Endocrinology Practice Questions

Q: Which is the most common pancreatic endocrine neoplasm?

Insulinoma. ***Insulinoma*** - It is the **most common pancreatic endocrine neoplasm**, characterized by excessive insulin production leading to hypoglycemia. - Most patients present with **symptoms of hypoglycemia**, such as sweating, confusion, and palpitations due to overproduction of insulin [1]. *Gastrinoma* - Generally implicated in **Zollinger-Ellison syndrome**, it causes excessive gastric acid secretion, leading to severe ulcers but is less common than insulinoma. - Associated with **diarrhea and abdominal pain**, not typically causing hypoglycemia [1]. *Glucagonoma* - Rarely seen, it causes **hyperglycemia** and characteristic **necrotizing migratory erythema**, rather than hypoglycemic episodes. - Comprises a minority of pancreatic endocrine tumors and is not the most common type. *VIPoma* - Produces **vasoactive intestinal peptide**, leading to profuse watery diarrhea and severe electrolyte imbalance. - It is uncommon compared to insulinoma and primarily causes gastrointestinal symptoms rather than hypoglycemia.

Q: Patient has fatigue but is not gaining weight. Body was warm. Which investigation is most likely to be informative?

Low TSH with elevated T3 and T4. ***Low TSH with elevated T3 and T4*** - This pattern is indicative of **hyperthyroidism**, which aligns with symptoms of **fatigue** (despite increased metabolic rate due to catabolic effects), not gaining weight, and feeling warm, as thyroid hormones regulate metabolism and body temperature [1]. - An elevated **Free T4** and **Free T3** with a suppressed **TSH** confirms a diagnosis of primary hyperthyroidism [1]. *High TSH with normal T3 and T4* - This suggests **subclinical hypothyroidism** (also known as latent hypothyroidism), where the thyroid gland is beginning to fail, but **peripheral thyroid hormone levels** are still within the normal range due to thyroid compensatory mechanisms [1]. - Patients with subclinical hypothyroidism are usually asymptomatic (as the body has compensated to produce sufficient amounts of T3 and T4), but when symptoms do emerge, they are those of **hypothyroidism**, such as weight gain and cold intolerance, which contradict the patient's presentation [1]. *High TSH with euthyroid status* - **Euthyroid** means having normal thyroid function, therefore this option is practically identical to "High TSH with normal T3 and T4". - This implies **subclinical hypothyroidism**, which typically presents with normal body temperature and potential for weight gain, not fatigue without weight gain alongside a warm body [1]. *Increased T3 with decreased T4 levels* - This specific pattern is rare and could be indicative of certain conditions affecting thyroid hormone metabolism, such as **T4 to T3 conversion issues** or specific forms of **thyroiditis**, but is not typical of a primary thyroid disorder presenting with the given symptoms. - While an elevated T3 might suggest some hyperthyroid features, the decreased T4 complicates the picture and does not directly support the clinical presentation of *unexplained fatigue* and *warm body* in typical thyroid disease.

Q: Which of the following is commonly seen in Pituitary apoplexy?

Headache. ***Headache*** - **Severe headache** is the most common symptom of pituitary apoplexy, resulting from the sudden expansion of a pituitary mass due to hemorrhage or infarction [1]. - The rapid increase in pressure within the sella turcica, especially on the **dura mater**, causes intense pain. *Hypertension* - While stress can elevate blood pressure, **hypertension** is not a characteristic or direct symptom of acute pituitary apoplexy itself. - Instead, the condition often leads to **adrenal insufficiency**, which is associated with hypotension [1]. *Hypotension* - **Hypotension** is a common and serious manifestation of pituitary apoplexy, often due to acute **adrenal insufficiency** caused by the destruction of ACTH-producing cells [1]. - Reduced ACTH leads to decreased cortisol production, impairing vascular tone and fluid balance. *Vomiting* - **Vomiting** is a common symptom in pituitary apoplexy, often accompanying the severe headache. - It results from the increased **intracranial pressure** and irritation of pathways in the brainstem.

