Endocrinology Practice Questions

Q: A patient is diagnosed with Cushing Syndrome. What electrolyte imbalance is typically found in this condition?

Hypokalemia. ***Hypokalemia*** - Excess **cortisol** in Cushing syndrome has **mineralocorticoid effects**, leading to increased **renal potassium excretion** and **sodium retention**. - This results in **low serum potassium levels** (hypokalemia), which is the most characteristic electrolyte imbalance in Cushing syndrome. *Hypernatremia* - While **sodium retention** occurs due to cortisol's mineralocorticoid activity, **hypernatremia** is not the primary electrolyte abnormality. - The body typically maintains **normal serum sodium** levels despite increased sodium retention through compensatory mechanisms. *Hyperkalemia* - This is the **opposite** of what occurs in Cushing syndrome - patients develop **hypokalemia**, not hyperkalemia. - Excess cortisol promotes **potassium loss** through the kidneys, making high potassium levels unlikely. *Hypocalcemia* - **Low calcium levels** are not a characteristic feature of Cushing syndrome's electrolyte profile. - The primary electrolyte disturbance involves the **renin-angiotensin-aldosterone system** affecting potassium and sodium balance.

Q: A patient presents with the clinical findings shown in the image. What is the most appropriate screening test to identify the underlying endocrine condition?

Insulin-like growth factor 1 (IGF-1). ***Insulin-like growth factor 1 (IGF-1)*** - **IGF-1** is the most reliable **screening test for acromegaly** because its levels remain stable throughout the day, unlike GH which is secreted pulsatilely. - The image shows large, spade-like hands with thick fingers — classic features of **acromegaly** caused by chronic excess GH/IGF-1 secretion. - Elevated IGF-1 confirms systemic growth promotion and is the recommended first-line screening test (Harrison's 19th ed., p. 2269; 20th ed., p. 2678). *Random serum growth hormone (GH) levels* - A **single GH measurement is unreliable** due to the pulsatile nature of GH secretion — random levels can be normal even in acromegaly. - GH must be assessed dynamically (i.e., suppression during OGTT) rather than as a random sample. *Oral glucose tolerance test (OGTT)* - OGTT is the **confirmatory (gold-standard) test** for acromegaly, not the initial screening test. - In acromegaly, GH **fails to suppress to <0.4 μg/L** within 1–2 hours of an oral glucose load, confirming the diagnosis. - It is performed after elevated IGF-1 on screening. *Serum prolactin levels* - Prolactin may be elevated in acromegaly due to **mass effect** of the pituitary adenoma disrupting dopaminergic inhibition of the pituitary stalk. - However, elevated prolactin is **not diagnostic of acromegaly** and is not an appropriate screening test for this condition.

Q: A 25 -year-old presents with weakness, craving for salty foods and postural hypotension. Lab shows serum sodium = 130 mEq /dL and serum potassium of 6.0 mEq , fasting blood sugar of 65 mg%. All are possible causes of the condition shown except:

Autoimmune hypophysitis. ***Autoimmune hypophysitis*** - The patient's symptoms (weakness, salt craving, postural hypotension) and lab findings (hyponatremia, hyperkalemia, hypoglycemia) are characteristic of **primary adrenal insufficiency (Addison's disease)**. - **Autoimmune hypophysitis** causes **secondary adrenal insufficiency** by damaging the pituitary gland, leading to reduced ACTH production. However, in secondary adrenal insufficiency, **aldosterone secretion is typically preserved**, and thus hyperkalemia and salt craving are not usually seen. *Histoplasmosis* - **Histoplasmosis** can cause **primary adrenal insufficiency** by directly infecting and destroying the adrenal glands. - This destruction leads to impaired production of both cortisol and aldosterone, explaining the observed electrolyte imbalances and symptoms. *Amyloidosis* - **Amyloidosis** can infiltrate and destroy the adrenal glands, leading to **primary adrenal insufficiency**. - Adrenal amyloidosis can cause symptoms consistent with hypoadrenalism, including electrolyte disturbances like hyponatremia and hyperkalemia. *Autoimmune polyglandular syndrome* - **Autoimmune polyglandular syndromes (APS)**, particularly APS type 1 and type 2, frequently include **autoimmune primary adrenal insufficiency (Addison's disease)**. - This autoimmune destruction of the adrenal cortex directly causes the symptoms and laboratory findings of aldosterone and cortisol deficiency.

