Endocrinology Practice Questions

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: 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: 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 is the ideal treatment for macroprolactinoma?

Bromocriptine. **Bromocriptine** - **Dopamine agonists** like bromocriptine are the **first-line treatment** for macroprolactinomas, effectively reducing tumor size and prolactin levels [1]. - These medications are successful in **over 80%** of patients, often leading to significant clinical improvement and avoiding the need for surgery [2]. *Surgical excision* - Surgical excision is typically reserved for cases where **dopamine agonists are ineffective**, poorly tolerated, or if there is rapid neurological deterioration not managed by medical therapy [2]. - Surgical removal of macroprolactinomas can be challenging and carries risks, including **hypopituitarism** and damage to surrounding structures. *Stereotactic radiosurgery* - **Radiosurgery** is generally considered a **secondary or tertiary treatment option** for macroprolactinomas failing medical therapy or surgery, or in cases of residual tumor [1]. - While effective in controlling tumor growth and hormone secretion, its effects are **delayed**, and it can lead to **hypopituitarism** over time. *Watchful waiting* - **Watchful waiting** is generally not appropriate for **macroprolactinomas** due to their potential for continued growth, which can lead to significant mass effect symptoms like **visual field defects** and headaches [1]. - This approach is more commonly applied to **microprolactinomas** that are asymptomatic and do not show significant growth [1].

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: Which of the following conditions is least likely to be associated with osteoporosis?

Hypoparathyroidism. ***Hypoparathyroidism*** - This condition is characterized by **low parathyroid hormone (PTH)** levels, leading to **hypocalcemia** and **hyperphosphatemia**. - Without sufficient PTH, the normal regulation of bone turnover is impaired, typically resulting in **increased bone density** rather than osteoporosis. *Thyrotoxicosis* - **Excess thyroid hormone** directly stimulates bone remodeling, leading to an **increased rate of bone resorption** over bone formation. - This imbalance results in a net loss of bone mass and can significantly increase the risk of osteoporosis. *Rheumatoid arthritis* - Chronic inflammation in **rheumatoid arthritis** releases pro-inflammatory cytokines that directly promote osteoclast activity and bone loss (local and systemic) [1]. - Reduced physical activity, systemic effects of the disease, and the use of glucocorticoids for treatment can all contribute to **secondary osteoporosis** [1]. *Steroid therapy* - **Glucocorticoids** (steroids) inhibit osteoblast function, reduce calcium absorption in the gut, and increase renal calcium excretion [1]. - Long-term use of systemic steroids is a well-established major risk factor for **steroid-induced osteoporosis** and fractures [1].

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: Which of the following is NOT a cause of fasting hypoglycemia?

Chronic pancreatitis. ***Chronic pancreatitis*** - This condition primarily affects the **exocrine function of the pancreas**, leading to malabsorption and, in later stages, often **diabetes mellitus** due to islet cell destruction [1]. - While it can lead to **pancreatic insufficiency**, it is not typically a cause of **fasting hypoglycemia**; rather, it often causes hyperglycemia [1]. *Alcohol intake* - **Ethanol metabolism** can inhibit gluconeogenesis in the liver, especially when **glycogen stores are depleted**, leading to **hypoglycemia**. - This is a common cause of **fasting hypoglycemia**, particularly in individuals with poor nutrition. *Pentamidine therapy* - **Pentamidine**, used to treat *Pneumocystis jiroveci* pneumonia, can cause **direct toxicity to pancreatic beta cells**, leading to acute **insulin release** and subsequent hypoglycemia. - While long-term use can lead to **beta-cell destruction** and diabetes, its acute effect is often **severe hypoglycemia**. *Renal insufficiency* - **Kidney failure** can lead to hypoglycemia through several mechanisms, including **reduced renal gluconeogenesis** and decreased insulin clearance. - The kidneys play a significant role in **insulin degradation** and glucose production, so impaired function can result in **prolonged insulin levels** and lower blood glucose.

