Ans: d (Hypothyroidism) Ref: Harrison's, 16th ed, p. 2109; 17th ed, p. 2230 Hypothyroidism does not present as anxiety. In hypothyroidism the patient becomes weak, tired, will have difficulty in concentrating and will have a poor memory. Pheochromocytoma, temporal lobe epilepsy, and hypoglycemia may present as anxiety. In pheochromocytoma, there is an increased secretion of catecholamines which in turn results in overactivity of the sympathetic system. Clinical features are palpitations, sweating, headache, and anxiety. Ultimately blunting of sympathetic activity leads to postural hypotension. In temporal lobe epilepsy, before a seizure attack, the patient may report alteration of mood, memory, complex hallucinations (smell, taste) and emotional changes like sexual arousal and anxiety. In hypoglycemia, there is overactivity of the sympathetic system which leads to increased sweating, trembling, pounding heart, anxiety and hunger. It can also cause neuroglycopenic symptoms like confusion, inability to concentrate and drowsiness. BRIDGE Mild diastolic hypertension is seen in Conn syndrome also but edema is not seen even in presence of hyperaldosteronism. It is due to "escape" phenomenon from the sodium-retaining aspects of mineralocorticoid Clinical features of hypothyroidism Dry scaly skin Cold intolerance Loss of hair from scalp and body Physical and mental slowness Generalized edema Lethargy and somnolence Brittle nails Delayed tendon reflex Hoarseness of voice and slowness of speech Paraesthesias Constipation Menorrhagia Weight gain and loss of appetite Galactorrhoea Bradycardia Carpal tunnel syndrome Mild diastolic hypertension Breathlessness Some important points of pheochromocytoma More common on the right side Most common symptom - headache Most common manifestation - paroxysmal hypertension In MEN 2 pheochromocytomas are multicentric and bilateral but not extra adrenal Though hypertension is seen, orthostatic hypotension is also seen It is called the 10% tumour 10% are bilateral 10% are familial 10% are extra-adrenal 10% are malignant 10% are multiple 10% occur in children VMA assay is less specific than metanephrine or catecholamines for diagnosis of pheochromocytoma Note: . Hypothyroidism in boys-Debre Kocher Semelaigne syndrome (infant Hercules) Hypothyroidism in adults - Hoffman's syndrome