Q: A patient presents with hypertension and hypokalemia. CT abdomen was performed. What is the diagnosis?

Conn syndrome. ***Conn syndrome*** - The image shows a **contrast-enhancing nodule in the right adrenal gland** (indicated by the arrow), consistent with an **aldosteronoma**. - This, combined with **hypertension** and **hypokalemia**, is the classic presentation of **primary hyperaldosteronism** (Conn syndrome). *Pheochromocytoma* - While pheochromocytomas can cause hypertension and are often found in the adrenal gland, they typically present with paroxysmal symptoms such as **palpitations, headaches, and sweating**, which are not mentioned. - They also do not typically cause hypokalemia, as they produce catecholamines, not aldosterone. *Liddle syndrome* - Liddle syndrome is a **genetic disorder** causing **severe hypertension and hypokalemia** due to increased renal sodium reabsorption, mimicking hyperaldosteronism. - However, it is characterized by **low plasma renin activity** and **low aldosterone levels**, and there would be no adrenal mass on imaging. *Secondary hyperaldosteronism* - Secondary hyperaldosteronism is characterized by **high renin levels** (due to conditions like renal artery stenosis or heart failure) leading to increased aldosterone production. - The presence of an **adrenal mass (aldosteronoma)** points to a primary adrenal pathology, rather than a secondary cause driven by systemic factors.

Q: All of the following will be seen in the patient shown below except:

Myxedema. ***Myxedema*** - The patient in the image exhibits **exophthalmos** and a **staring gaze**, which are classic signs of **thyrotoxicosis** or **Grave's disease** (hyperthyroidism). - **Myxedema** refers to severe **hypothyroidism**, characterized by non-pitting edema, dry skin, and generalized swelling, which is the opposite of the clinical picture presented. *Dalrymple sign* - This sign is characterized by **abnormal widening of the palpebral fissure** (eyelid opening) due to spasm or retraction of the upper eyelid, leading to visible sclera above the iris. - It is a common ocular manifestation of **hyperthyroidism**, which aligns with the patient's appearance. *Moist warm hands* - **Hyperthyroidism** causes an increase in **metabolic rate**, leading to elevated body temperature, increased perspiration, and a characteristic finding of **warm, moist skin** and hands. - This is a typical physical finding in patients with **thyrotoxicosis** due to increased sympathetic activity and thermogenesis. *Constipation* - **Hyperthyroidism** typically accelerates gastrointestinal motility, often leading to **diarrhea** or increased bowel movements. - **Constipation** is usually associated with **hypothyroidism** due to decreased gut motility.

Q: All are true about the condition shown except:

Hyperkalemia. The image depicts a patient with classic features of **Cushing's syndrome**, characterized by **central obesity** (truncal obesity and "buffalo hump"), **moon facies**, and relatively thin extremities. The question asks what is *not* true about this condition. ***Hyperkalemia*** - Cushing's syndrome typically causes **hypokalemia** due to the mineralocorticoid effects of excessive cortisol, leading to increased potassium excretion in the kidneys. - The elevated cortisol levels also increase sensitivity of epithelial sodium channels (ENaC) to aldosterone, exacerbating potassium loss. *Hyperpigmentation in ectopic ACTH production* - **Hyperpigmentation** occurs in Cushing's syndrome caused by ectopic ACTH production (e.g., from small cell lung cancer) because of the co-secretion of melanocyte-stimulating hormone (MSH) precursors along with ACTH. - This is a true statement regarding Cushing's syndrome, specifically in the context of ectopic ACTH. *Purplish striae* - **Purplish striae** (stretch marks) are a classic dermatological feature of Cushing's syndrome. - They result from the breakdown of collagen and elastin in the skin due to high cortisol levels, leading to thinning and fragility of the skin. *Metabolic alkalosis* - Patients with Cushing's syndrome often develop **metabolic alkalosis** due to increased renal hydrogen ion excretion and potassium wasting, driven by the mineralocorticoid effects of excess cortisol. - The hypokalemia often observed further contributes to this alkalosis.

