Endocrinology — MCQs
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A patient with cushingoid features presents with hemoptysis. The patient shows no response to a dexamethasone suppression test. What is the most likely diagnosis?
Which of the following statements are true or false? 1. Hirsutism, defined as androgen-dependent excessive male pattern hair growth, affects approximately 25% of women. 2. Virilization refers to a condition in which androgen levels are sufficiently high to cause additional signs and symptoms. 3. Patients with growth hormone excess (i.e., acromegaly) frequently present with hirsutism. 4. A simple and commonly used method to grade hair growth is the modified Ferriman-Gallwey scale. 5. Scores above 8 suggest excess androgen-mediated hair growth.
A 40-year-old man presents with gynecomastia. Ultrasound reveals a 1 cm solid mass within the body of the testis. Serum testosterone is 600 ng/dL, and estradiol is 35 pg/mL. What is the most likely diagnosis?
A patient presents with complaints of excessive thirst and increased urination of around 6–7 liters per day. He had a history of cerebral trauma one month ago. What is the most appropriate treatment?
A man presents with high VLDL and chylomicrons, with eruptive xanthomas. What is the most likely diagnosis?
A female presents with amenorrhea and galactorrhea. Serum prolactin is elevated. MRI shows pituitary adenoma. Best management for this patient?
A 35-year-old male has had chronic hypercalcemia for the last 1.5 years, but PTH levels are normal. Which of the following is most likely the cause?
Patient presents with hypertension and hypokalemic metabolic alkalosis. CT scan shows a unilateral adrenal mass with elevated ARR. What is the next best step for the management of this patient?
A patient presents with palpitations, headache, and sweating. His BP is $180/100 \mathrm{mmHg}$ . 24-hour urinary metanephrine values are elevated. What is the diagnosis?
A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where TSH level is 27.3 mU/L, T3 is 1.24 ng/mL, and T4 is 4.87 μg/dL. Which of the following manifestations is true regarding the condition?
Endocrinology Indian Medical PG Practice Questions and MCQs
Question 1281: A patient with cushingoid features presents with hemoptysis. The patient shows no response to a dexamethasone suppression test. What is the most likely diagnosis?
- A. Adrenal hyperplasia
- B. Adrenal adenoma
- C. Lung cancer with ectopic ACTH production (Correct Answer)
- D. Pituitary microadenoma
Explanation: ### Explanation **1. Why Option C is Correct:** The patient presents with **Cushing syndrome** (cushingoid features) and **hemoptysis**, which is a classic "red flag" for underlying pulmonary malignancy. In medical exams, the combination of Cushing syndrome and a lung symptom (cough, hemoptysis, or a mass) strongly points toward **Ectopic ACTH Syndrome**, most commonly caused by **Small Cell Lung Cancer (SCLC)** [1]. The biochemical hallmark of ectopic ACTH production is its **autonomy**. Unlike pituitary causes (Cushing Disease), ectopic sources do not respond to feedback inhibition [3, 4]. Therefore, there is **no suppression** of cortisol levels even with a High-Dexamethasone Suppression Test (HDDST) [2]. **2. Why Other Options are Incorrect:** * **Adrenal Hyperplasia (Option A):** This is usually a secondary result of excess ACTH. If it is "Macronodular Adrenal Hyperplasia," it would not explain the hemoptysis [1]. * **Adrenal Adenoma (Option B):** While adrenal tumors are autonomous and do not suppress with dexamethasone, they are associated with **low ACTH levels** (due to negative feedback on the pituitary) [3]. They do not explain the respiratory symptom of hemoptysis. * **Pituitary Microadenoma (Option D):** Also known as Cushing Disease. These tumors typically show **partial suppression** ( >50% reduction in cortisol) with a High-Dose Dexamethasone Suppression Test, as they retain some sensitivity to glucocorticoid feedback [2]. **3. NEET-PG High-Yield Pearls:** * **Most common cause of Ectopic ACTH:** Small Cell Lung Cancer (SCLC) [1]. * **Most common cause of Endogenous Cushing Syndrome:** Pituitary Adenoma (Cushing Disease). * **Ectopic ACTH Presentation:** Often presents with rapid onset, severe hyperpigmentation (due to very high ACTH/MSH), and profound hypokalemia, rather than just weight gain. * **Dexamethasone Rule:** * *Cushing Disease:* Suppresses with High Dose [2]. * *Ectopic ACTH & Adrenal Tumors:* No suppression with High Dose [2].
