Endo Questions

Question 1

Causes diffuse goitre

Answer 1

Idiopathic
Puberty, pregnancy, postpartum
Graves disease
Thyroiditis- hashimotos, subacute (Tender), chronic fibrosing (riedel’s)
Simple goitre- iodine deficiency
Goitrogens- iodine excess, drugs (lithium etc)
Inherited disorders/inborn errors

Question 2

Causes hypothyroidism

Answer 2

Without goitre- decreased/absent thyroid tissue
o	Idiopathic atrophy
o	Treatment (iodine, surgery)
o	Agenesis or lingual thyroid
o	Unresponsiveness to TSH

With goitre- decreased synthesis
o	Chronic thyroiditis- hashimotos, riedels
o	Drugs- lithium, amiodarone
o	Iodine deficiency
o	Inborn errors

Secondary
o Pituitary lesions

Tertiary
o Hypothalamic lesions

Transient
o Thyroid hormone treatment withdrawal
o Subacute thyroiditis
o Postpartum thyroiditis

Question 3

Neurological associations of hypothyroidism

Answer 3

Common
o Entrapment- carpal or tarsal tunnel
o Delayed relaxation phase of ankle jerks
o Nerve deafness

Uncommon
o	Peripheral neuropathy
o	Proximal myopathy (with normal CK levels)
o	Hypokalaemic periodic paralysis
o	Eaton Lambert syndrome or unmasking of myasthenia gravis
o	Cerebellar syndrome
o	Pyschosis
o	Coma
o	Cerebrovascular disease
o	High CSF protein
o	Muscle cramps

Question 4

Causes panhypopituitarism

Answer 4

Chromophobe adenoma
Other space occupying lesion (craniopharyngioma, metastatic carcinoma, granuloma)
Iatrogenic (surgery, radiation)
Sheehans syndrome (postpartum necrosis)
Head injury
Idiopathy

Question 5

Evidence activity in acromegaly

Answer 5

• Skin tag number
• Excessive sweating
• Presence of glycosuria
• Increasing visual field loss or development of cranial nerve palsies of 3, 4, 6 and 5
• Enlarging goitre
• Hypertension
• Symptoms of headache
• Increasing ring size, shoe size or dentures

Question 6

Autoimmune disease associations

Answer 6

• Addison’s disease
• Hyooparathyrodism
• Mucocutaneous candidiasis
• T1DM
• Hashimotos thyroiditis
• Graves disease
• Primary ovarian failure
• Pernicious anaemia
• Vitiligo
• Alopecia
• Hypophysitis
• Myasthenia gravis

Question 7

Causes addisons (chronic adrenal insufficiency)

Answer 7

Iatrogenic
Primary
-Autoimmune adrenal disease
-Polyglandular syndromes (i.e. a/w other AI dx)
-Tuberculosis, histoplasmosis
-Infiltration (e.g. amyloidosis, sarcoidosis, metastatic malignant Dx)
-Demyelinating Dx
-Drugs

Secondary
-Pituitary or hypothalamic disease- usually no mineralocorticoid deficiency

Question 8

Diabetic retinopathy

Answer 8

• Haemorrhages
• Hard exudates
• Cotton wool spots
• Microaneurysms
• Dilated veins
• New vessels, vitreous haemorrhages, scar formation, retinal detachment and laser scars- if proliferative