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Question 16
1. Does the absence of bradycardia exclude hypothyroidism?
2. How often is hypothyroidism accompanied by bradycardia?
Question 17
Should patients with hypo- or hyperthyroidism be given iodine
supplements?
Question 18
Is Hashimoto’s thyroiditis associated with dementia?
Question 19
Please explain the causes of, and suggest recommended treatments for,
euthyroid and hypothyroid states.
Question 20
What is the role of propranolol in the management of a 35-year-old male
thyrotoxic patient who is also hypertensive?
Question 21
What else could we use instead of propranolol in thyrotoxicosis with
bronchial asthma?
Question 22
At what dose, and for how long, would steroid therapy give rise to
secondary adrenal insufficiency? For adrenal insufficiency due to longterm steroid use, when should we start to give a cortisone supplement?
How should we monitor these patients?
Question 23
What dose of Synacthen is equivalent to adrenocorticotrophic hormone
(ACTH)?
Question 24
I want to know the mechanism that causes anaemia in Addison’s disease.
I am unable to find the real cause.
Question 25
What causes hypercalcaemia in Addison’s disease?
Question 26
In the diagnosis of Cushing’s disease using the high-dose dexamethasone suppression test, how can the exogenous steroid suppress
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adrenocorticotrophic hormone (ACTH) when the grossly elevated serum
cortisol levels fail to do so?
Question 27
Does alternate-day therapy with steroids decrease their efficacy
compared with daily therapy?
Question 28
Regarding the renin–angiotensin–aldosterone axis, it states that dietary
sodium excess suppresses renin secretion. Then why are we asking
hypertensives to restrict sodium intake? Also if we are using angiotensinconverting enzyme (ACE) inhibitors, the plasma renin activity increases
due to loss of feedback inhibition. Wouldn’t that be counterproductive?
Question 29
How does a phaeochromocytoma give rise to Raynaud’s phenomenon?
Question 30
How well do symptoms of hypercalcaemia correlate with serum calcium
levels. Can I ignore an asymptomatic patient with a serum calcium of
3.7 mmol/L but have to give treatment to a symptomatic patient who has
a serum calcium of 3.3 mmol/L?
Question 31
A 64-year-old woman tells me she has been on hormone replacement
therapy (HRT) – oestrogen only following a hysterectomy – for 7 years.
She wants to continue with this therapy as she thinks it helps her. How
long should I continue prescriptions?
Question 32
Is there a difference between impotence and erectile dysfunction and are
the treatments different if they are different conditions?
Question 33
In multiple endocrine neoplasia under screening, you say that family
members who are ‘at risk’ should be screened. What does that mean?
Question 34
You mention that a number of tests can be used in the diagnosis of a
phaechromocytoma. Can you say which is the best and do they all need
to be done, considering the expense of those investigations?
Question 35
In a patient who is found to be hypertensive, how should we exclude
Conn’s syndrome?
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191
Question 36
Diabetes mellitus and diabetes insipidus are very different conditions so
why are they both called diabetes?
Question 37
I have a young patient who has hirsutism associated with the polycystic
ovary syndrome. She has become desperate about her symptoms,
which have not been improved by long-term medical treatment with
oestrogens, spironolactone and cyproterone. She has asked about
whether surgery would help.
Question 38
In a previously fertile patient with infertility secondary to testosterone
replacement, how soon after stopping testosterone therapy will he
become fertile again? Can reduced fertility and hypogonadism be treated
other than with testosterone replacement therapy?
Question 39
Why is the ‘insulin-like growth factor’ (released from the liver in
response to the growth hormone) so called, although it opposes the
effects of insulin?
Question 40
Does hyperprolactinaemia cause gynaecomastia?
Question 41
Is it practical, after a period of time, to try to wean patients on thyroxine
treatment for hypothyroidism, if the thyroid gland has not been
surgically removed? Should TSH monitoring be used? And after how
long from the start of treatment should this be tried?
Question 42
Why and how does uraemia occur in Addison’s disease?
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