Endocrine

Question 1

Causes of Cushing’s Syndrome

Answer 1

1. Exogenous corticosteroids
   
   2. Adrenal hyperplasia
      a. Cushing disease
      i. Microadenoma
      ii. Macroadenoma
      iii. Pituitary-hypothalamic dysfunction
      b. Secondary to ACTH producing tumours
      i. Small cell lung carcinoma
   3. Adrenal neoplasia
      a. Adenoma
      b. Carcinoma

Question 2

Causes of neck swelling

Answer 2

1. Midline
   a. Goitre (moves up on swallow)
   b. Thyroglossal cyst (tongue protrusion)
   c. Submental lymph nodes
   d. Parathyroid gland
   
   2. Lateral
      a. Lymph nodes
      b. Salivary glands
      c. Sebaceous cyst ir lipoma
      d. Cystic hygroma
      e. Carotid artery aneurysm
      f. Pharyngeal pouch or brachial arch cyst

Question 3

Causes of diffuse goitre (often euthyroid)

Answer 3

1. Idiopathic
   
   2. Puberty or pregnancy
   3. Thyroiditis
      a. Hashimoto
      b. Subacute (tender)
   4. Goitrogens - iodine excess/ drugs (lithium)
   5. Inborn errors of thyroid hormone synthesis
      a. Pendred’s syndrome (sensorineural deafness)

Question 4

Causes of solitary thyroid nodule

Answer 4

1. Benign
   a. Dominant nodule in MNG
   b. Degeneration or haemorrhage into colloid cyst or nodules
   c. Follicular adenoma
   d. Simple cyst
   
   2. Malignant
      a. Carcinoma
      i. Primary or secondary
      b. Lymphoma

Question 5

Causes of exophthalmos

Answer 5

1. Bilateral
   a. Grave’s disease
   
   2. Unilateral
      a. Tumours of the orbit
      i. Dermoid, optic nerve glioma
      ii. Neurofibroma
      iii. Granuloma
      b. Cavernous sinus thrombosis
      c. Graves disease
      d. Pseudotumours of the orbit

Question 6

Causes of thyrotoxicosis

Answer 6

1. Primary
   a. Graves disease
   b. Tocix MNG
   c. Toxic uninodular goitre
   d. Hashimoto thyoroiditis
   e. Subacute thyroiditis
   f. Post partum thyroiditis
   g. Iodine induced (Jod-Basedow phenomenon)
   
   2. Secondary
      a. Pituitary (TSH hypersecretion)
      b. Drugs - amiodarone
      c. Hydatidiform mole/ Choriocarcinoma with HCG secretion

Struma ovarii

Question 7

Causes of hypothyroidism

Answer 7

1. Primary
   a. Graves disease
   b. Tocix MNG
   c. Toxic uninodular goitre
   d. Hashimoto thyoroiditis
   e. Subacute thyroiditis
   f. Post partum thyroiditis
   g. Iodine induced (Jod-Basedow phenomenon)
   
   2. Secondary
      a. Pituitary (TSH hypersecretion)
      b. Drugs - amiodarone
      c. Hydatidiform mole/ Choriocarcinoma with HCG secretion
      d. Struma ovarii

Causes of hypothyroidism

1. Primary
	a. Without goitre
		i. Idiopathic atrophy
		ii. Treatment of hyperthyroidism
		iii. Agenesis
		iv. Unresponsive to TSH
	b. With goitre
		i. Autoimmune
			1) Hashimoto
		ii. Drugs
			1) Lithium
			2) Amiodarone
		iii. Inborn errors
		iv. Endemic iodine deficiency
2. Secondary
	a. Pituitary lesions
3. Tertiary
	a. Hypothalamic lesions
4. Transient
	a. Thyroid hormone treatment withdrawal
	b. Subacute thyroiditis
	c. Postpartum thyroiditis

Question 8

Causes of hypopituitarism

Answer 8

1. Space occupying lesion
   a. Pituitary tumour (nonsecretory ro secretory)
   b. Other tumours: craniopharyngioma, metastatic carcinoma, sarcoma
   c. Granulomata: sarcoid, tuberculosis
   
   2. Iatrogenic- surgery or irradiation
   3. Head injury
   4. Sheehan’s syndrome
   5. Infarction or pituitary apoplexy
   6. Idiopathic

Question 9

Causes of Addison’s disease

Answer 9

1. Chronic
   a. Primary
   i. Autoimmune adrenal disease
   ii. Infection (HIV, tuberculosis)
   iii. Granuloma
   iv. Following heparin therapy
   v. Malignant infiltration
   vi. Haemochromatosis
   vii. Adrenoleucodystrophy
   b. Secondary
   i. Pituitary or hypothalamic disease
   
   2. Acute
      a. Septicaemia
      b. Adrneelectomy
      c. Stress on chronic hypoadrenalism

Question 10

Causes of hypercalcemia

Answer 10

1. Primary hyperparathyroidism
   
   2. Carcinoma
   3. Thiazide
   4. Vitamin D excess
   5. Excessive vitamin D metabolite
      a. Sarcoidosis
      b. T cell lymphoma
   6. Thyrotoxicosis
   7. Associated with renal failure
   8. Multiple myeloma
   9. Prolonged immobilisation

Question 11

Causes of hypocalcemia

Answer 11

1. Hypoparathyroidism
   a. After thyroidectomy
   
   2. Malabsorption
   3. Chronic renal failure
   4. Acute pancreatitis
   5. Pseudohypoparathyroidism
   6. Magnesium deficiency
   7. Hypocalcemia of malignant disease

Question 12

Causes of hirsutism

Answer 12

1. PCOS
   
   2. Adrenal: Cushing syndrome, congenital adrenal hyperplasia, virilising tumour
   3. Ovarian tumour
   4. Drugs: phenytoin, anabolic steroids
   5. Acromegaly, PCT