Endocrinology Practice Questions

Q: A patient surgically treated for bilateral pheochromocytoma has started developing a gait abnormality. An MRI of the head was performed. What is the probable diagnosis?

Von Hippel Landau Syndrome. **Von Hippel Landau Syndrome** - This syndrome is characterized by a predisposition to developing various tumors, including **pheochromocytomas** (which are often bilateral) and central nervous system **hemangioblastomas**, which can cause gait abnormalities. - The presence of **bilateral pheochromocytoma** and the subsequent development of **gait abnormality** requiring a head MRI strongly suggests VHL, as **cerebellar hemangioblastomas** are a common feature that would explain the neurologic symptoms. *Multiple endocrine neoplasia type 4* - MEN4 involves a genetic predisposition to tumors of the **parathyroid, pituitary, and adrenal glands**, but it is less commonly associated with bilateral pheochromocytomas or specific neurological manifestations like hemangioblastomas causing gait issues. - It is a more recently described syndrome with overlapping features with other MEN disorders but does not typically include CNS tumors as a prominent feature. *Autoimmune polyglandular syndrome* - This syndrome is characterized by **autoimmune destruction of multiple endocrine glands**, leading to deficiencies (e.g., Addison's disease, type 1 diabetes), rather than tumor formation like pheochromocytomas. - It does not involve the formation of CNS tumors such as hemangioblastomas that would cause a gait abnormality. *Multiple endocrine neoplasia type 2B* - MEN2B is strongly associated with **medullary thyroid carcinoma**, **pheochromocytoma** (often bilateral), **mucosal neuromas**, and a **marfanoid habitus**. - While it includes pheochromocytomas, it does not typically involve CNS hemangioblastomas leading to gait abnormalities, which are a hallmark of VHL.

Q: All statements are true for osteomalacia except:

Raised serum calcium. ***Raised serum calcium*** - **Osteomalacia** is characterized by defective **bone mineralization**, predominantly due to **vitamin D deficiency** (or abnormal metabolism) or phosphate deficiency [1]. - This typically leads to **hypocalcemia** (low serum calcium), not elevated calcium, as vitamin D is essential for calcium absorption from the gut [1], [3]. *Muscular weakness* - **Proximal muscle weakness**, particularly in the thighs and pelvic girdle, is a common symptom of **osteomalacia** [1]. - This **myopathy** is thought to be directly related to **vitamin D deficiency** and the resulting metabolic disturbances affecting muscle function [1]. *Looser's zone on X-ray* - **Looser's zones**, also known as **pseudofractures**, are characteristic radiological findings in **osteomalacia** [2]. - These are areas of **unmineralized osteoid** that appear as radiolucent bands perpendicular to the bone cortex, often found in the femoral neck, pubic rami, or ribs [2]. *Commoner in females* - **Osteomalacia** is indeed more common in **females**, particularly in those of **childbearing age** or with **multiple pregnancies**, due to increased calcium and vitamin D demands. - **Postmenopausal women** are also at higher risk, often linked to reduced sun exposure, dietary deficiencies, or medication use.

Q: A 35-year-old woman presents with 6-month history of skin rash and fatigue. Physical examination shows pallor and a necrotizing erythematous skin rash of her lower body. Laboratory studies reveal mild anemia and fasting blood glucose of 160 mg/dL. A CT scan of the abdomen demonstrates a 2-cm mass in the pancreas. Which of the following is the most likely diagnosis?

Glucagonoma. ***Glucagonoma*** - The necrotizing erythematous skin rash (necrolytic migratory erythema), mild anemia, hyperglycemia (fasting blood glucose 160 mg/dL), and a pancreatic mass are classic features of a **glucagonoma**. [1] - **Glucagon** excess leads to skin rash, glucose intolerance due to its counter-regulatory effects on insulin, and often anemia. [1] *Insulinoma* - An insulinoma typically presents with symptoms of **hypoglycemia** (e.g., sweating, palpitations, confusion), especially in the fasting state. [2] - While it involves a pancreatic mass, the patient's hyperglycemia and specific skin rash are inconsistent with insulinoma. [2] *Gastrinoma* - Gastrinomas cause **Zollinger-Ellison syndrome**, characterized by severe peptic ulcer disease, abdominal pain, and diarrhea due to excessive **gastrin** production. [1] - The patient's symptoms, particularly the skin rash and hyperglycemia, are not typical of a gastrinoma. *Carcinoid tumor* - Carcinoid tumors can arise in various locations, including the pancreas, but typically produce **serotonin** and other vasoactive substances. [1] - Symptoms usually include **flushing**, diarrhea, and bronchospasm (carcinoid syndrome), which are absent in this patient's presentation. [1]

Q: A 88 year-old woman from Mexico is admitted to the hospital following a bout of severe vomiting and generalized weakness. Initial laboratory values reveal elevated Ca2+ levels. The referring physician tells you that she has breast cancer and her bone scan indicates metastasis to bone. The most likely cause of hypercalcemia is:

Increased PTHrP production. ***Increased PTHrP production*** - **Breast cancer** with bone metastases commonly leads to **humoral hypercalcemia of malignancy (HHM)**, which is typically mediated by the production of **parathyroid hormone-related protein (PTHrP)** by tumor cells. - This PTHrP mimics the action of PTH on bone and kidney, causing **increased bone resorption** and **renal calcium reabsorption**, leading to elevated serum calcium [2]. *Decreased responsiveness to calcitonin* - While calcitonin normally lowers calcium levels, a decreased responsiveness to it is not the primary mechanism behind cancer-associated hypercalcemia. - Tumors primarily cause hypercalcemia through increased bone resorption, not by directly inhibiting calcitonin's effects to a clinically significant degree. *Increased responsiveness of the PTH receptor 1* - Although PTHrP acts on the **PTH receptor 1**, the issue is not an increased responsiveness of the receptor itself, but rather the **overproduction of its ligand (PTHrP)** by the tumor. - The receptor's intrinsic responsiveness is typically normal; it's the external stimulus from PTHrP that drives the hypercalcemia. *Increased PTH production* - This scenario describes **primary hyperparathyroidism**, which is typically caused by a parathyroid adenoma or hyperplasia [1]. - While PTH causes hypercalcemia, in the context of advanced breast cancer with bone metastasis, the hypercalcemia is almost always due to malignancy itself, not primary parathyroid dysfunction [3]. *Increased PTHrP secretion* - This option is essentially a rephrasing of the correct answer but in a less precise format. - The term "production" is more appropriate when referring to the synthesis of a protein by tumor cells.

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: Diabetes is associated with all of the following in the elderly EXCEPT:

Myocardial infarction. ***Myocardial infarction*** - Diabetes is a major risk factor for **myocardial infarction** (heart attack), significantly increasing its incidence in the elderly [1]. - It accelerates **atherosclerosis**, leading to coronary artery disease, which is the primary cause of myocardial infarction [2]. *Cognitive decline* - Diabetes is strongly associated with an increased risk of **cognitive decline** and **dementia** in older adults. - Mechanisms include microvascular damage, chronic inflammation, and insulin resistance affecting brain function. *Cerebrovascular accident* - Diabetes is a significant risk factor for **cerebrovascular accidents** (strokes), both ischemic and hemorrhagic, in the elderly [2]. - It promotes **atherosclerosis** in cerebral vessels and contributes to hypertension and dyslipidemia, increasing stroke risk [2]. *Osteoarthritis* - While not a direct causal link like cardiovascular complications, diabetes can indirectly contribute to **osteoarthritis** progression, particularly in obese individuals with diabetes. - High glucose levels can lead to changes in cartilage composition and increased inflammation, potentially exacerbating joint damage.

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: 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.

Question 1

A patient surgically treated for bilateral pheochromocytoma has started developing a gait abnormality. An MRI of the head was performed. What is the probable diagnosis?

Accepted Answer

Von Hippel Landau Syndrome

Answer

Multiple endocrine neoplasia type 4

Answer

Autoimmune polyglandular syndrome

Answer

Multiple endocrine neoplasia type 2B

Question 2

All statements are true for osteomalacia except:

Accepted Answer

Raised serum calcium

Answer

Muscular weakness

Answer

Loosers zone on X-ray

Answer

Commoner in females

Question 3

A 35-year-old woman presents with 6-month history of skin rash and fatigue. Physical examination shows pallor and a necrotizing erythematous skin rash of her lower body. Laboratory studies reveal mild anemia and fasting blood glucose of 160 mg/dL. A CT scan of the abdomen demonstrates a 2-cm mass in the pancreas. Which of the following is the most likely diagnosis?

Accepted Answer

Glucagonoma

Answer

Insulinoma

Answer

Gastrinoma

Answer

Carcinoid tumor

Question 4

A 88 year-old woman from Mexico is admitted to the hospital following a bout of severe vomiting and generalized weakness. Initial laboratory values reveal elevated Ca2+ levels. The referring physician tells you that she has breast cancer and her bone scan indicates metastasis to bone. The most likely cause of hypercalcemia is:

Accepted Answer

Increased PTHrP production

Answer

Decreased responsiveness to calcitonin

Answer

Increased responsiveness of the PTH receptor 1

Answer

Increased PTH production

Answer

Increased PTHrP secretion

Question 5

Most common hormone deficiency that occurs after intracranial irradiation is

Accepted Answer

Growth hormone

Answer

Gonadotropins

Answer

ACTH

Answer

Prolactin

Question 6

Diabetes is associated with all of the following in the elderly EXCEPT:

Accepted Answer

Myocardial infarction

Answer

Cognitive decline

Answer

Cerebrovascular accident

Answer

Osteoarthritis

Question 7

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 8

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

Accepted Answer

Glucagonoma

Answer

Somatostatinoma

Answer

Insulinoma

Answer

Gastrinoma

Question 9

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 10

Slow relaxation of tendon reflexes may be a manifestation of:

Accepted Answer

Hypothyroidism

Answer

Hypoparathyroidism

Answer

Hyperparathyroidism

Answer

Hyperthyroidism

Endocrinology — MCQs

Endocrinology — MCQs

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