A 32-year-old woman presents to her physician with complaints of fatigue of 2 months’ duration. She also indicates she has been anxious lately, and has been experiencing increased sweating and palpitations. Which of the following hormones is most likely in excess?

A. ADH
B. Growth hormone
C. Parathyroid hormone
D. Prolactin
E. Thyroid hormone

The correct answer is E. The patient’s symptoms of fatigue, heat intolerance, palpitations, and anxiety are all consistent with hyperthyroidism. In a 32-year-old woman, this is most likely an autoimmune disorder (Graves’ disease) in which autoantibodies to the thyroid-stimulating hormone receptor activate the receptor and cause excessive thyroid hormone production. Other symptoms include weight loss, diarrhea, and ophthalmopathy.

Answer A is not correct. An excess of ADH can lead to the syndrome of inappropriate ADH secretion (SIADH). SIADH can also be seen after trauma, brain tumors, or extracranial malignancies that secrete ADH (eg, small cell lung cancer). The elevated ADH causes excessive water reabsorption in the kidney, leading to hyponatremia. Early on, patients present with headaches, nausea, and vomiting. As hyponatremia becomes more severe, patients can develop seizures and coma due to cerebral edema.

Answer B is not correct. An excess of growth hormone causes acromegaly. Other findings in this condition include frontal bossing, increased nose size, increased heel pad thickness, and mandibular overgrowth.

Answer C is not correct. The classic presentation of hyperparathyroidism includes “stones, bones, groans (abdominal pain due to peptic ulcers or pancreatitis), and psychiatric overtones.”

Answer D is not correct. An excess of prolactin causes hyperprolactinemia and is usually due to a prolactinoma in the anterior pituitary. In women, prolactin excess presents with weight gain, decreased libido, amenorrhea, and galactorrhea. In men, hyperprolactinemia can present with decreased libido, impotence, weight gain, and gynecomastia. Hyperprolactinemia can also be found in patients with renal failure, hypothyroidism, and those taking various medications, including neuroleptic drugs

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