Endocrinology Practice Questions

Q: Most common hormone deficiency that occurs after intracranial irradiation is

Growth hormone. ***Growth hormone*** - **Growth hormone (GH)** deficiency is the **most common and earliest hormonal deficiency** to occur after intracranial irradiation, particularly in children [1]. - The **somatotrophs** in the pituitary gland, responsible for GH production, are highly sensitive to radiation damage [1]. *Gonadotropins* - Deficiencies in **gonadotropins (LH and FSH)** are also common after irradiation but typically occur later than GH deficiency [1]. - While significant, they are not usually the *first* or *most common* deficiency. *ACTH* - **ACTH (adrenocorticotropic hormone)** deficiency is less common than GH and gonadotropin deficiencies following intracranial irradiation [1]. - The **corticotrophs** are relatively more resistant to radiation, making ACTH deficiency a later and less frequent complication. *Prolactin* - **Prolactin** deficiency is the **least common** pituitary hormone deficiency after cranial irradiation. - The **lactotrophs** are highly resistant to radiation-induced damage.

Q: Commonest cause of hypothyroidism is

Thyroid dysgenesis. **Thyroid dysgenesis** - **Thyroid dysgenesis** refers to congenital defects in thyroid gland development (e.g., aplasia, hypoplasia, ectopia) and is the most frequent cause worldwide of **congenital hypothyroidism** [1]. - Early detection and treatment with thyroid hormone replacement are crucial to prevent **intellectual disability** and developmental delays [1]. *Defect of iodide transport* - This is a rare genetic disorder affecting the **sodium-iodide symporter (NIS)**, leading to impaired iodide uptake by the thyroid gland. - While it causes hypothyroidism, it is significantly less common than thyroid dysgenesis. *Defective synthesis of thyroxine* - This refers to various inherited defects in the enzymes involved in thyroid hormone synthesis (e.g., peroxidase deficiency, organification defects). - These are collectively known as **dyshormonogenesis**, and although they cause congenital hypothyroidism, their incidence is lower than that of thyroid dysgenesis [1]. *Hashimoto's thyroiditis* - **Hashimoto's thyroiditis** is the most common cause of **acquired hypothyroidism** in adults, an autoimmune condition leading to thyroid gland destruction. - It is not the most common cause of hypothyroidism in general, especially when considering congenital forms.

Q: A 30-year-old woman presents with a history of amenorrhea and impaired vision of six months' duration. Physical examination shows normal findings except for pale optic discs and diminished visual acuity. The most likely diagnosis is -

Pituitary adenoma. ***Pituitary adenoma*** - Pituitary adenomas, particularly **macroadenomas**, can cause **bitemporal hemianopsia** due to compression of the **optic chiasm**, leading to impaired vision and pale optic discs [1]. - They also frequently secrete hormones, with **prolactinomas** being a common type, leading to **amenorrhea** in women due to inhibition of GnRH. *Benign intracranial hypertension* - This condition is primarily characterized by **increased intracranial pressure** leading to headache, pulsatile tinnitus, and **papilledema**, which presents as a swollen optic disc, not pale. - While it can cause visual field defects, **amenorrhea** is not a typical associated symptom. *Hypothalamic glioma* - Hypothalamic gliomas can cause visual field defects and endocrine dysfunction due to their location near the **optic chiasm** and **hypothalamus**. - However, they are more common in children and usually present with symptoms like **diabetes insipidus**, growth abnormalities, or precocious puberty, rather than isolated amenorrhea and optic disc pallor. *Craniopharyngioma* - Craniopharyngiomas are **suprasellar tumors** that can compress the optic chiasm, causing visual disturbances, and impact the pituitary stalk and hypothalamus, leading to endocrine dysfunction. - They often present with symptoms of **hydrocephalus**, **growth retardation**, or **diabetes insipidus**, and are more frequently diagnosed in childhood or adolescence, although they can occur in adults.

Q: The tumor which is more commonly located in the tail of the pancreas is:

Glucagonoma. ***Glucagonoma*** - **Glucagonomas** are most commonly found in the **tail of the pancreas**. - They are associated with a distinct clinical syndrome including **necrolytic migratory erythema**, diabetes, weight loss, and anemia. *Somatostatinoma* - **Somatostatinomas** are typically located in the **head of the pancreas** or duodenum. - Their classical presentation involves diabetes, cholelithiasis, steatorrhea, and weight loss. *Insulinoma* - **Insulinomas** are usually small and evenly distributed throughout the **pancreas**, without a predilection for the tail. - They cause symptoms of hypoglycemia due to excessive insulin secretion, such as **whipple's triad**. *Gastrinoma* - **Gastrinomas** are most frequently found in the **"gastrinoma triangle"**, which includes the head of the pancreas, duodenum, and peripancreatic lymph nodes. [1] - They cause **Zollinger-Ellison syndrome**, characterized by severe peptic ulcer disease and diarrhea due to hypersecretion of gastrin. [1]

Q: In Osteoporosis which of these is seen?

