Endocrinology Practice Questions

Q: What is the initial treatment for most patients with growth hormone-secreting pituitary adenoma?

Transphenoidal surgical resection. ***Transphenoidal surgical resection*** - This is the **preferred initial treatment** for most growth hormone (GH)-secreting pituitary adenomas, as it offers the best chance for **cure** and rapid reduction in GH levels [1]. - Success rates are high, especially for **smaller tumors** (microadenomas), and it can quickly relieve mass effect symptoms [1]. *Somatostatin analogs* - These are typically used as **second-line therapy** if surgery is unsuccessful or contraindicated, or in patients not surgical candidates. - They work by **inhibiting GH secretion** but do not usually achieve a complete cure like surgery. *GH receptor antagonists* - These medications, such as pegvisomant, **block the action of GH** at its receptor, normalizing IGF-1 levels. - They are primarily used when other treatments, including surgery and somatostatin analogs, have failed to control GH excess. *Dopamine agonists* - While dopamine agonists (e.g., cabergoline) can **sometimes reduce GH secretion** in a minority of patients, they are significantly less effective for GH-secreting tumors compared to prolactinomas [1]. - They are occasionally used as **adjunctive therapy** or in specific cases where the GH-secreting tumor also co-secretes prolactin [1].

Q: A 25-year-old patient presents with thinning of the outer third of the eyebrows. Which condition is most likely associated with this finding?

Hypothyroidism. ### Hypothyroidism - **Thinning of the outer third of the eyebrows** (also known as the **Hertoghe sign**) is a classic dermatological manifestation of **hypothyroidism**. - Other common symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, and dry skin [1]. *Cutaneous TB* - **Cutaneous tuberculosis** presents with various skin lesions, such as lupus vulgaris, scrofuloderma, or papulonecrotic tuberculid, but typically does not manifest as isolated thinning of the eyebrows. - Eyebrow loss in this context would usually be part of a broader immune response or severe systemic disease, not a specific diagnostic sign. *Lichen planus* - **Lichen planus** can affect hair follicles, leading to scarring alopecia, particularly on the scalp, but it is not typically associated with isolated thinning of the outer third of the eyebrows [1]. - It usually presents with **pruritic, purple, polygonal papules** on the skin, wrists, and ankles, and can affect mucous membranes. *Psoriasis* - **Psoriasis** is a chronic inflammatory skin condition characterized by **red, silvery-scaled plaques** and can affect the scalp, but it does not specifically cause thinning of the outer third of the eyebrows. - Eyebrow involvement in psoriasis would typically present as scaly plaques within the eyebrow area, not hair loss conforming to the Hertoghe sign.

Q: Azoospermia with normal FSH would indicate?

Obstruction of vas deferens. ***Obstruction of vas deferens*** - **Azoospermia** with **normal FSH** and normal testicular size strongly suggests an obstructive cause, as the testes are producing sperm but it cannot exit [2]. - This scenario means the **gonadal axis** (hypothalamus-pituitary-testis) is functioning correctly, hence normal FSH, but there is a physical block in the reproductive tract [1], *Hypothalamic failure* - This would lead to secondary hypogonadism, characterized by **low FSH** and **low testosterone**, which is not seen here. - Reduced stimulation of the testes would result in decreased or absent sperm production, but the hormonal profile would be different. *Testicular failure* - Primary testicular failure (e.g., Klinefelter syndrome) would lead to **azoospermia** accompanied by **high FSH** due to lack of negative feedback from the damaged testes [1]. - This condition implies the testes themselves are unable to produce sperm, prompting the pituitary to release more FSH in an attempt to stimulate them. *None of the options* - Obstruction of the vas deferens is a specific and accurate explanation for the given clinical presentation. - Therefore, one of the provided options is indeed correct.

Q: What percentage of patients with primary hyperparathyroidism have parathyroid adenomas?

80%. 80% - **Parathyroid adenomas** are the most common cause of **primary hyperparathyroidism**, accounting for approximately 80% of cases [1]. - This typically involves a **single enlarged gland** producing excess parathyroid hormone (PTH) [1]. *50%* - This percentage is too low; **parathyroid adenomas** constitute a significantly higher proportion of primary hyperparathyroidism cases. - Such a low percentage would imply a much higher prevalence of other causes, which is not accurate. *60%* - While a majority, 60% still underestimates the true prevalence of **parathyroid adenomas** in primary hyperparathyroidism presentations. - This figure does not accurately reflect the strong predominance of **single adenomas** as the underlying pathology. *70%* - This value is closer but still slightly below the accepted frequency for **parathyroid adenomas** in the context of primary hyperparathyroidism. - Most sources and clinical experience point to a prevalence that is higher than 70%.

Q: In which condition is radioiodine preferred for treatment?

