endocrinology PT 1 2016 modif

Endocrinology You are asked by the respiratory physicians to see a 74-year-old man who has been admitted from t he Emergency Department with an abnormal chest X-ray revealing a right hi lar mass There is a history of 40 years of cigarette smoking He is noted ro have a markedly raised corrected calcium level of 3.25 mmol/1 Apart from a mildly raised urea level due ro dehydrar1on, his other renal function tesung 1s normal He also has a normochrom,c normocytic anaemia, with a haemoglobin of 10.0 g/dl What 1s likely to be the underlying cause of his hypercalcaemia? A Primary hyperparathyroidism B Secondary hyperparathyro 1d1sm C Tertiary hyperpararhyroidism D Pseudo-hyperparathyroidism E Raised parathyroid hormo ne-related prorein A Primary hyperparat hyroidism B Secondary hyperpararhyroid1sm c Tertiary hyperparathyroidism D Pseudo-hyperparathyro1dism II Raised parathyroid hormone-related protein Explanation Humeral hypercalcaemia of malignancy Parathyroid hor mone-related protein (PTHrP) is a 144-amino-acid polypeptide, rne initial sequence of which shows some homology with the b1olog1cally active part of PTH This is being produced by his bronchial carcinoma Primary tumours which can be associated with hypercalcaemia include bronchial, breast, renal and prostate carcinomas, myeloma and lymphoma Treatment involves rehydration and intravenous bisphosphonate therapy Patients are of,en trialled on prednisolo ne, but this is rarely successful A SO-year-old woman with hypertension that has been d ifficult to control with drugs 1s found to have hypercortisolaemia Whtch one of the following clinical findmgs would suggest most strongly that ectopic secretion of adrenocorticorropic hormone (ACTH) is the cause of the condition? A Glycosu ria B Worsening hypertension C Hypokalaemia D Muscle wasting E Weight loss A Glycosuna B Worsening hypertension C Hypol