Q: A 32-year-old woman complains of amenorrhea since the delivery of a baby 15 months previously, despite the fact that she did not breastfeed her baby. The delivery was complicated by excessive hemorrhage that required a transfusion of 2.5 liters of blood. She has also been fatigued and has gained an additional 4.5Kg since the baby was born. Laboratory data show the following: Serum LH < 1 IU/L (normal, 4-24 IU/L) Serum estradiol 5 pg/mL (normal, 20 - 100 pg/mL) Serum TSH 0.1 mU/L (normal, 0.5 - 5 mU/L) Serum GH 3 ng/mL (normal, < 5 ng/mL) Serum ACTH 28 pg/mL (normal, 10 - 50 pg/mL) Serum prolactin 2 ng/mL (normal, < 20 ng/mL). Injection of 500 μg of TRH failed to produce the expected rise in both serum TSH and prolactin. Which of the following diagnoses most likely explains the findings in this patient?

Hypopituitarism due to Sheehan's syndrome. ### Hypopituitarism due to Sheehan's syndrome - The patient's history of **postpartum hemorrhage** followed by amenorrhea, fatigue, and weight gain, along with low levels of **LH**, **estradiol**, **TSH**, and **prolactin**, despite normal ACTH and GH, points towards anterior pituitary dysfunction due to **ischemic necrosis** caused by Sheehan's syndrome [1]. - The failure of **TRH stimulation** to increase TSH and prolactin further supports a pituitary origin, as the pituitary is unable to respond due to damage. ### Hashimoto's thyroiditis - This condition primarily causes **hypothyroidism**, characterized by elevated TSH and low thyroid hormones, which is inconsistent with the patient's low TSH. - It does not explain the **gonadotropin deficiency** (low LH and estradiol) or the history of postpartum hemorrhage leading to multi-hormone deficiencies. ### Isolated gonadotropin deficiency - While the patient exhibits **amenorrhea** and low LH and estradiol, this diagnosis does not account for the **low TSH** [3] or the historical context of a severe postpartum hemorrhage. - Isolated gonadotropin deficiency does not explain the lack of TSH and prolactin response to TRH. ### Primary amenorrhea - This refers to the absence of menstruation by age 15 (with breast development) or 13 (without breast development) in a patient who has never menstruated, which is not applicable to a 32-year-old woman who has delivered a baby. - The patient's presentation is secondary amenorrhea, occurring after menarche and delivery, and is associated with other pan-hypopituitary features [4]. ### Pituitary apoplexy - Pituitary apoplexy typically presents with the **sudden onset** of severe headache, visual disturbances, and ophthalmoplegia due to acute hemorrhage or infarction of a pituitary adenoma. - This patient's symptoms are more chronic and progressive, evolving over 15 months, and lack the acute, severe presentation typical of apoplexy [2].

Q: A 55-year-old postmenopausal woman presents with chronic low backache of 6 months duration. She has no history of trauma. What is the most likely diagnosis?

Osteoporosis. ***Osteoporosis*** - **Postmenopausal women** are at a high risk of developing osteoporosis due to **estrogen deficiency**, which leads to accelerated bone loss [1]. - **Chronic low backache** without trauma in this demographic suggests **vertebral compression fractures**, a common complication of osteoporosis [1]. *Hurler's syndrome* - This is a **lysosomal storage disorder** (mucopolysaccharidosis type I) that manifests in **childhood** with skeletal deformities, coarse facial features, and developmental delays. - It would not present as new-onset chronic low backache in a 55-year-old adult. *Paget’s disease* - Paget's disease involves **localized abnormal bone remodeling**, leading to enlarged and weakened bones [2]. - While it can cause bone pain, it's characterized by elevated **alkaline phosphatase** and often affects the pelvis, skull, or long bones, and a simple low backache presentation in a postmenopausal woman points more strongly to osteoporosis [2], [3]. *Renal osteodystrophy* - This condition is a complication of **chronic kidney disease**, resulting from imbalances in calcium, phosphate, parathyroid hormone, and vitamin D metabolism. - It would require a history of **renal dysfunction** and the low backache would likely be accompanied by other symptoms of kidney failure or bone pain related to specific lesions, which are not mentioned.