Post-surgery for differentiated thyroid cancer. ### Post-surgery for differentiated thyroid cancer - **Radioiodine (radioactive iodine, I-131)** is preferentially used after surgery for **differentiated thyroid cancer** to ablate any remaining thyroid tissue or metastatic disease [1]. - This therapy targets and destroys thyroid cells that absorb iodine, effectively reducing recurrence risk and improving survival rates [1]. *Hyperthyroidism in young patients* - While radioiodine can be used in hyperthyroidism, it's generally reserved for older patients or those who fail antithyroid medications due to concerns about potential long-term effects, such as **hypothyroidism** for which replacement will be required lifelong [1]. - Younger patients often start with **antithyroid drugs** (e.g., methimazole or propylthiouracil) as the initial treatment option [1]. *Hyperthyroidism during pregnancy* - **Radioiodine therapy is absolutely contraindicated during pregnancy** because it can cross the placenta and damage the fetal thyroid gland, leading to **fetal hypothyroidism**. - **Antithyroid drugs** (specifically propylthiouracil in the first trimester, then methimazole in later trimesters) are the preferred treatment options [1]. *Recent onset of hyperthyroidism with toxic goiter* - For recent onset hyperthyroidism, especially with a **toxic goiter**, initial treatment typically involves **antithyroid medications** to control thyroid hormone levels [1]. - Radioiodine might be considered later if medical therapy fails or is not tolerated, but it's not usually the primary choice for *recent onset* cases due to the potential for a temporary exacerbation of hyperthyroidism after treatment.

Q: Which of the following is used in quantifying hirsutism?

Ferriman-Gallwey score. Detailed assessment of androgen excess requires specific clinical tools. ***Ferriman-Gallwey score*** - The **Ferriman-Gallwey score** is a semi-quantitative method used to assess the degree of **hirsutism** by evaluating hair growth in nine body areas [1]. - Each area is scored from 0 (no terminal hair) to 4 (extensive terminal hair growth), and the total score indicates the severity of hirsutism [1]. *Bishop score* - The **Bishop score** is used to assess cervical ripeness and predict the likelihood of successful vaginal birth induction. - It evaluates cervical dilation, effacement, consistency, position, and fetal station, not hair growth. *Rotterdam criteria* - The **Rotterdam criteria** are diagnostic criteria for **polycystic ovary syndrome (PCOS)** [1]. - They require the presence of at least two out of three criteria: **oligo- or anovulation**, clinical or biochemical signs of **hyperandrogenism** (including hirsutism), and polycystic ovaries on ultrasound [1]. *All of the options* - This option is incorrect because only the **Ferriman-Gallwey score** is specifically designed for quantifying hirsutism directly. - The other options pertain to different clinical assessments unrelated to the direct measurement of hair growth severity.

Q: Which of the following causes of hypercalcemia is not associated with high bone turnover?

Thiazides. ***Thiazides*** - Thiazide diuretics cause hypercalcemia by increasing **renal reabsorption of calcium** in the distal tubule [1], not by stimulating bone breakdown. - This effect leads to a higher serum calcium concentration without an increase in **bone turnover markers**. *Hyperthyroidism* - Excessive thyroid hormone can directly stimulate **osteoclast activity**, leading to increased bone resorption and high bone turnover. - This results in a net release of calcium from the bone into the bloodstream, contributing to hypercalcemia. *Vitamin D intoxication* - Excess vitamin D drastically increases intestinal absorption of calcium and phosphate [1], as well as stimulating **osteoclastic bone resorption** [3], thereby increasing bone turnover. - This leads to significant elevation of serum calcium levels [3]. *Vitamin A intoxication* - Chronic excessive intake of Vitamin A can lead to bone toxicity, promoting **osteoclastogenesis** and osteoclastic bone resorption [2]. - This process directly contributes to increased bone turnover and subsequent hypercalcemia [2].

Q: Metabolic syndrome diagnosis in men based on NCEP ATP III criteria includes the following except:

HDL 40 inches* - **Abdominal obesity**, defined as a **waist circumference > 40 inches (102 cm)** in men, is indeed one of the NCEP ATP III criteria for metabolic syndrome. - This criterion reflects **visceral adiposity**, which is strongly associated with insulin resistance and cardiovascular risk. *BP >/= 130/85 mm Hg* - This **blood pressure** threshold is a correct criterion for diagnosing metabolic syndrome in both men and women by NCEP ATP III. - It signifies **elevated blood pressure**, a key component of the syndrome contributing to cardiovascular risk. *Fasting glucose > 110 mg/dL* - An **elevated fasting plasma glucose** of **≥ 110 mg/dL** is a correct NCEP ATP III criterion for metabolic syndrome. - This indicates **impaired fasting glucose** or **insulin resistance**, a core feature of metabolic syndrome.

