Endocrinology Practice Questions

Q: Enlargement of a pituitary tumor after adrenalectomy is called as?

Nelson's syndrome. **Explanation:** **Nelson’s Syndrome** (Option A) is the correct answer. It refers to the development of an ACTH-secreting pituitary adenoma following **bilateral adrenalectomy**, typically performed as a treatment for Cushing’s disease. [1] * **Mechanism:** The removal of both adrenal glands eliminates the negative feedback loop of cortisol on the hypothalamus and pituitary. In the absence of cortisol, the pre-existing pituitary microadenoma undergoes rapid growth and hypersecretion of ACTH and melanocyte-stimulating hormone (MSH). [1] * **Clinical Features:** Patients present with hyperpigmentation (due to high MSH levels) and symptoms of local tumor expansion, such as visual field defects and headaches. **Why other options are incorrect:** * **Steel-Richardson Syndrome (Option B):** Also known as Progressive Supranuclear Palsy (PSP), it is a neurodegenerative tauopathy characterized by vertical gaze palsy, postural instability, and falls. * **Hamman-Rich Syndrome (Option C):** Also known as Acute Interstitial Pneumonia (AIP), it is a rare, fulminant form of idiopathic diffuse lung disease leading to rapid respiratory failure. * **Job’s Syndrome (Option D):** Also known as Hyper-IgE Syndrome, it is a primary immunodeficiency characterized by the triad of high IgE levels, recurrent "cold" staphylococcal abscesses, and eczematoid dermatitis. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Elevated plasma ACTH levels (>200 pg/mL) and MRI evidence of an enlarging pituitary mass. * **Prevention:** The incidence of Nelson's syndrome has decreased significantly due to the use of transsphenoidal surgery (TSS) as the first-line treatment for Cushing’s disease, rather than bilateral adrenalectomy. * **Key Association:** Always look for the combination of **bilateral adrenalectomy + hyperpigmentation + pituitary mass** in clinical vignettes.

Q: Which of the following is NOT TRUE regarding Hashimoto's thyroiditis?

None of the above. **Explanation:** Hashimoto’s Thyroiditis (Chronic Lymphocytic Thyroiditis) is the most common cause of hypothyroidism in iodine-sufficient regions. It is an autoimmune condition characterized by the destruction of thyroid follicles. **Analysis of Options:** * **Option A (Neutrophilic infiltration):** This is **NOT** a feature of Hashimoto’s. The hallmark histopathology shows a dense **lymphocytic and plasma cell infiltrate** with the formation of germinal centers. Neutrophilic infiltration is typically seen in acute infectious (suppurative) thyroiditis. * **Option B (Maximum incidence in children):** This is **NOT** true. Hashimoto’s thyroiditis most commonly affects **middle-aged women** (between 30 and 50 years of age), with a female-to-male ratio of approximately 10:1 to 20:1. * **Option C (Pain in the hyoid region):** This is **NOT** true. Hashimoto’s is typically a **painless**, diffuse enlargement of the thyroid (goiter). Pain and tenderness are characteristic features of Subacute Granulomatous (De Quervain’s) Thyroiditis or infectious thyroiditis. Since **all three statements (A, B, and C) are incorrect** regarding Hashimoto’s thyroiditis, the question asks which is "NOT TRUE." Technically, all are false. In the context of this specific MCQ structure, "None of the above" is the designated correct answer because none of the provided statements accurately describe the disease. **NEET-PG High-Yield Pearls:** * **Histology:** Look for **Hürthle cells** (Askanazy cells)—large epithelial cells with abundant eosinophilic, granular cytoplasm. * **Antibodies:** High titers of **Anti-TPO** (Antithyroid peroxidase) and **Anti-Tg** (Antithyroglobulin) antibodies. * **Risk:** Increased risk of **B-cell Non-Hodgkin Lymphoma** of the thyroid and other autoimmune diseases (e.g., Type 1 Diabetes, Pernicious Anemia). * **Genetics:** Associated with **HLA-DR3 and HLA-DR5**.

Q: The triad of cirrhosis, hemochromatosis, and diabetes is referred to as which of the following?