Question 1282: Which of the following statements are true or false? 1. Hirsutism, defined as androgen-dependent excessive male pattern hair growth, affects approximately 25% of women. 2. Virilization refers to a condition in which androgen levels are sufficiently high to cause additional signs and symptoms. 3. Patients with growth hormone excess (i.e., acromegaly) frequently present with hirsutism. 4. A simple and commonly used method to grade hair growth is the modified Ferriman-Gallwey scale. 5. Scores above 8 suggest excess androgen-mediated hair growth.
- A. Statements 1, 2, and 3 are true; statements 4 and 5 are false.
- B. Statements 1, 3, and 5 are true; statements 2 and 4 are false.
- C. Statements 2, 4, and 5 are true; statements 1 and 3 are false. (Correct Answer)
- D. Statements 1, 2, 3, and 4 are true; statement 5 is false.
Explanation: This question tests the clinical evaluation of androgen excess, a high-yield topic in Endocrinology. **Analysis of Statements:** 1. **Statement 1 (False):** Hirsutism affects approximately **5–10%** of women of reproductive age, not 25% [1]. It is a common clinical sign of underlying hyperandrogenism (most commonly PCOS). 2. **Statement 2 (True):** **Virilization** is a more severe state than hirsutism. It occurs when androgen levels are high enough to cause "masculinization," including clitoromegaly, deepening of the voice, increased muscle mass, and temporal hair recession. 3. **Statement 3 (False):** While acromegaly causes skin thickening and **hypertrichosis** (generalized non-androgen-dependent hair growth), it does **not** typically cause hirsutism (male-pattern hair growth). 4. **Statement 4 (True):** The **modified Ferriman-Gallwey (mFG) scale** is the gold standard for visual scoring of hirsutism, assessing 9 androgen-sensitive body areas. 5. **Statement 5 (True):** In most populations (especially Caucasian and African American), an **mFG score ≥8** is considered the threshold for diagnosing hirsutism. **Why Option C is Correct:** Statements 2, 4, and 5 accurately describe the clinical definition of virilization and the diagnostic criteria/scoring for hirsutism. Statements 1 and 3 contain factual errors regarding prevalence and the specific type of hair growth in acromegaly. **NEET-PG High-Yield Pearls:** * **Hirsutism vs. Hypertrichosis:** Hirsutism is androgen-dependent (terminal hair in male pattern); Hypertrichosis is androgen-independent (generalized vellus hair, often due to drugs like Minoxidil, Phenytoin, or systemic disease). * **Most Common Cause:** PCOS accounts for ~70–80% of hirsutism cases [1]. * **Rapid Onset:** Sudden onset hirsutism with virilization should raise suspicion for **androgen-secreting tumors** (Adrenal or Ovarian) [1]. * **mFG Scale Areas:** Upper lip, chin, chest, upper/lower back, upper/lower abdomen, and upper arms/thighs.
Question 1283: A 40-year-old man presents with gynecomastia. Ultrasound reveals a 1 cm solid mass within the body of the testis. Serum testosterone is 600 ng/dL, and estradiol is 35 pg/mL. What is the most likely diagnosis?
- A. Leydig cell tumor (Correct Answer)
- B. Sertoli cell tumor
- C. Spermatocytic tumor
- D. Granulosa cell tumor
Explanation: ***Correct: Leydig cell tumor*** - **Most common** sex cord-stromal tumor in adults, accounting for **1-3%** of all testicular tumors - Arises from interstitial cells that produce **testosterone and estradiol** through aromatization [2], [4] - Classic presentation: **Gynecomastia** (30-40% of cases) due to increased estrogen production or altered testosterone/estrogen ratio [1], [3] - Typically presents as a **small, benign solid mass** (90% are <5 cm and benign) [3] - Ultrasound shows **solid, well-circumscribed intratesticular mass** [3] - Laboratory findings: **Elevated estradiol**, testosterone may be normal or elevated [3] *Incorrect: Sertoli cell tumor* - Less common sex cord-stromal tumor (also can cause gynecomastia but **much rarer** than Leydig cell tumor) - Only **10-20%** present with endocrine manifestations - More likely to present with painless testicular mass without hormonal effects - When hormonal effects occur, usually **estrogen production** but less pronounced than Leydig cell tumor *Incorrect: Spermatocytic tumor* - Germ cell tumor that occurs in **older men** (mean age 50-55 years) - **Does NOT produce hormones** - no gynecomastia - Presents as painless testicular enlargement - Typically larger masses, good prognosis, virtually **never metastasizes** *Incorrect: Granulosa cell tumor* - **Extremely rare** in males (primarily an ovarian tumor) - When it occurs in males, can produce estrogen and cause gynecomastia - However, represents **<1%** of testicular tumors in males - Leydig cell tumor is far more common with this presentation
Question 1284: A patient presents with complaints of excessive thirst and increased urination of around 6–7 liters per day. He had a history of cerebral trauma one month ago. What is the most appropriate treatment?
