❇️Gold stander Diagnostic test for Panhypopituitrism is

➡️Insulin stress test.

❇️C/I of Insulin stress test

📝Epilepsy
📝IHD
📝Adrenal insufficiency

⏺️Important note

Patients with TSH deficiency should not treated with levothyroxine until ACTH deficiency has been ruled out
Because levothyroxine increase the clearnse of cortisone and may precipitate adrenal cirsis📝

❇️DX of Acromegaly

📝IGF 1 ➡️ Initial test + screening test
📝OGTT➡️ definitive test

⏺️ Important note

📝Acromegaly ⬆️ the risk for colon cancer so regular Colonoscopy screening should be started at age of 40 yrs.

✴️Levels of prolactin

<1000 ➡️Drug induced prolactinaemia
1000-3000➡️Microprolactinoma
>3000➡️Macroprolactinoma

❇️ Most common cause of hypothyroidism is

📝Hashimoto thyroiditis.

❇️ Indication for treatment in patient with subclinical hypothyroidism

📝TSH> 10
📝Symptomatic
📝pregnancy

❇️Most common cause of hyperthyroidism is

📝Graves disease.

❇️indication of treatment for patients with subclinical hyperthyroidism

📝TSH<0.1
📝Symptomatic
📝older than 65
📝Risk of osteoporosis or heart disease

🟦Mx of thyrotoxicosis in pregnancy

📝1 St trimester ➡️ Propylothiouracil
📝2nd + 3rd trimester ➡️ Carbimazol

✴️ TTT of Multinodular goiter

📝First line➡️ Radioiodine therapy
📝 Second line➡️ Surgical

❇️ Major complications of Carbimazol is

📝 Carbimazol induced agranulocytosis (Neutrophils< 0.5)

🩺How to treat

➡️Stop Carbimazol
➡️Start broad spectrum antibiotics
➡️G CSF

🟥 TTT of moderate to sever thyroid eye disease 👁

(Sight threatening➡️ malignant exophthalmous, diplopia , loss of color vision)

🩺IV glucocorticoids
🩺 Surgical orbital decompression

❇️Most common cause of hypercalcemia is

📝primary hyperparathyroidism

❇️Most common cause of primary hyperparathyroidisim is

📝 solitary adenoma.

🟪Most common cause of primary hyperaldesteronism is

📝Bilateral adrenal hyperplasia

🟨rule of 10 pheochromocytoma🩺

🟩Pheochromocytoma chould be part of

🩺MEN 2A
🩺MEN 2B
🩺NF1
🩺VHL

🟧DX of pheochromocytoma

📝Initial test ➡️ Plasma free metanephrines test
📝Definitive test➡️ CT or MRI abdomen.

⬜️Most common cause of adrenal insufficiency is

🩺Autoimmune ➡️Developed countries
🩺TB ➡️ Developing countries

⬛️DX of adrenal insufficiency

📝Initial test ➡️ Morning cortisol level
📝Gold standard test➡️ Short synacthen test

مهم هلبا في ال MCQ. 💢