Endocrine & Metabolic

Reference: Davidson 23rd, Page: 756, Box: 20.36

Reference: Davidson 23rd, Page: 634, Box: 18.3

Headache indicates pituitary cause of weight gain.

Whipple’s triad confirmed
Patient had symptoms of hypoglycaemia
Low blood glucose measured at the time of symptoms
Symptoms resolved on correction of hypoglycaemia

Reference: Davidson 23rd; P-676

Explanation: Prolactin is the hormone that stimulates milk production in the mammary glands. Davidson explains that prolactin levels rise during pregnancy and after childbirth, promoting lactation. Harrison adds that oxytocin is responsible for milk ejection, but prolactin is key to maintaining milk production.

Explanation: among Asians, BMI > 23.0 is overweight and > 25.0 is obese.

Reference: Davidson 23rd; P-642

Reference: Davidson 23rd; P-634

Reference: Davidson 23rd; P-646

Reference: Davidson 23rd; P-649

( Ref : Davidson 23rd ,p –693 )

Reference: Davidson 23rd; P-666

Reference: Davidson 23rd; P-634

Ref: Davidson 23rd; P-989

Reference: Davidson 23rd; P-51(Box-3.8).

Reference: Davidson 23rd; P-658 , box : 18.28

Hypothyroidism causes weight gain, all other disorder in the option causes weight loss

Stem Breakdown:

Episodic headaches, palpitations, and sweating: These are the classic "triad" of symptoms for pheochromocytoma, a catecholamine-secreting tumor.
Consistently elevated blood pressure: Pheochromocytoma often causes paroxysmal or sustained hypertension.
Increased metanephrines and normetanephrines in urine: These are metabolites of catecholamines and are diagnostic for pheochromocytoma.
Option Analysis:

A) Hyperthyroidism: Hyperthyroidism can cause palpitations and sweating, but it typically does not cause paroxysmal hypertension or elevated metanephrines.
B) Pheochromocytoma: This is the correct diagnosis. Davidson and Harrison explain that pheochromocytoma is a rare adrenal tumor that secretes excess catecholamines (epinephrine and norepinephrine), leading to episodic symptoms of headache, palpitations, sweating, and hypertension. Elevated urine or plasma metanephrines confirm the diagnosis.
C) Primary hyperaldosteronism: Primary hyperaldosteronism (Conn’s syndrome) causes hypertension and hypokalemia due to excess aldosterone, but it does not cause episodic symptoms or elevated catecholamine metabolites.
D) Cushing’s syndrome: Cushing’s syndrome can cause hypertension due to excess cortisol, but it is associated with other features such as weight gain, moon face, and purple striae. It also does not cause elevated metanephrines.