Normal calcium, normal ALP. ***Normal calcium, normal ALP*** - In **osteoporosis**, the primary defect is a reduction in **bone mass** due to imbalanced bone remodeling, but the remaining bone tissue is normally mineralized [1]. - Therefore, **serum calcium** and **alkaline phosphatase (ALP)**, which reflect bone turnover and mineralization, typically remain within normal ranges [3]. *Normal calcium, decreased ALP* - While **serum calcium** is usually normal in osteoporosis, **decreased ALP** is not a characteristic finding. - Decreased ALP might indicate conditions like **hypophosphatasia** or certain nutritional deficiencies, which are distinct from osteoporosis. *Decreased calcium, increased ALP* - **Decreased serum calcium** (hypocalcemia) combined with **increased ALP** is often seen in conditions like **osteomalacia** or **rickets**, where there is defective bone mineralization [2]. - This pattern is not typical of osteoporosis, where the problem is a quantitative reduction in bone, not qualitative mineralization defect [3]. *Decreased calcium, decreased ALP* - A combination of **decreased calcium** and **decreased ALP** is an unusual biochemical profile in bone disorders. - It could potentially be seen in severe malnutrition leading to multiple deficiencies, but it is not indicative of osteoporosis.

Q: Pendred's syndrome is:

Deaf and goitrous patient since infancy.. ***Deaf and goitrous patient since infancy*** - **Pendred's syndrome** is an autosomal recessive disorder characterized by **sensorineural hearing loss** and a **goiter** due to a defect in iodine organification [1]. - The symptoms typically manifest from **infancy** or early childhood, with profound deafness being one of the earliest signs [1]. *Thyroiditis extending into adjacent structures* - This describes an inflammatory process of the thyroid gland that has spread, which is not characteristic of **Pendred's syndrome**. - **Pendred's syndrome** is a genetic developmental disorder, not primarily an inflammatory condition causing direct tissue invasion. *None* - This option is incorrect because there is a correct description of Pendred's syndrome provided. - **Pendred's syndrome** is a well-defined genetic condition with specific clinical manifestations. *Autoimmune thyroiditis* - **Autoimmune thyroiditis** (e.g., Hashimoto's thyroiditis) involves the immune system attacking the thyroid gland, leading to hypothyroidism and goiter. - While it can cause a goiter, it does not typically present with congenital **sensorineural deafness** as a primary feature.

Q: Slow relaxation of tendon reflexes may be a manifestation of:

Hypothyroidism. ***Hypothyroidism*** - **Slow relaxation of tendon reflexes**, often described as a "hung-up" reflex, is a classic sign of **hypothyroidism**. [1] - This is due to slowed muscle contraction and relaxation phases, reflecting the generalized metabolic slowing in the body. *Hypoparathyroidism* - This condition is primarily characterized by **hypocalcemia** and can lead to increased neuromuscular excitability, manifesting as **tetany**, muscle cramps, and seizures. - It does not typically cause slow relaxation of tendon reflexes; instead, reflexes may be hyperactive due to lower calcium levels. *Hyperparathyroidism* - This condition leads to **hypercalcemia**, which can cause generalized muscle weakness, fatigue, and bone pain. - While it affects muscle function, it does not typically present with the characteristic slow relaxation of tendon reflexes. *Hyperthyroidism* - **Hyperthyroidism** typically leads to **brisk reflexes** (hyperreflexia) and may even manifest with a fast-relaxing or quickly exhausted reflex. - This is due to the increased metabolic rate and heightened neuromuscular excitability.

Q: Osteomalacia is due to -

Vitamin D deficiency. ***Vitamin D deficiency*** - **Osteomalacia** is characterized by defective **bone mineralization** in adults, primarily due to insufficient **calcium** and **phosphate** availability for deposition into the bone matrix [1]. - The most common cause of impaired mineralization is severe and prolonged **vitamin D deficiency**, which leads to reduced absorption of calcium and phosphate from the gut [1]. [2]. *Vitamin E deficiency* - **Vitamin E** is an important **antioxidant** that protects cells from damage, but its deficiency is not directly linked to osteomalacia. - Deficiency can lead to **neurological symptoms** like ataxia, peripheral neuropathy, and muscle weakness. *Vitamin C deficiency* - **Vitamin C** is crucial for **collagen synthesis**, and its deficiency causes **scurvy**, characterized by weakened blood vessels, bleeding gums, and impaired wound healing. - It does not directly affect the mineralization of bone, which is the hallmark of osteomalacia. *None of the options* - This option is incorrect because **Vitamin D deficiency** is a well-established cause of osteomalacia [2].