Q: VMA is excreted in urine in which condition -

Pheochromocytoma. ***Pheochromocytoma*** - Pheochromocytoma is characterized by excessive secretion of catecholamines, leading to increased levels of **vanillylmandelic acid (VMA)** in the urine. - It is often associated with symptoms like **hypertension**, palpitations, and sweating due to catecholamine release. *Alkaptonuria* - Caused by a deficiency in **homogentisate oxidase**, leading to the accumulation of **homogentisic acid**, not VMA. - Clinically presents with **dark urine** and can lead to **ochronosis**, but does not involve catecholamines. *Phenylketonuria* - A metabolic disorder resulting from a deficiency in **phenylalanine hydroxylase**, leading to elevated levels of **phenylalanine** rather than VMA. - Symptoms include intellectual disability and musty odor, unrelated to catecholamine metabolism. *Diabetic ketoacidosis* - This is a condition caused by severe **insulin deficiency**, resulting in elevated ketone bodies and glucose levels, but does not cause increased VMA excretion. - Symptoms include **fruity breath**, dehydration, and metabolic acidosis, focusing on ketone production rather than catecholamine metabolism.

Q: Which one of the following statements about Graves' disease is FALSE?

Common in male. ***Common in male*** - Graves' disease is significantly **more common in females** than males, with a female-to-male ratio of approximately 7:1 [1]. It is a female predominant disease [2]. - The peak incidence is between the ages of 20 and 50 years, and it is the most common cause of **hyperthyroidism** in women [1], [2]. *Results in hyperthyroidism* - Graves' disease is characterized by the production of **autoantibodies** against the TSH receptor, leading to excessive stimulation of the thyroid gland [1]. - This overstimulation results in **increased synthesis and release of thyroid hormones**, causing a state of hyperthyroidism [2]. *Autoimmune disorder* - Graves' disease is a classic example of an **organ-specific autoimmune disease** [2]. - The immune system mistakenly produces antibodies that mimic the action of TSH, leading to thyroid overactivity [1]. *Referred to as toxic diffuse goiter* - The term "toxic" refers to the **hyperthyroid state** (thyrotoxicosis), and "diffuse goiter" describes the generally uniform enlargement of the entire thyroid gland [1]. - This terminology accurately reflects the typical presentation of Graves' disease, which involves an overactive, diffusely enlarged thyroid gland [2].

Q: Calcitonin levels increased in

Medullary thyroid carcinoma. Medullary thyroid carcinoma - Calcitonin is a hormone produced by the parafollicular C cells of the thyroid gland. - Medullary thyroid carcinoma is a neuroendocrine tumor arising from these C cells, leading to excessive and unregulated calcitonin production. Hyperparathyroidism - This condition involves increased production of parathyroid hormone (PTH), which acts to increase serum calcium levels [2]. - Calcitonin secretion is typically decreased or normal in hyperparathyroidism, as calcitonin works to lower serum calcium. Hypoparathyroidism - This condition is characterized by insufficient production of parathyroid hormone (PTH), leading to low serum calcium levels [1]. - Calcitonin levels are generally unaffected or may even be slightly decreased in response to the low calcium, as its primary role is to lower calcium. Cushing Syndrome - Cushing Syndrome is caused by prolonged exposure to high levels of cortisol, a glucocorticoid. - While cortisol can affect bone metabolism, it does not directly impact calcitonin production or secretion, which is primarily regulated by serum calcium levels and C-cell activity.

Q: Which condition is associated with congenital adrenal hyperplasia?