- A. Hydrochlorothiazide
- B. Tolvaptan
- C. Desmopressin (Correct Answer)
- D. Insulin
Explanation: ***Desmopressin***- This clinical presentation of excessive thirst and massive polyuria (6–7 L/day) following **cerebral trauma** strongly suggests **Central Diabetes Insipidus (CDI)**, which results from inadequate production or release of **Antidiuretic Hormone (ADH)/Vasopressin** in the posterior pituitary or hypothalamus.- **Desmopressin** (DDAVP) is a synthetic ADH analog and acts as the highly effective hormone replacement therapy [1], directly addressing the underlying deficiency and drastically reducing urine output.- This causes water permeability of the collecting ducts to increase through binding of ADH to the V2 receptor, which enhances collecting duct water permeability through the insertion of aquaporin (AQP-2) channels into the luminal cell membrane [2].*Hydrochlorothiazide*- This medication is paradoxically used in the treatment of **Nephrogenic Diabetes Insipidus (NDI)**, where the renal tubules fail to respond to ADH [1].- It works by inducing mild volume depletion, which leads to increased proximal tubule reabsorption of solutes and water, thereby decreasing fluid delivery to the collecting duct.*Tolvaptan*- **Tolvaptan** is a **V2 vasopressin receptor antagonist** primarily used to promote water excretion in conditions like **SIADH** (Syndrome of Inappropriate ADH) to correct hyponatremia.- Administering an ADH antagonist in a state of ADH deficiency (Diabetes Insipidus) would be contraindicated, as it would worsen polyuria and potentially cause severe **hypernatremia**.*Insulin*- **Insulin** is the definitive treatment for **Diabetes Mellitus**, a condition characterized by high blood glucose levels and subsequent osmotic diuresis leading to polyuria.- While Diabetes Mellitus can cause polyuria, the history of recent **cerebral trauma** and the absence of expected accompanying symptoms like persistent hyperglycemia and glycosuria make CDI the far more likely diagnosis.
Question 1285: A man presents with high VLDL and chylomicrons, with eruptive xanthomas. What is the most likely diagnosis?
- A. Familial hyperlipidemia
- B. Familial dysbetalipoproteinemia
- C. Familial hypertriglyceridemia (Correct Answer)
- D. Familial hypercholesterolemia
Explanation: ***Familial hypertriglyceridemia (Type IV or V hyperlipidemia)*** - This condition presents with **elevated VLDL and chylomicrons**, causing severe hypertriglyceridemia [1] - **Eruptive xanthomas** are pathognomonic for triglyceride levels >1000 mg/dL, appearing as small yellow papules on extensor surfaces and buttocks - Patients are at risk for **acute pancreatitis** due to extreme triglyceride elevation - Treatment includes **fibrates, omega-3 fatty acids, and strict dietary fat restriction** [2] *Familial hyperlipidemia* - This is a non-specific term that could refer to any inherited lipid disorder - Not a precise diagnostic entity used in clinical practice *Familial dysbetalipoproteinemia (Type III)* - Characterized by elevated **IDL (intermediate-density lipoproteins)**, not primarily VLDL + chylomicrons [1] - Presents with **palmar xanthomas (yellowish discoloration of palmar creases)** and tuberoeruptive xanthomas [1] - Different lipid pattern and xanthoma distribution than described *Familial hypercholesterolemia* - Characterized by elevated **LDL cholesterol**, not triglycerides [1] - Presents with **tendinous xanthomas, xanthelasma, and corneal arcus** [1] - Does not cause eruptive xanthomas or chylomicronemia
Question 1286: A female presents with amenorrhea and galactorrhea. Serum prolactin is elevated. MRI shows pituitary adenoma. Best management for this patient?