Q: Prevention or treatment of osteoporosis in post- menopausal women may be achieved by all EXCEPT

Multivitamins. ***Multivitamins*** - While multivitamins may contain some **calcium** and **vitamin D**, the dosages are generally insufficient to effectively prevent or treat osteoporosis, which requires targeted, higher doses of these specific nutrients. - Multivitamins provide a broad range of vitamins and minerals, many of which are not directly involved in **bone metabolism** or have a significant impact on **bone mineral density**. *Calcium and vitamin D supplementation* - **Calcium** is a fundamental component of bone, and adequate intake is crucial for maintaining **bone mineral density** and strength, especially in postmenopausal women who are at higher risk of osteoporosis [1, 4]. - **Vitamin D** is essential for the absorption of calcium in the gut and plays a key role in regulating **calcium and phosphate homeostasis**, directly impacting bone health [3]. *Bisphosphonates* - **Bisphosphonates** are potent **antiresorptive agents** that inhibit **osteoclast activity**, thereby reducing bone turnover and preventing bone loss, making them a cornerstone of osteoporosis treatment. - They effectively increase **bone mineral density** and significantly reduce the risk of **vertebral and non-vertebral fractures** in postmenopausal women. *Estrogen and progesterone hormone replacement therapy* - **Estrogen deficiency** after menopause is a primary cause of accelerated bone loss; **estrogen replacement therapy** helps to maintain bone density by reducing **bone resorption** [2]. - While effective, HRT is typically reserved for women with significant menopausal symptoms or those who cannot tolerate other osteoporosis treatments, due to potential risks like increased risk of **breast cancer** and **cardiovascular events** [2].

Question 1

Most common hormone deficiency that occurs after intracranial irradiation is

Accepted Answer

Growth hormone

Answer

Gonadotropins

Answer

ACTH

Answer

Prolactin

Question 2

Commonest cause of hypothyroidism is

Accepted Answer

Thyroid dysgenesis

Answer

Defect of iodide transport

Answer

Defective synthesis of thyroxine

Answer

Hashimoto's thyroiditis

Question 3

Which of the following statements about thyroid eye disease is false?

Accepted Answer

The management corresponds to improvement in thyrotoxic state

Answer

NOSPECS score is used to classify thyroid eye disease

Answer

Can lead to visual loss

Answer

Seen in more than 10% of patients with hyperthyroidism

Question 4

A 30-year-old woman presents with a history of amenorrhea and impaired vision of six months' duration. Physical examination shows normal findings except for pale optic discs and diminished visual acuity. The most likely diagnosis is -

Accepted Answer

Pituitary adenoma

Answer

Benign intracranial hypertension

Answer

Hypothalamic glioma

Answer

Craniopharyngioma

Question 5

The tumor which is more commonly located in the tail of the pancreas is:

Accepted Answer

Glucagonoma

Answer

Somatostatinoma

Answer

Insulinoma

Answer

Gastrinoma

Question 6

In Osteoporosis which of these is seen?

Accepted Answer

Normal calcium, normal ALP

Answer

Normal calcium, decreased ALP

Answer

Decreased calcium, increased ALP

Answer

Decreased calcium, decreased ALP

Question 7

Pendred's syndrome is:

Accepted Answer

Deaf and goitrous patient since infancy.

Answer

Thyroiditis extending into adjacent structures.

Answer

None.

Answer

Autoimmune thyroiditis.

Question 8

Slow relaxation of tendon reflexes may be a manifestation of:

Accepted Answer

Hypothyroidism

Answer

Hypoparathyroidism

Answer

Hyperparathyroidism

Answer

Hyperthyroidism

Question 9

Osteomalacia is due to -

Accepted Answer

Vitamin D deficiency

Answer

Vitamin E deficiency

Answer

Vitamin C deficiency

Answer

None of the options

Question 10

Prevention or treatment of osteoporosis in post- menopausal women may be achieved by all EXCEPT

Accepted Answer

Multivitamins

Answer

Calcium and vitamin D supplementation

Answer

Bisphosphonates

Answer

Estrogen and progesterone hormone replacement therapy

Endocrinology — MCQs

Endocrinology — MCQs

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