Unit 3: Endocrine & Digestive

Tumi Hurtz is a 30 year old male who presents to your family medicine clinic with the complaint of generalized fatigue that has gotten progressively more severe over the past 3 months.

1. Upon further investigation, you discover he has had 20lbs of unintentional weight loss over the same span of time with complaints of excessive thirst, urination, and hunger. What is your most likely diagnosis? Explain the difference between the two major types of this disease.

2. What is the endocrine function of the pancreas and how does this compare to its exocrine function?

3. A significant complication of this disease if uncontrolled is ketoacidosis. What would happen to the breathing rate of Tumi if he were in ketoacidosis? What is it called in this condition?

4. One way to test for the specific type of this disease is to do an antibody test for glutamic acid decarboxylase (GAD-65). Which cells are primarily responsible for production of these antibodies?

A. CD8+ cells

B. CD4+ cells

C. Mast cells

D. B cells

5. It is found that GAD-65 and islet cell auto-antibodies are present. Given this information and what we know about the patient's disease, what is the only appropriate treatment option for this patient?

Follow-Up

6. Type I is sometimes associated with other autoimmune conditions. On follow-up, Tumi mentions slight weight loss, fast heart rate, increase hunger, even though he is following his medication regimen perfectly. On physical exam you notice bulging eyes and bilateral swelling and redness of his legs (consistent with pretibial myxedema). What is the most likely diagnosis? What is the pathophysiology?

7. Thyroid uptake is done and is shown (left=normal, right=patient). Explain why this finding is consistent with this disease.

8. Which of the following is the correct pathway of T3/T4 synthesis?

A. Iodide uptake, iodide binding to thyroid binding globulin, coupling of MIT/DIT to T3/T4

B. Iodide uptake, iodide binding to thyroglobulin, coupling of MIT/DIT to T3/T4

C. Sodium uptake, sodium binding to thyroid binding globulin, coupling of MIT/DIT to T3/T4

D. Sodium uptake, sodium binding to thyroglobulin, coupling of MIT/DIT to T3/T4

9. Which amino acid and enzyme is essential in the creation of T3/T4?

A. Tyrosine and thyroid synthase

B. Tryptophan and thyroid synthase

C. Tyrosine and thyroid peroxidase

D. Tryptophan and thyroid peroxidase

10. One of the drugs used to treat this disease is methimazole. What is this drug's mechanism of action? Additionally, beta blockers can be used early in the treatment of this disease. Explain why.

Extend Your Knowledge: Interventional Radiology and Diabetic Wounds

Unfortunately, poorly controlled diabetes can lead to a host of problems, including diabetic neuropathy and non-healing ulcers and wounds. Diabetes is also a strong risk factor for peripheral arterial disease (PAD). PAD is characterized by poor arterial flow, especially to the lower extremities. A key symptom is pain with activity that is relieved at rest (intermittent claudication). Wounds heal poorly due to bad blood flow. If this gets bad enough, the leg will not get enough blood flow and will be at immediate risk of amputation (critical limb ischemia).

11. If there is plaque in the popliteal artery, an interventional radiologist can enter through the arterial system and remove this blockage in a minimally invasive manner. Describe the process of balloon angioplasty and stenting of a peripheral plaque.