Bronze diabetes. **Explanation:** The correct answer is **Bronze diabetes**. This term refers to the classic clinical triad seen in **Hereditary Hemochromatosis**, an autosomal recessive disorder characterized by excessive intestinal iron absorption and subsequent deposition in various organs [1]. 1. **Why it is correct:** In Hemochromatosis, iron (hemosiderin) deposits in the **pancreas**, leading to islet cell destruction and secondary diabetes mellitus [1]. Simultaneously, iron deposition in the **liver** causes cirrhosis, and deposition in the **skin** (along with increased melanin production) results in a characteristic metallic, slate-gray, or "bronze" hyperpigmentation [1]. The combination of these three features—Cirrhosis, Diabetes, and Hyperpigmentation—defines "Bronze Diabetes." 2. **Why the other options are incorrect:** * **Silver diabetes:** This is not a recognized medical term for any specific clinical syndrome. * **Diabetes mellitus:** While this is a component of the triad, it refers generally to hyperglycemia and does not encompass the multisystem involvement of iron overload. * **Diabetes insipidus:** This is a disorder of water metabolism caused by a deficiency of or resistance to Antidiuretic Hormone (ADH), unrelated to iron overload or cirrhosis. **High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** Most commonly due to a mutation in the **HFE gene** (C282Y mutation on Chromosome 6) [1][2]. * **Screening:** The most sensitive initial test is **Transferrin Saturation** (>45% is suggestive). * **Gold Standard Diagnosis:** Liver biopsy (Perls' Prussian Blue stain) or MRI (T2* weighted) to quantify iron overload [2]. * **Other Features:** "Honeymooner’s Arthritis" (2nd/3rd MCP joints), Dilated Cardiomyopathy, and Hypogonadotropic Hypogonadism [1]. * **Treatment:** Therapeutic phlebotomy is the mainstay of management [2].

Q: Which of the following investigations is used to differentiate between hypercalcemia of malignancy and primary hyperparathyroidism?

Hydrocortisone suppression test. The **Hydrocortisone suppression test** (also known as the Dent test) is a classic biochemical tool used to differentiate causes of hypercalcemia. **1. Why Option A is Correct:** In **Hypercalcemia of Malignancy** (specifically those involving bone metastases, multiple myeloma, or sarcoidosis), the administration of high-dose glucocorticoids (e.g., 100 mg hydrocortisone daily for 10 days) typically **lowers** serum calcium levels [1]. Glucocorticoids reduce calcium by inhibiting Vitamin D-mediated intestinal absorption and suppressing cytokine-induced osteoclast activity. In contrast, in **Primary Hyperparathyroidism (PHPT)**, the hypercalcemia is driven by autonomous PTH secretion, which is **not suppressed** by steroids. Therefore, a failure of calcium levels to drop suggests PHPT [1]. **2. Why the Other Options are Incorrect:** * **B. Glucose challenge test:** This is used to diagnose Acromegaly (failure of Growth Hormone suppression) and has no role in calcium metabolism. * **C. 24-hour urine calcium:** This is primarily used to differentiate PHPT from **Familial Hypocalciuric Hypercalcemia (FHH)** [1]. In FHH, urine calcium is low (Calcium:Creatinine clearance ratio <0.01), whereas it is normal or high in PHPT [1]. * **D. Percentage of ionized calcium:** While ionized calcium is the physiologically active form, it does not reliably differentiate the underlying etiology of hypercalcemia, as it can be elevated in both malignancy and PHPT [1]. **Clinical Pearls for NEET-PG:** * **Most common cause of hypercalcemia in outpatients:** Primary Hyperparathyroidism. * **Most common cause of hypercalcemia in hospitalized patients:** Malignancy [1]. * **PTH levels:** In PHPT, PTH is elevated or inappropriately normal. In malignancy-associated hypercalcemia, PTH is typically suppressed (low) [1]. * **PTHrP:** This is the mediator in Humoral Hypercalcemia of Malignancy (e.g., Squamous cell carcinoma of the lung).

Q: Diabetes mellitus is associated with all of the following conditions except?

Pendred syndrome. **Explanation** The correct answer is **Pendred syndrome**. **1. Why Pendred syndrome is the correct answer:** Pendred syndrome is an autosomal recessive disorder caused by mutations in the *SLC26A4* gene (encoding the pendrin protein). It is classically characterized by a triad of **sensorineural hearing loss**, **goiter**, and an abnormal perchlorate discharge test. While it involves the thyroid gland (hypothyroidism or euthyroid goiter), it has **no established clinical association with Diabetes Mellitus** [1]. **2. Why the other options are incorrect:** Chromosomal aneuploidies are frequently associated with an increased risk of autoimmune and metabolic endocrine disorders, including Diabetes Mellitus: * **Down’s syndrome (Trisomy 21):** Patients have a significantly higher prevalence of **Type 1 Diabetes Mellitus** due to increased susceptibility to autoimmunity [2]. * **Turner’s syndrome (45, XO):** There is a high incidence of **Type 2 Diabetes** and impaired glucose tolerance, likely due to a combination of haploinsufficiency of X-chromosome genes affecting insulin sensitivity and beta-cell function [3]. * **Klinefelter’s syndrome (47, XXY):** These patients often exhibit abdominal obesity and hypogonadism, leading to insulin resistance and a high risk of **Type 2 Diabetes** and Metabolic Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Pendred Syndrome:** "P" for **P**endred, **P**erchlorate test, and **P**erceptive (sensorineural) deafness. * **Other Genetic Syndromes associated with DM:** Wolfram syndrome (DIDMOAD), Prader-Willi syndrome, Alström syndrome, and Friedreich’s ataxia. * **Wolfram Syndrome (DIDMOAD):** **D**iabetes **I**nsipidus, **D**iabetes **M**ellitus, **O**ptic **A**trophy, and **D**eafness.

Q: Wermer syndrome is characterized by which of the following?

