Question 1

Is growth hormone deficiency in childhood commonly associated with

panhypopituitarism?

Question 2

I would like to ask why, when treating hypopituitarism, an adrenal

crisis occurs if thyroid replacement is given before steroid replacement

therapy? And what is the underlying mechanism? Thank you!

Question 3

Why, in Sheehan's syndrome, is there an anterior pituitary involvement

more than a posterior one?

Question 4

Is the cyclic presence of Montgomery tubercles, where they reduce and

later increase, in a nulliparous woman's breast normal? And, if so, what

is the cause?

Question 5

Does methyltestosterone, if given in a daily dose of 2.5 mg per day, cause

liver cell injury or hypothalamic gonadal suppression? Can this drug be

prescribed for other cases with hypothalamic hypogonadism, usually

being given by intramuscular injection or implant?

Question 6

Does IM testosterone increase levels of serum thyroid-stimulating

hormone (TSH)?

Question 7

For some time now I have been confused regarding tests for acromegaly. 187

Endocrine disease 18

1. Which is best - screening or diagnosing test in these patients?

2. Your book says the 'glucose tolerance test [GTT] is diagnostic'. Does

this mean GTT with growth hormone (GH) evaluation or that a patient

who is clinically an acromegalic with a positive GTT (diabetic) can be

labelled as acromegalic?

Incidentally, a lot of people around me are similarly confused and others

have been following the latter saying that 'Kumar and Clark say so'.

Please clarify.

Question 8

Does acromegaly cause depression?

Question 9

1. Breathlessness can be a feature of acromegaly. What are the

characteristics of this breathlessness?

2. If a patient presents with headaches due to acromegaly, what are the

likely characteristics of these headaches?

Question 10

Why does hypothyroidism cause a transudative pleural effusion?

Question 11

What is the significance of the thyroid-releasing horomone (TRH) test in

differentiating various causes of hypothyroidism?

Question 12

Is retention of urine/incomplete voiding related to hypothyroidism? If

so, how?

Question 13

It is stated that a little overtreatment might be required for

hypothyroidism, i.e. slightly raised thyroxine (T4) and suppressed

thyroid-stimulating hormone (TSH). Is the clinical improvement the best

criteria or is there an optimum/maximum level that one should watch

out for when monitoring TSH and T4?

Question 14

Why is thyroid-stimulating hormone (TSH) normal or increased

in patients with peripheral resistance to tri-iodothyronine (T3) and

thyroxine (T4)? The thyroid hormone levels are high in these patients, so

the TSH should drop lower: why doesn't it?