Q: In case of hypothyroidism, which investigation is most informative and commonly used?

Serum TSH Level. ***Serum TSH Level*** - **Thyroid-stimulating hormone (TSH)** is the most sensitive and specific biomarker for primary hypothyroidism, as even small changes in thyroid hormone levels cause significant reciprocal changes in TSH [1]. - A **high TSH level** indicates that the pituitary gland is working harder to stimulate a underactive thyroid gland [1]. *Serum T3, T4 Level* - While **low T3 and T4 levels** are characteristic of hypothyroidism, TSH is a more reliable initial test due to its greater sensitivity as a first-line screen [1]. - T4 levels may be affected by various conditions like malnutrition, non-thyroidal illness, and medication, which might complicate interpretation. *Serum Calcitonin assay* - **Calcitonin** is a hormone involved in calcium regulation and is primarily used as a tumor marker for medullary thyroid cancer. - It has no role in diagnosing hypothyroidism. *Serum T3 level* - **Triiodothyronine (T3)** levels can be maintained within the normal range even in early hypothyroidism due to increased peripheral conversion of T4 to T3 [1]. - T3 measurement is generally more useful in **hyperthyroidism** diagnosis or in assessing the severity of thyrotoxicosis rather than hypothyroidism [1].

Q: What is the average time period that HbA1c reflects blood glucose control?

2 - 3 months. ***2 - 3 months*** - **Hemoglobin A1c (HbA1c)** reflects the average blood glucose levels over the preceding **2-3 months** due to the typical lifespan of red blood cells [1]. - Glucose molecules bind irreversibly to hemoglobin within red blood cells, and the level of glycosylation directly correlates with the average plasma glucose concentration during and after the red cell's formation [1], [2]. *1 - 2 months* - This timeframe is too short to accurately represent the full lifespan of red blood cells, which is the basis for HbA1c measurement. - While some red blood cells are younger, a significant portion reflecting the earlier part of the 3-month period would be missed, providing an incomplete picture. *3 - 4 months* - This period is generally considered too long, as the contribution of red blood cells older than approximately 3 months to the overall HbA1c value becomes negligible due to their natural turnover [1]. - Focusing on this longer duration might incorporate data from red blood cells that have already been replaced, potentially overestimating or underestimating recent glucose control. *4 - 5 months* - This timeframe would be significantly inaccurate for HbA1c measurement. - The vast majority of red blood cells from 4-5 months prior would have been replaced, leading to a poor reflection of actual blood glucose control.

Question 1

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 2

What percentage of patients with primary hyperparathyroidism have parathyroid adenomas?

Accepted Answer

80%

Answer

50%

Answer

60%

Answer

70%

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 is the ideal treatment for macroprolactinoma?

Accepted Answer

Bromocriptine

Answer

Surgical excision

Answer

Stereotactic radiosurgery

Answer

Watchful waiting

Question 5

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 6

Which of the following conditions is least likely to be associated with osteoporosis?

Accepted Answer

Hypoparathyroidism

Answer

Thyrotoxicosis

Answer

Steroid therapy

Answer

Rheumatoid arthritis

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

Which of the following is NOT a cause of fasting hypoglycemia?

Accepted Answer

Chronic pancreatitis

Answer

Pentamidine therapy

Answer

Renal insufficiency

Answer

Alcohol intake

Question 9

In case of hypothyroidism, which investigation is most informative and commonly used?

Accepted Answer

Serum TSH Level

Answer

Serum T3, T4 Level

Answer

Serum Calcitonin assay

Answer

Serum T3 level

Question 10

What is the average time period that HbA1c reflects blood glucose control?

Accepted Answer

2 - 3 months

Answer

3 - 4 months

Answer

4 - 5 months

Answer

1 - 2 months

Endocrinology — MCQs

Endocrinology — MCQs

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