Multiple Endocrine Neoplasia type 1 (MEN 1). **Explanation:** **Wermer Syndrome** is the eponym for **Multiple Endocrine Neoplasia type 1 (MEN 1)**. It is an autosomal dominant disorder caused by a mutation in the *MEN1* gene on chromosome 11q13, which encodes the protein **menin**, a tumor suppressor. The syndrome is classically characterized by the **"3 Ps"**: 1. **Parathyroid hyperplasia:** The most common feature (present in >95% of cases), leading to primary hyperparathyroidism. 2. **Pancreatic islet cell tumors:** Most commonly Gastrinomas (Zollinger-Ellison Syndrome) or Insulinomas. 3. **Pituitary adenomas:** Most commonly Prolactinomas. **Analysis of Incorrect Options:** * **MEN 2A (Sipple Syndrome):** Characterized by Medullary Thyroid Carcinoma (MTC), Pheochromocytoma, and Parathyroid hyperplasia. It is associated with the *RET* proto-oncogene. * **MEN 2B (Wagenmann-Froboese Syndrome):** Characterized by MTC, Pheochromocytoma, Mucosal neuromas, and Marfanoid habitus. It does *not* typically involve the parathyroid glands. * **Acute Intermittent Porphyria (AIP):** A metabolic disorder of heme biosynthesis; it is unrelated to the MEN syndromes. **High-Yield Clinical Pearls for NEET-PG:** * **Most common initial presentation of MEN 1:** Hypercalcemia (due to hyperparathyroidism). * **Most common pituitary tumor in MEN 1:** Prolactinoma. * **Most common cause of death in MEN 1:** Malignant pancreatic neuroendocrine tumors (especially Gastrinomas). * **Screening:** Genetic testing for *MEN1* mutation is recommended for first-degree relatives of affected patients.

Question 1

A 45-year-old male presents with palpitations, tachycardia, and anxiety. His blood pressure is 158/90 mmHg. He has mild depression and is currently taking citalopram, labetalol, and amlodipine for blood pressure control. 24-hour urine total metanephrines show an elevation of 1.5 times the upper limit of normal. What is the next best step?

Accepted Answer

Hold labetalol for 1 week and repeat testing

Answer

Hold citalopram for 1 week and repeat testing

Answer

Refer immediately for surgical evaluation

Answer

Measure 24-hour urine vanillylmandelic acid level

Question 2

Enlargement of a pituitary tumor after adrenalectomy is called as?

Accepted Answer

Nelson's syndrome

Answer

Steel-Richardson syndrome

Answer

Hamman-Rich syndrome

Answer

Job's syndrome

Question 3

A patient with autoimmune thyroiditis presents with hypothyroidism. Which of the following is true?

Accepted Answer

Thyroid peroxidase antibodies

Answer

Painless enlargement of the thyroid

Answer

Common in men

Answer

No malignant risk

Question 4

A 26-year-old woman has episodic hypertension with headache, diaphoresis, and palpitation. Which of the following diagnostic procedures would be most useful in evaluating the possibility that pheochromocytoma might be the cause of these findings?

Accepted Answer

Urinary vanillylmandelic acid

Answer

Serum C-peptide

Answer

Serum calcitonin

Answer

Urinary aldosterone

Question 5

A patient has random plasma glucose levels of 110 mg/dL and 113 mg/dL on two separate occasions. What advice would you give?

Accepted Answer

Declare the patient as normal.

Answer

Declare him as having Diabetes mellitus.

Answer

Proceed for an oral glucose tolerance test.

Answer

Check for glycosylated hemoglobin and if it is raised, declare him as having DM.

Question 6

Which of the following is NOT TRUE regarding Hashimoto's thyroiditis?

Accepted Answer

None of the above

Answer

Neutrophilic infiltration

Answer

Maximum incidence in children

Answer

Pain in the hyoid region

Question 7

The triad of cirrhosis, hemochromatosis, and diabetes is referred to as which of the following?

Accepted Answer

Bronze diabetes

Answer

Silver diabetes

Answer

Diabetes mellitus

Answer

Diabetes insipidus

Question 8

Which of the following investigations is used to differentiate between hypercalcemia of malignancy and primary hyperparathyroidism?

Accepted Answer

Hydrocortisone suppression test

Answer

Glucose challenge test

Answer

24-hour urine calcium measurement

Answer

Percentage of ionized calcium

Question 9

Diabetes mellitus is associated with all of the following conditions except?

Accepted Answer

Pendred syndrome

Answer

Down's syndrome

Answer

Turner's syndrome

Answer

Klinefelter's syndrome

Question 10

Wermer syndrome is characterized by which of the following?

Accepted Answer

Multiple Endocrine Neoplasia type 1 (MEN 1)

Answer

Multiple Endocrine Neoplasia type 2A (MEN 2A)

Answer

Multiple Endocrine Neoplasia type 2B (MEN 2B)

Answer

Acute Intermittent Porphyria (AIP)

Endocrinology — MCQs

Endocrinology — MCQs

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