- A. Bromocriptine (Correct Answer)
- B. Tamoxifen
- C. Goserelin
- D. Letrozole
Explanation: ***Bromocriptine***- It is a **dopamine agonist** and represents the initial and standard treatment for **prolactinomas**, effectively reducing tumor size and lowering prolactin levels [1].- Dopamine agonists resolve symptoms such as **amenorrhea** and **galactorrhea** by inhibiting prolactin secretion from the pituitary [1]. *Letrozole*- This is an **aromatase inhibitor** primarily used in the management of hormone-sensitive breast cancer or for ovulation induction in conditions like PCOS. - Its mechanism is unrelated to suppressing prolactin secretion from the pituitary or shrinking a prolactinoma. *Tamoxifen*- This is a **Selective Estrogen Receptor Modulator (SERM)** most commonly used in the treatment and prevention of estrogen receptor-positive breast cancer. - It does not act on dopamine receptors and is ineffective in reversing elevated prolactin levels or associated symptoms. *Goserelin*- This agent is a **Gonadotropin-Releasing Hormone (GnRH) agonist** used primarily for conditions like endometriosis, uterine fibroids, or prostate cancer by initially stimulating then desensitizing the GnRH receptor. - While it suppresses LH and FSH [2], it is not the primary treatment for hyperprolactinemia caused by a pituitary adenoma.
Question 1287: A 35-year-old male has had chronic hypercalcemia for the last 1.5 years, but PTH levels are normal. Which of the following is most likely the cause?
- A. Malignancy
- B. C.K.D
- C. Sarcoidosis (Correct Answer)
- D. Parathyroid hyperplasia
Explanation: ***Sarcoidosis*** - Causes hypercalcemia via ectopic synthesis of **1,25-dihydroxyvitamin D** (calcitriol) by activated macrophages in the granulomas, leading to increased intestinal calcium absorption [1]. - Although the resulting hypercalcemia usually suppresses PTH (making it low), in chronic, mild cases, the PTH level may appear in the lower end of the **normal reference range**, consistent with the clinical picture of a non-PTH-mediated cause [1]. *Malignancy* - Hypercalcemia related to solid tumors (Humoral Hypercalcemia of Malignancy) is typically mediated by **PTH-related peptide (PTHrP)**, resulting in high calcium. - This non-PTH mediated hypercalcemia leads to appropriate **suppression of the parathyroid glands**, meaning PTH levels would be significantly **low or undetectable**, not normal [1]. *Parathyroid hyperplasia* - This condition represents **primary hyperparathyroidism**, characterized by autonomous secretion of PTH [1]. - In primary hyperparathyroidism, PTH levels are typically inappropriately **elevated** (or grossly high-normal) despite the presence of hypercalcemia, which contradicts a normal PTH value [1]. *C.K.D* - Chronic kidney disease usually results in **hypocalcemia** due to impaired 1-alpha-hydroxylase function and resultant low 1,25(OH)₂D levels [2]. - If hypercalcemia were present (e.g., due to tertiary hyperparathyroidism), PTH levels would be markedly **elevated**, not normal, due to persistent glandular stimulation [2].
Question 1288: Patient presents with hypertension and hypokalemic metabolic alkalosis. CT scan shows a unilateral adrenal mass with elevated ARR. What is the next best step for the management of this patient?
- A. Adrenalectomy (Correct Answer)
- B. Spironolactone on a lifelong basis
- C. Dexamethasone suppression test
- D. ACTH stimulation test
Explanation: ***Adrenalectomy*** - The combination of **hypertension**, **hypokalemic metabolic alkalosis**, elevated **Aldosterone-to-Renin Ratio (ARR)**, and a unilateral **adrenal mass** is diagnostic for Primary Aldosteronism, likely due to an Aldosterone-Producing Adenoma (**APA**) [1]. - **Unilateral adrenalectomy** is the definitive, potentially curative treatment for a confirmed APA, addressing the root cause of the hyperaldosteronism and hypertension [1]. *Spironolactone on a lifelong basis* - This treatment involves a **Mineralocorticoid Receptor Antagonist** and is the preferred therapy for patients with **Bilateral Adrenal Hyperplasia (BAH)** or for patients with an APA who are not surgical candidates [1]. - Since a likely unilateral adenoma is identified and surgery offers a cure, medical therapy is not the *next best step*. *ACTH stimulation test* - This test is used primarily to evaluate the reserve capacity of the adrenal cortex and diagnose **Adrenal Insufficiency** (e.g., Addison's disease or secondary adrenal insufficiency) [2]. - It is not indicated for the diagnosis or management of hyperaldosteronism. *Dexamethasone suppression test* - This test is the standard screening tool used to diagnose **Cushing's syndrome** (hypercortisolism) by assessing the feedback loop involving the hypothalamic-pituitary-adrenal axis [3]. - It is irrelevant in the workup for primary hyperaldosteronism.
