile sexual development, protrusion of tongue, pot belly &
severe mental retardation.

Questions:

1. What is your diagnosis? What endocrine abnormality is the

cause for above condition? (1)

2. What is the reason for pot belly and stunted growth? (1)

3. What is the nutritional deficiency in mother which can lead to

this condition? (1)

4. What is the characteristic feature about mentalretardation? (1)

5. What is the treatment for the child? When should treatment be

started for the child? (1)
1. What is your diagnosis?
Cretinism

2. What endocrine abnormality is the cause for above

condition?
Hypothyroidism from birth

3. What is the reason for pot belly and stunted growth?

In this condition, skeletal growth is characteristically
more inhibited than soft tissue growth. So soft tissues
enlarge excessively giving pot belly while skeletal growth
is stunted.

4. What is the nutritional deficiency in mother which can

lead to this condition?
Iodine deficiency during pregnancy.

5. What is the characteristic feature about mental

retardation?
It is the most common cause of preventable mental
retardation in children all over the world.

6. What is the treatment for the child? When should

treatment be started for the child?
 Prompt replacement of thyroxine is the treatment.
 Treatment should be started as soon as possible after
the diagnosis is made or in the first 6 months of life.
 Chart- 9

A restless patient presents with the following features: Goitre,

exophthalmos, heat intolerance, sweating, increased appetite,

fine tremors of the hands.

Questions:

1. What is your diagnosis? What endocrine abnormality is

the cause for the above condition? (1)

2. What type of disease is the above disease? What is the

probable causative agent? (1)

3. What happens to the BMR? (1)

4. Write 3 blood investigations that can give the diagnosis (1)

5. What is exophthalmos? What is it due to in this

condition? What is the treatment for this condition? (1)

1. What is your diagnosis? What endocrine abnormality is
the cause for the above condition?

Grave’s disease, Hyperthyroidism

2. What type of disease is the above disease? What is

theprobable causative agent?

The above disease is an autoimmune disease. Presence of

antibodies to TSH receptor is the causative agent.

3. What happens to the BMR?

BMR increases to as high as +100%

4. Write 3 blood investigations that can give the diagnosis?

Estimation of T3, T4 and TSH

5. What is exophthalmos? What is it due to in

this condition? What is the treatment for this condition?

Protrusion of eyeballs is called exophthalmos. It is due to

the release of cytokines which promote inflammation and
edema in the retro-orbital tissues. Antithyroid drugs.
 Chart - 10

Question:

Comment on this clinical condition.

Answer:

Hyperthyroidism with
e xophthalmos.
Causes may be,
• Graves disease ( Autoimmune disorder) – thyroid
stimulatingantibodies against TSH receptor.
Clinical features:
• Exophthalmos (protrusion of the eyes and retraction of the
superior eyelids due to edematous swelling of the retro
orbital tissues and degenerative changes in the extraocular
muscles)
• Intolerance to heat
• Tremor
• Muscle weakness, Tachycardia, Diarrhea, Oligomenorrhea
 Chart- 11

Question:

Comment on this clinical condition.

Answer:

Myxedema – Hypothyroidism in adults

Clinical features:
• Puffy face with swollen eyelids and oedematous
(due toaccumulation of mucopolysaccharides) skin.
• weight gain, anemia and constipation.
• Intolerance to heat, Menorrhagia.
• Slow pulse, low BP and hypercholesterolemia.
• Mental symptoms – myxedema madness.
• Slow reflexes and prolonged relaxation time of reflexes.
 Chart- 12

Question:

Comment on this clinical condition.

Answer: Acromegaly Hypersecretion of growth hormone after
epiphyseal closure due to pituitary/Hypothalamic tumor.

Clinical features:
• The person cannot become taller because the epiphyseal
plates are closed. So, the bone increases in thickness and
this occurs only in membraneous bones like jaw bone,
skull and bones of hands & feet.
• Hands & feet are broadened & thickened.
• Gorilla face(Enlarged jaws & supraorbital ridge, thick
and wrinkled forehead due to increase in skin thickness,
enlargedtongue and lips
• Enlarged viscera, prognathism( Protrusion of jaw)
• Galactorrhea is present due to lactogenic effect of
growthhormone.
 Chart- 13

Question:

Comment on this clinical condition.

Answer:

Gigantism Hypersecretion of growth hormone before

epiphyseal closure due to pituitary/Hypothalamic tumor.

Clinical features:

• Tall stature( abnormal increase in length of long bones)

• Hyperglycemia.

• Head ache & Visual defects( tumour pressing optic

chiasma causing bitemporal hemianopia
 Chart - 14

Comment on this clinical condition.

Answer:
Cretinism – Hypothyroidism in infants, childhood
Causes:
• Maternal iodine deficiency, Congenital dysfunction of
thyroid gland, Iodine deficiency in children.
Clinical features:
• Disproportionate growth short stature with Mental retardation
• Protruded tongue., Pot belly, Umbilical hernia
• Sexual dysfunction
 Chart- 15

Question:

Comment on this clinical condition

Answer:
Dwarfism due to growth hormone deficiency due to hypothalamic or
pituitary lesion (chromophils destroyed)
Other causes – somatomedin deficiency ( IGF 2)
Clinical features:
• Proportionate short stature
• I Q normal, Sexual function normal
• Small genitalia & visceral organs
• Hypoglycemia.
 Chart- 16

Question:

1. Identify the diagram

2. What is A?

3. Explain the physiological basis behind this reflex.

Answers:

1. Milk ejection reflex / Neuroendocrine reflex /

Neurohumoral reflex / Milk let down reflex

2. Oxytocin

3.Suckling stimulates receptors in the nipple and impulses

pass through spinal cord and stimulate synthesis of oxytocin
in the hypothalamus and secretion from the post pituitary.
Oxytocin actson myoepithelial cells of alveoli and causes it to
contract and eject milk.
 Chart - 17

Question:

Comment on the picture and give the reason

Answers:

• Carpopedal spasm in Hypocalcemictetany

• Can occur in hypoparathyroidism.

• Flexion at wrist and metacarpophalangeal

joint, hyperextension of interphalangeal joints
of fingers

• Hypocalcemia causes increased neuronal excitability

Increased depolarization Continuous muscle contraction
Tetany.
 Response Station – 18

Question:

Comment on this clinical condition.

Answers:

Rickets due to

1. Deficiency of Vitamin D3

2. Chronic renal failure

Vit D3 deficiency causes inadequate mineralization of bones 

bones cannot bear the weight of the body

Clinical features:

 Harrison sulcus (a groove in the rib cage)

 Rachitic rosary (swelling at the costo-chondral

junction)Bowing at elbows and knees

 Kyphosis, scoliosis,

lordosis Stunted growth,

 Large fore head