Female pseudohermaphroditism. ***Female pseudohermaphroditism*** - In **21-hydroxylase deficiency**, the most common form of CAH, virilization of a female fetus occurs due to excessive **androgen production** [2], [3]. - This leads to ambiguous genitalia in genetically female (XX) infants, presenting as **female pseudohermaphroditism** [2]. *Male pseudohermaphroditism* - This condition occurs when a **genetically male individual (XY)** has external genitalia that are undervirilized or ambiguous. - It is typically caused by inadequate **androgen synthesis** or action, such as in **androgen insensitivity syndrome**, which is not the primary presentation of CAH [2]. *True pseudohermaphroditism* - This term refers to individuals who possess both **ovarian and testicular tissue**, either in separate gonads or as ovotestes [1], [2]. - It is distinct from CAH, where gonadal tissue is uniform (either ovaries or testes), but the external genitalia are ambiguous due to hormonal imbalances [2]. *Sequential pseudohermaphroditism* - This term is not a recognized medical classification for conditions like CAH. - It does not describe a specific developmental anomaly of the reproductive system related to adrenal function.

Q: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Follicular adenoma. ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.

Question 1

Which is the most common pancreatic endocrine neoplasm?

Accepted Answer

Insulinoma

Answer

Gastrinoma

Answer

VIPoma

Answer

Glucagonoma

Question 2

Patient has fatigue but is not gaining weight. Body was warm. Which investigation is most likely to be informative?

Accepted Answer

Low TSH with elevated T3 and T4

Answer

High TSH with normal T3 and T4

Answer

High TSH with euthyroid status

Answer

Increased T3 with decreased T4 levels

Question 3

Which of the following is commonly seen in Pituitary apoplexy?

Accepted Answer

Headache

Answer

Hypertension

Answer

Hypotension

Answer

Vomiting

Question 4

A 32-year-old woman complains of amenorrhea since the delivery of a baby 15 months previously, despite the fact that she did not breastfeed her baby. The delivery was complicated by excessive hemorrhage that required a transfusion of 2.5 liters of blood. She has also been fatigued and has gained an additional 4.5Kg since the baby was born. Laboratory data show the following: Serum LH < 1 IU/L (normal, 4-24 IU/L) Serum estradiol 5 pg/mL (normal, 20 - 100 pg/mL) Serum TSH 0.1 mU/L (normal, 0.5 - 5 mU/L) Serum GH 3 ng/mL (normal, < 5 ng/mL) Serum ACTH 28 pg/mL (normal, 10 - 50 pg/mL) Serum prolactin 2 ng/mL (normal, < 20 ng/mL). Injection of 500 μg of TRH failed to produce the expected rise in both serum TSH and prolactin. Which of the following diagnoses most likely explains the findings in this patient?

Accepted Answer

Hypopituitarism due to Sheehan's syndrome

Answer

Pituitary apoplexy

Answer

Isolated gonadotropin deficiency

Answer

Hashimoto's thyroiditis

Answer

Primary amenorrhea

Question 5

A 55-year-old postmenopausal woman presents with chronic low backache of 6 months duration. She has no history of trauma. What is the most likely diagnosis?

Accepted Answer

Osteoporosis

Answer

Hurler's syndrome

Answer

Paget’s disease

Answer

Renal osteodystrophy

Question 6

VMA is excreted in urine in which condition -

Accepted Answer

Pheochromocytoma

Answer

Alkaptonuria

Answer

Phenylketonuria

Answer

Diabetic ketoacidosis

Question 7

Which one of the following statements about Graves' disease is FALSE?

Accepted Answer

Common in male

Answer

Referred to as toxic diffuse goiter

Answer

Results in hyperthyroidism

Answer

Autoimmune disorder

Question 8

Calcitonin levels increased in

Accepted Answer

Medullary thyroid carcinoma

Answer

Hypoparathyroidism

Answer

Cushing Syndrome

Answer

Hyperparathyroidism

Question 9

Which condition is associated with congenital adrenal hyperplasia?

Accepted Answer

Female pseudohermaphroditism

Answer

Male pseudohermaphroditism

Answer

True pseudohermaphroditism

Answer

Sequential pseudohermaphroditism

Question 10

Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Accepted Answer

Follicular adenoma

Answer

Multinodular goiter

Answer

Thyroid cyst

Answer

Follicular carcinoma

Endocrinology — MCQs

Endocrinology — MCQs

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