Q: A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Erythema nodosum. ***Erythema Nodosum*** - The image shows **tender, red nodules** primarily on the shins, consistent with the characteristic presentation of erythema nodosum. - While exact values for **HbA1c** and **cholesterol** don't directly diagnose this, erythema nodosum is often associated with systemic conditions, and the patient's progressive shortness of breath prompts further investigation into potential underlying causes. *Necrobiosis lipoidica diabeticorum* - This condition presents as **well-demarcated, yellow-brown patches** with a waxy or atrophic center, often with telangiectasias, not the acute tender nodules seen here. - Although it is associated with **diabetes**, the patient's HbA1c (5.8%) is within the prediabetic range, not typically indicative of established diabetes that commonly precedes significant necrobiosis lipoidica. *Xanthoma* - Xanthomas are **yellowish plaques or nodules** caused by lipid deposits in the skin, which can vary in appearance depending on the type (e.g., eruptive, tendinous, planar). - While hyperlipidemia can cause xanthomas, the patient's **normal cholesterol level** (175 mg%) makes this diagnosis less likely, and the lesions in the image are more erythematous and nodular than typical xanthomas. *Carotenemia* - **Carotenemia** is characterized by a harmless **yellow-orange discoloration of the skin**, particularly on the palms and soles, caused by excessive intake of carotene-rich foods. - This condition does not present with discrete, erythematous nodules as depicted in the image.

Q: A 50-year-old man presents with frontal bossing, enlarged tongue and following appearance of hand. Which of the following tests should be done in this patient?

Insulin like growth factor. ***Insulin like growth factor*** - The patient's symptoms of **frontal bossing**, **enlarged tongue (macroglossia)**, and the image showing an **enlarged hand** (suggestive of **acral enlargement**) are classic features of **acromegaly**. - **Insulin-like growth factor 1 (IGF-1)** is the best screening test for acromegaly because its levels are stable throughout the day and reflect integrated GH secretion; elevated IGF-1 is indicative of the condition. *Thyroid hormone assay* - This test measures **thyroid function** and is primarily used to diagnose conditions like **hypothyroidism** or **hyperthyroidism**. - While some symptoms of thyroid disorders can overlap with other conditions, the specific constellation of **acral enlargement**, **macroglossia**, and **frontal bossing** is not typical for thyroid dysfunction. *Serum prolactin* - **Serum prolactin** is primarily used to assess for **hyperprolactinemia**, which can cause symptoms like **galactorrhea** or **hypogonadism**. - While a **prolactinoma** (a pituitary tumor secreting prolactin) can sometimes coexist with a **growth hormone-secreting tumor**, prolactin itself is not the direct cause of acromegalic features, and its assay is not the initial diagnostic test for acromegaly. *Serum Testosterone* - **Serum testosterone** levels are assessed in cases of suspected **hypogonadism** or other **androgen-related disorders**. - The clinical presentation with **acral enlargement** and **facial changes** is not characteristic of testosterone deficiency or excess.

Q: Comment on the diagnosis of the image shown below. (AIIMS Nov 2017)

Hypothyroidism. ***Hypothyroidism*** - The image depicts **myxoedema**, characterized by localized, non-pitting edema and thickened skin, typically on the shins, which is a classic manifestation of severe **hypothyroidism**. - This condition results from the accumulation of **hyaluronic acid** and chondroitin sulfate in the dermis, causing a characteristic doughy texture. *Hyperthyroidism* - While hyperthyroidism (specifically Graves' disease) can cause **pretibial myxoedema**, the image alone showing generalized myxoedematous changes is more indicative of **hypothyroidism**. - Pretibial myxoedema associated with hyperthyroidism typically presents as elevated, firm, non-pitting plaques, whereas the image shows a more widespread thickening. *Sarcoidosis* - Sarcoidosis involves the formation of **non-caseating granulomas** in various organs, including the skin. - Skin manifestations of sarcoidosis can include **erythema nodosum**, plaques, or lupus pernio, which do not match the generalized thickening seen in the image. *Diabetes* - Diabetes mellitus can cause various skin manifestations such as **diabetic dermopathy**, necrobiosis lipoidica diabeticorum, and acanthosis nigricans. - These conditions present with different visual characteristics, like hyperpigmented atrophic macules or waxy yellow plaques, unlike the diffuse thickening shown.

