October 30, 2010

PLAB Question 23

A 34 year old complains of fatigue and weight gain. On examination she is found to have dry skin and a bitemporal hemianopia.

The cause of her weight gain is most likely to be:

a) Pickwickian syndrome
b) Cushing's syndrome
c) affective disorder
d) Sjogren's syndrome
e) Laurence-Moon-Bardet-Biedl Syndrome
f) fibromyalgia
g) Stein-Leventhal Syndrome
h) secondary hypothyroidism
i) hypothalamic disorder
j) Carpenter's syndrome








ANSWER
The correct answer is H



Explanation
Secondary hypothyroidism should be suspected when, in the setting of overt hypothyroidism, the TSH level is inappropriately low.

Concurrent amenorrhea, galactorrhea, postural hypotension, or visual field cut also suggests pituitary-hypothalamic pathology. Imaging of the sellar region is indicated.

Computed tomography (CT) scan is best for detection of small lesions within the sella; magnetic resonance imaging (MRI) is best for imaging the suprasellar region. TRH stimulation is sometimes used to confirm secondary hypothyroidism, but the test often fails to distinguish among secondary causes.

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