Q: What is the HbA1C criteria for a patient to be diagnosed with diabetes mellitus?

6.5%. ***6.5%*** - An HbA1C level of **6.5% or higher** is the diagnostic threshold for **diabetes mellitus** according to major international guidelines [1]. - This value reflects an average blood glucose level over the preceding **two to three months**, indicating chronic hyperglycemia [1]. *5.5%* - An HbA1C of 5.5% falls within the **normal range** for individuals without diabetes or prediabetes [1]. - It does not indicate impaired glucose regulation or diabetes. *4.5%* - An HbA1C of 4.5% is considered a **very good** or **low-normal** value, indicating excellent blood glucose control. - This level is far below the threshold for diagnosing diabetes. *7.5%* - While 7.5% is indicative of diabetes, it is **higher** than the diagnostic cutoff. - An HbA1C of 7.5% or more would suggest **poorly controlled diabetes** rather than just meeting the diagnostic criteria.

Q: In which condition is a hypotonic solution administered for correction?

Hyperosmolar hyperglycemic state (HHS). ***Hyperosmolar hyperglycemic state (HHS)*** - In **HHS**, patients have severe **hyperglycemia** and **hyperosmolality**, leading to significant dehydration and intracellular fluid shifts. - Administering a **hypotonic solution** (e.g., 0.45% saline) helps to gradually lower serum osmolality and **rehydrate cells**, correcting both the fluid deficit and the hypertonic state [2], [4]. *Dehydration secondary to diuretic therapy* - This typically involves **isotonic or hypotonic fluid loss**, and administering a hypotonic solution could exacerbate **hyponatremia** or fluid overload. - Treatment usually focuses on replacing lost volume with **isotonic fluids** and addressing the underlying electrolyte imbalances. *Diabetic ketoacidosis (DKA)* - Initial fluid resuscitation in **DKA** typically involves **isotonic saline** (e.g., 0.9% NaCl) to expand the extracellular volume and restore perfusion [1], [2]. - While DKA eventually requires free water, a hypotonic solution is not the initial or primary fluid for correction of the acute phase due to significant fluid and electrolyte deficits [1]. *Hypotonic dehydration* - In **hypotonic dehydration**, there's a greater loss of sodium than water, leading to **hyponatremia** [3]. - Administering a **hypotonic solution** would worsen the already low serum sodium concentration, which can be dangerous [3].

Question 1

What is the initial treatment for most patients with growth hormone-secreting pituitary adenoma?

Accepted Answer

Transphenoidal surgical resection

Answer

Somatostatin analogs

Answer

Dopamine agonists

Answer

GH receptor antagonists

Question 2

A 25-year-old patient presents with thinning of the outer third of the eyebrows. Which condition is most likely associated with this finding?

Accepted Answer

Hypothyroidism

Answer

Cutaneous TB

Answer

Lichen planus

Answer

Psoriasis

Question 3

Azoospermia with normal FSH would indicate?

Accepted Answer

Obstruction of vas deferens

Answer

Hypothalamic failure

Answer

Testicular failure

Answer

None of the options

Question 4

What percentage of patients with primary hyperparathyroidism have parathyroid adenomas?

Accepted Answer

80%

Answer

50%

Answer

60%

Answer

70%

Question 5

In which condition is radioiodine preferred for treatment?

Accepted Answer

Post-surgery for differentiated thyroid cancer

Answer

Hyperthyroidism in young patients

Answer

Hyperthyroidism during pregnancy

Answer

Recent onset of hyperthyroidism with toxic goiter

Question 6

Which of the following is used in quantifying hirsutism?

Accepted Answer

Ferriman-Gallwey score

Answer

Bishop score

Answer

Rotterdam criteria

Answer

All of the options

Question 7

Which of the following causes of hypercalcemia is not associated with high bone turnover?

Accepted Answer

Thiazides

Answer

Hyperthyroidism

Answer

Vitamin D intoxication

Answer

Vitamin A intoxication

Question 8

Metabolic syndrome diagnosis in men based on NCEP ATP III criteria includes the following except:

Accepted Answer

HDL < 50 mg / dL

Answer

Fasting glucose > 110 mg/dL

Answer

Abdominal obesity > 40 inches

Answer

BP >/= 130/85 mm Hg

Question 9

What is the HbA1C criteria for a patient to be diagnosed with diabetes mellitus?

Accepted Answer

6.5%

Answer

5.5%

Answer

4.5%

Answer

7.5%

Question 10

In which condition is a hypotonic solution administered for correction?

Accepted Answer

Hyperosmolar hyperglycemic state (HHS)

Answer

Dehydration secondary to diuretic therapy

Answer

Hypotonic dehydration

Answer

Diabetic ketoacidosis

Endocrinology — MCQs

Endocrinology — MCQs

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