Which one of the following statements describes the underlying pathology of Grave's disease?

Correct Answer: A

Rationale: Graves' disease is an autoimmune disorder where autoantibodies, known as thyroid-stimulating immunoglobulins (TSIs) or thyroid-stimulating antibodies (TSAs), bind to and stimulate the thyroid-stimulating hormone (TSH) receptors on thyroid follicular cells. This leads to increased production and secretion of thyroid hormones T3 (triiodothyronine) and T4 (thyroxine), causing hyperthyroidism. The autoantibodies essentially mimic the action of TSH, resulting in excess thyroid hormone release and manifestation of hyperthyroid symptoms. This underlying pathology of Graves' disease is distinct from other causes of hyperthyroidism, making choice A the correct statement.

Correct Answer: D

Rationale: Persistent muscular weakness is characteristic of myxoedema, which is severe hypothyroidism. Myxoedema can lead to general weakness and fatigue, as thyroid hormones play a crucial role in controlling metabolism and energy production in the body. Other symptoms of myxoedema include cold intolerance, weight gain, dry skin, and hair loss. Conn's syndrome (hyperaldosteronism) is characterized by hypertension and low potassium levels, not persistent muscular weakness. Acromegaly is a condition resulting from excess growth hormone production, leading to enlarged body parts and metabolic changes but not specifically muscular weakness. Hyperparathyroidism is associated with high levels of parathyroid hormone, which can lead to bone weakening and calcium imbalance, but it is not typically a primary cause of muscular weakness.

Correct Answer: D

Rationale: Neurogenic diabetes insipidus is due to a deficiency in vasopressin (antidiuretic hormone, ADH) production in the hypothalamus or a failure of proper vasopressin release from the posterior pituitary. Causes of neurogenic DI typically involve factors affecting vasopressin synthesis, storage, or release. However, mutations in the vasopressin gene itself would be a cause of genetic forms of diabetes insipidus, not neurogenic diabetes insipidus. Common causes of neurogenic diabetes insipidus include traumatic brain injury, brain tumors, pituitary adenomas, meningitis, and Sheehan's syndrome.

Correct Answer: A

Rationale: Thyrotoxicosis, also known as hyperthyroidism, is a condition characterized by excessive thyroid hormone production by the thyroid gland. Symptoms of thyrotoxicosis can include weight loss, heat intolerance, tremors, hyperactivity, and fatigue. While musculoskeletal symptoms such as weakness and tremors are common in thyrotoxicosis, true myopathy (muscle disease) is not a typical feature of the condition. Therefore, myopathy is the correct choice among the given options.

Correct Answer: D

Rationale: Blood calcium levels are primarily regulated by the actions of parathyroid hormone (PTH) and Vitamin D. Vitamin D plays a crucial role in maintaining calcium balance in the body by promoting the absorption of calcium from the intestines. When blood calcium levels are low, Vitamin D works to increase absorption of calcium to raise the levels back to normal. Therefore, elevated blood calcium levels are commonly associated with excess Vitamin D intake or conditions that increase Vitamin D levels, such as hypervitaminosis D.

Correct Answer: E

Rationale: Neurogenic diabetes insipidus is a condition characterized by a deficiency of vasopressin (antidiuretic hormone). Vasopressin is responsible for regulating the body's water balance by controlling the reabsorption of water in the kidneys. In neurogenic diabetes insipidus, there is a problem with either the production, release, or action of vasopressin, leading to excessive urination and thirst. This condition can be caused by damage to the hypothalamus or pituitary gland, which are involved in producing and releasing vasopressin. Symptoms of neurogenic diabetes insipidus include frequent urination, excessive thirst, and dehydration.

Correct Answer: A

Rationale: The most common cause of Cushing's disease is an ACTH-producing pituitary adenoma. In this condition, the pituitary gland produces excessive amounts of adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce high levels of cortisol. This leads to the signs and symptoms of Cushing's disease, such as weight gain, high blood pressure, and muscle weakness. Adrenocortical adenoma refers to a benign tumor of the adrenal cortex that can also cause Cushing's syndrome, but it is not as common as an ACTH-producing pituitary adenoma. Ectopic ACTH secretion occurs when a non-pituitary tumor produces ACTH, leading to Cushing's syndrome. McCune-Albright syndrome is a rare genetic disorder that can cause various endocrine abnormalities, but it is not a common cause of Cushing's disease.

Correct Answer: A

Rationale: Cushing's syndrome is a condition characterized by excessive levels of cortisol in the body. Cortisol is a hormone produced by the adrenal glands that helps regulate various bodily functions, including metabolism, immune response, and stress response. When there is an overproduction of cortisol, either due to excessive production by the adrenal glands or prolonged use of corticosteroid medications, it can result in Cushing's syndrome. Symptoms of Cushing's syndrome include weight gain, particularly in the face and abdomen, high blood pressure, muscle weakness, and irregularities in menstruation. It is important to diagnose and manage Cushing's syndrome to prevent potential complications such as diabetes, osteoporosis, and cardiovascular disease.

Correct Answer: A

Rationale: Phaeochromocytoma is a neuroendocrine tumor that arises from the chromaffin cells of the adrenal medulla. It is the most common cause of a catecholamine-secreting tumor in adults. While it can also rarely occur outside the adrenal gland (referred to as extra-adrenal or paraganglioma), the majority of cases originate within the adrenal medulla. Symptoms of phaeochromocytoma are due to the excessive release of catecholamines (epinephrine and norepinephrine), leading to a characteristic triad of headaches, sweating, and palpitations. Therefore, the commonest cause of phaeochromocytoma is a tumor of the adrenal medulla.