Endocrinology

Question 1

Subclinical hypothyroidism

Answer 1

High TSH but normal T4

Repeat TFT in 3 months:
If TSH > 10 and T4 is normal then start levothyroxine

Then recheck every 3 months and adjust the dose

Question 2

What is Waterhouse- Friderichsen syndrome

Answer 2

caused by Neisseria meningitidis

Bleeding into renal capsule
which leads to shock and adrenal insufficiency and often DIC

Question 3

Overnight Dexamethasone suppression test results

Answer 3

ACTH: not detectable Cortisol: not suppressed by low or high dose of dexa
——Primary adrenal addenoma (think why?)

ACTH: normal or high Cortisol: not suppressed by low but is suppressed by high dose
——Cushing’s disease (pituitary adenoma) (why?)

ACTH: normal or high Cortisol: not suppressed by low or high dose of dexa (ectopic ACTH- such as small cell carcinoma) (why?)