Causes,symptoms, diagnosis and treatments of...

Question 1

Acromegaly

Answer 1

Pituitary adenoma secreting excess growth hormone (GH)

Enlarged hands, feet, jaw, nose, tongue (coarsened features)

Elevated IGF-1

Oral glucose tolerance test (OGTT): GH fails to suppress

Surgical resection (transsphenoidal surgery)

Question 2

Cushing’s

Answer 2

Cushing’s disease: pituitary ACTH-secreting adenoma (most common endogenous)
Adrenal adenoma/carcinoma (↑ cortisol)

Weight gain
Thin skin, purple striae, easy bruising

24-hr urinary free cortisol
Imaging: MRI pituitary, CT adrenal

Surgical removal of tumor (pituitary or adrenal)

Question 3

Conns

Answer 3

Aldosterone-secreting adrenal adenoma

Hypertension (often resistant)
Hypokalemia → muscle cramps, weakness

Plasma aldosterone:renin ratio (ARR) (↑ aldosterone, ↓ renin)
Saline suppression test or fludrocortisone suppression test

Question 4

Hyperthyroidism

Answer 4

Graves’ disease (autoimmune, most common)

Weight loss despite increased appetite
Heat intolerance, sweating, tremors
Palpitations, anxiety, insomnia
Diarrhea

TSH, ↑ free T4/T3
TSH receptor antibodies (TRAb) for Graves’

Antithyroid drugs: carbimazole
Surgery (thyroidectomy)

Question 5

Hypothyroidism

Answer 5

Hashimoto’s thyroiditis (autoimmune, most common)
Iodine deficiency
Li exposure

Fatigue, cold intolerance
Weight gain, constipation
Dry skin, brittle hair, slow reflexes

↑ TSH, ↓ free T4 (primary)
Anti-TPO and anti-thyroglobulin antibodies (Hashimoto’s)

Levothyroxine (T4) replacement therapy