Endo

Question 1

Causes of a diffuse goitre

Answer 1

Idiopathic
Puberty, pregnancy and postpartum
Graves’ disease
Thyroiditis - Hashimotos, subacute thyroiditis
Iodine deficiency
Goitrogens - iodine excess, drugs - lithium
Inborn errors of thyroid hormone synthesis - Pendred’s syndrome

Question 2

Causes of thyrotoxicosis

Answer 2

Primary:
Graves
Toxic adenoma or multinodular goitre 
Hashimoto’s thyroiditis 
Subacute thyroiditis 
Iodine induced 
Excess thyroid hormone replacement 
Postpartum thyroiditis 
Drugs - amiodarone 

Secondary:
Pituitary or ectopic thyroid- stimulating hormone hypersecretion
Hydatidiform mole
Struma ovarii

Question 3

Causes of hypothyroidism

Answer 3

Primary:
Without a goitre:
Idiopathic atrophy
Treatment (radioiodine, surgery)
Agenesis or a lingual thyroid
Unresponsiveness to TSH

With a goitre:
Chronic thyroiditis 
Drugs (amiodarone, lithium)
Endemic iodine deficiency
Iodine-induced hypothyroidism 
Inborn errors

Secondary
Pituitary lesions

Tertiary
Hypothalamic lesions

Transient
Thyroid hormone treatment withdrawn
Subacute thyroiditis
Postpartum thyroiditis

Question 4

Signs of Acromegaly disease activity

Answer 4

SSHHEGG

Skin tag number
Sweating excessively
HTN
Headache Symptoms + Increasing ring size, shoe size, and dentures
Eyes (Increasing visual field loss or development of CN pathology (3,4,5,6))
Goitre enlarging
Glycosuria

Question 5

Diagnosis of Acromegaly

Answer 5

Biochemical
-Increased IGF-1 in plasma with no suppression in a glucose tolerance test or a paradoxical rise in GH

Anatomical

• Skull XR film
• MRI B for pituitary adenoma

Question 6

Causes of Acromegaly

Answer 6

Pituitary adenoma
Ectopic production of growth hormone releasing hormone
Ectopic production of GH (Hypothalamic, carcinoid, and pancreatic tumors)

Question 7

Cushings Screening tests

Answer 7

Cortisol levels in morning and evening
24 hour urinary free cortisol (positive test is 3 fold increase above normal)
Overnight Dexamethasone suppression test
FBE (For secondary polycythemia, neutrophilia, and eosinopenia)
UEC for electrolytes
BSLs for hyperglycemia

Question 8

Definitive tests for Cushings

Answer 8

• Low dose Dexamethasone suppression test
• High dose Dexamethasone suppression test (Cushings Syndrome has no suppression, but Cushings disease will suppress)
• ACTH level (High in ectopic production and Cushings disease; Low in adrenal cause of Cushings Syndrome)
• Petrosal Sinus ACTH levels

Question 9

Autoimmune associated disease

Answer 9

Addisons
Hypoparathyroidism
Mucocutaneous candidiasis
T1DM
Hashimotos
Graves
Primary ovarian failure
Pernicious anaemia
Vitiligo
Alopecia
Hypophysitis
Myasthenia gravis

Question 10

Features of Autonomic neuropathy

Answer 10

• Postural Hypotension
• Loss of sinus arrhythmia
• Valsalva manoeuvre causes no slowing of the pulse
• Loss of sweating
• Erectile dysfunction
• Nocturnal diarrhea
• Urinary retention and incontinence

Question 11

Signs of diabetic retinopathy

Answer 11

Nonproliferative

• Dot haemorrhages
• Blot haemorrhages
• Hard and soft exudates
• Microanuerysms
• Dilated veins

Proliferative

• New vessels
• Vitreous hemorrhage
• Scar formation
• Retinal detachment
• Laser scars