Q: A 68-year-old postoperative patient who has undergone thyroidectomy presents with muscle cramps. ECG shows?

Prolonged QT interval. ***Prolonged QT interval*** - A patient who has undergone thyroidectomy and presents with muscle cramps likely has **hypocalcemia** due to inadvertent parathyroid gland removal. - Hypocalcemia is well-known to cause a **prolonged QT interval** on EKG, increasing the risk of arrhythmias. *Short QT interval* - A short QT interval is typically associated with **hypercalcemia** or genetic disorders. - This patient's presentation of muscle cramps is inconsistent with hypercalcemia. *ST elevation* - ST elevation is a hallmark of **acute myocardial infarction** or **pericarditis**. - This finding is unrelated to hypocalcemia or the patient's immediate postoperative and symptoms. *ST depression* - ST depression often indicates **myocardial ischemia** or **digoxin effect**. - It is not a characteristic ECG change associated with hypocalcemia or muscle cramps.

Question 1

A patient is diagnosed with Cushing Syndrome. What electrolyte imbalance is typically found in this condition?

Accepted Answer

Hypokalemia

Answer

Hypernatremia

Answer

Hyperkalemia

Answer

Hypocalcemia

Question 2

A patient presents with the clinical findings shown in the image. What is the most appropriate screening test to identify the underlying endocrine condition?

Accepted Answer

Insulin-like growth factor 1 (IGF-1)

Answer

Random serum growth hormone (GH) levels

Answer

Oral glucose tolerance test (OGTT)

Answer

Serum prolactin levels

Question 3

A 25 -year-old presents with weakness, craving for salty foods and postural hypotension. Lab shows serum sodium = 130 mEq /dL and serum potassium of 6.0 mEq , fasting blood sugar of 65 mg%. All are possible causes of the condition shown except:

Accepted Answer

Autoimmune hypophysitis

Answer

Histoplasmosis

Answer

Amyloidosis

Answer

Autoimmune polyglandular syndrome

Question 4

A patient presents with hypertension and hypokalemia. CT abdomen was performed. What is the diagnosis?

Accepted Answer

Conn syndrome

Answer

Pheochromocytoma

Answer

Liddle syndrome

Answer

Secondary hyperaldosteronism

Question 5

All of the following will be seen in the patient shown below except:

Accepted Answer

Myxedema

Answer

Dalrymple sign

Answer

Moist warm hands

Answer

Constipation

Question 6

All are true about the condition shown except:

Accepted Answer

Hyperkalemia

Answer

Hyperpigmentation in ectopic ACTH production

Answer

Purplish striae

Answer

Metabolic alkalosis

Question 7

A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Accepted Answer

Erythema nodosum

Answer

Necrobiosis lipidoica diabeticorum

Answer

Xanthoma

Answer

Carotenemia

Question 8

A 50-year-old man presents with frontal bossing, enlarged tongue and following appearance of hand. Which of the following tests should be done in this patient?

Accepted Answer

Insulin like growth factor

Answer

Thyroid hormone assay

Answer

Serum prolactin

Answer

Serum Testosterone

Question 9

Comment on the diagnosis of the image shown below. (AIIMS Nov 2017)

Accepted Answer

Hypothyroidism

Answer

Hyperthyroidism

Answer

Sarcoidosis

Answer

Diabetes

Question 10

A 68-year-old postoperative patient who has undergone thyroidectomy presents with muscle cramps. ECG shows?

Accepted Answer

Prolonged QT interval

Answer

Short QT interval

Answer

ST elevation

Answer

ST depression

Endocrinology — MCQs

Endocrinology — MCQs

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