30/10/2024 – Endo and Neuro

Question Easy: A 30-year-old woman presents with fatigue, weight gain, and cold intolerance. On examination, she has dry skin and a puffy face. 🔍 Which of the following is the most likely diagnosis?

A) Cushing’s syndrome
B) Addison’s disease
C) Hyperthyroidism
D) Hypothyroidism
E) Acromegaly

Explanations & Answers:

Question Easy Answer: D) Hypothyroidism

Question Easy Explanation: The symptoms described—fatigue, weight gain, cold intolerance, dry skin, and puffiness—are classic for hypothyroidism, specifically in the context of a younger adult. According to NICE guidelines, hypothyroidism typically presents with these symptoms, and the diagnosis is confirmed by elevated TSH and reduced free T4 levels.

Question Medium: A 45-year-old man complains of persistent headaches and visual disturbances. MRI of the brain reveals an enlargement of the pituitary gland. Which hormone is most commonly secreted in excess in this condition? 🤔

A) Thyroid-stimulating hormone (TSH)
B) Growth hormone (GH)
C) Prolactin
D) Adrenocorticotropic hormone (ACTH)
E) Luteinizing hormone (LH)

Explanations & Answers:

Question Medium Answer: C) Prolactin

Question Medium Explanation: The scenario describes a pituitary adenoma, with prolactin-secreting adenomas (prolactinomas) being the most common type. The symptoms and imaging hint at this diagnosis, with headaches and visual disturbances often occurring due to the mass effect of the enlarging pituitary gland. NICE guidelines recommend evaluating prolactin levels in such cases.

Question Hard: A 72-year-old woman with a history of hyperthyroidism presents with confusion, palpitations, and profound muscle weakness. Blood tests show low potassium levels. What is the most likely cause of her symptoms? 🧩

A) Exophthalmos
B) Myasthenia gravis
C) Thyrotoxic periodic paralysis
D) Addisonian crisis
E) Guillain-Barré syndrome

Explanations & Answers:

Question Hard Answer: C) Thyrotoxic periodic paralysis

Question Hard Explanation: This patient exhibits features suggestive of thyrotoxic periodic paralysis, a condition seen predominantly in men of Asian descent but also in women. It is characterized by episodes of muscle weakness associated with hypokalaemia due to hyperthyroidism. NICE guidelines suggest managing the underlying thyrotoxicosis to prevent recurrent episodes.

Medical fact of the day: 👀 Did you know that the UK’s first ever endovascular aneurysm repair (EVAR) took place in the 1990s? This procedure revolutionized the management of abdominal aortic aneurysms, reducing recovery times and complications associated with open surgery.

Quote of the day: “In the embrace of medicine lies the art of healing; in the pursuit of healing, we discover the heart of humanity.” 🌻