Question 1289: A patient presents with palpitations, headache, and sweating. His BP is $180/100 \mathrm{mmHg}$ . 24-hour urinary metanephrine values are elevated. What is the diagnosis?
- A. Carcinoid crisis
- B. Pheochromocytoma (Correct Answer)
- C. Neuroblastoma
- D. Carcinoid tumor
Explanation: Pheochromocytoma - The constellation of symptoms—palpitations, episodic sweating, severe headache, and hypertension (the classic triad)—is highly suggestive of excessive catecholamine release. - The diagnosis is confirmed by the elevated 24-hour urinary metanephrines (metabolites of epinephrine and norepinephrine), which is the definitive biochemical hallmark of this adrenal medullary tumor. Carcinoid tumor - This tumor primarily secretes serotonin and other vasoactive substances, leading to symptoms like flushing, diarrhea, and bronchospasm (carcinoid syndrome) [1]. - The biochemical marker for this condition is elevated urinary 5-hydroxyindoleacetic acid (5-HIAA), not metanephrines. Carcinoid crisis - This represents a severe, life-threatening exacerbation of carcinoid syndrome involving severe flushing, profound hypotension, and cardiac arrhythmias. - It is typically an acute event triggered by stressors such as surgery or chemotherapy, unlike the chronic presentation described. Neuroblastoma - This malignant tumor of the neural crest primarily affects infants and young children (usually under 5 years old), making it unlikely in an adult patient. - Although it can secrete catecholamines, its primary presenting features usually include an abdominal mass, fever, and metastasis, and the key diagnostic marker is often high urinary VMA (Vanillylmandelic acid) and HVA (Homovanillic acid).
Question 1290: A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where TSH level is 27.3 mU/L, T3 is 1.24 ng/mL, and T4 is 4.87 μg/dL. Which of the following manifestations is true regarding the condition?
- A. Weight gain (Correct Answer)
- B. Diarrhea
- C. Tachycardia
- D. Heat intolerance
Explanation: ***Weight gain***- The patient's thyroid function tests (TFTs), showing a **highly elevated TSH** (27.3 mU/L) and **low T4** (4.87 μg/dL), confirm a diagnosis of **Primary Hypothyroidism** [1].- Weight gain is a classic symptom of hypothyroidism, resulting from reduced **basal metabolic rate** and frequently accompanied by **fluid retention** leading to *myxedema* [2]. *Heat intolerance*- Heat intolerance is a characteristic feature of **Hyperthyroidism**, where excess thyroid hormone increases heat production.- Patients with hypothyroidism typically experience **cold intolerance** due to decreased thermogenesis [2]. *Tachycardia*- **Tachycardia** (increased heart rate) is a common cardiovascular manifestation of **Hyperthyroidism** due to enhanced adrenergic effects [2].- Hypothyroidism generally leads to **bradycardia** (slow heart rate) and reduced cardiac contractility [2]. *Diarrhea*- Diarrhea is associated with **Hyperthyroidism** because of increased gastrointestinal motility.- Patients suffering from hypothyroidism commonly present with decreased bowel motility, leading to **constipation** [2].
Practice by Chapter
Diabetes Mellitus
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Thyroid Disorders
Practice Questions
Adrenal Gland Disorders
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Pituitary Disorders
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Calcium and Bone Metabolism
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Reproductive Endocrinology
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Lipid Disorders
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Endocrine Hypertension
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Multiple Endocrine Neoplasia
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Obesity and Metabolic Syndrome
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Neuroendocrine Tumors
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Endocrine Emergencies
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