Endocrinology Practice Questions

Q: A 55 yr old patient presented to the opd with complaint of pain in back. On examination his limbs seemed to be bent with overlying warm and thick skin. Patient also complain of decreased hearing over a few days. On biochemical analysis his serum ALP was raised. X-ray obtained showed the following features. Most probable diagnosis?

Pagets disease. ***Pagets disease*** - The combination of **bent limbs** (skeletal deformities), **warm and thick skin** (increased vascularity and bone remodeling), **decreased hearing** (due to involvement of skull bones), and **raised serum ALP** (reflecting high osteoblastic activity) is highly characteristic of Paget's disease of bone. - The X-ray image showing **cotton wool appearance** of the skull and thickening of the calvarium strongly supports this diagnosis; these features are a hallmark of advanced Paget's disease. *Renal osteodystrophy* - This condition results from **chronic kidney disease** and typically involves abnormal bone turnover, but the specific combination of warm skin, bent limbs and decreased hearing is not typical. - X-ray findings in renal osteodystrophy often include osteosclerosis (especially "rugger-jersey spine") or osteopenia, not the **cotton wool appearance** seen in the skull here. *Osteoporosis* - Characterized by **decreased bone density** and increased fracture risk, often asymptomatic until a fracture occurs. - While back pain can occur due to vertebral compression fractures, the bone deformities, warm skin, hearing loss, and elevated ALP are **not features of osteoporosis**. *Osteopetrosis* - A rare genetic disorder characterized by **increased bone density** due to defective osteoclasts, leading to brittle bones and often hematologic problems. - While it can manifest as bone pain and hearing loss due to cranial nerve compression, the bones are abnormally dense and sclerotic on X-ray, in contrast to the **mixed lytic and blastic lesions** with cortical thickening seen in Paget's disease.

Q: Pheochromocytoma is characterized by excessive secretion of:

Catecholamines.. ***Catecholamines*** - **Pheochromocytoma** is a tumor of the **adrenal medulla** that secretes excessive amounts of **catecholamines**, primarily **epinephrine** and **norepinephrine** [1]. - This overproduction leads to classic symptoms such as **hypertension**, **tachycardia**, palpitations, sweating, and anxiety [1]. *Dopamine* - While dopamine is a **precursor** to norepinephrine and epinephrine, and some pheochromocytomas can secrete dopamine, it is not the primary or most characteristic hormone excessively secreted [1]. - Excessive dopamine secretion is more commonly associated with tumors like **neuroblastomas** or **ganglioneuromas**. *Aldosterone* - **Aldosterone** is a mineralocorticoid primarily secreted by the **adrenal cortex** (zona glomerulosa), not the adrenal medulla, and is involved in regulating blood pressure and electrolyte balance [1]. - Excessive aldosterone secretion is indicative of conditions like **primary hyperaldosteronism** (Conn's syndrome) or secondary hyperaldosteronism. *Glucocorticoids* - **Glucocorticoids**, such as **cortisol**, are hormones secreted by the **adrenal cortex** (zona fasciculata) and are vital for metabolism, immune function, and stress response [2]. - Excessive glucocorticoid secretion is characteristic of **Cushing's syndrome**, not pheochromocytoma [2].

Q: Reversible dementia is a feature of:

Endocrine disorder. ***Endocrine disorder*** - Certain **endocrine disorders**, such as **hypothyroidism** or **hyperparathyroidism**, can cause cognitive impairment that is reversible with appropriate treatment. - Correction of the underlying hormonal imbalance often leads to significant improvement or full resolution of cognitive symptoms. *Frontotemporal dementia* - This is a **progressive neurodegenerative disorder** characterized by changes in personality, behavior, and language, which are generally irreversible [3]. - It involves the degeneration of the **frontal and temporal lobes** of the brain, leading to permanent cognitive decline. *Vascular dementia* - Caused by **reduced blood flow to the brain** due to strokes or other cerebrovascular events, leading to irreversible brain damage [1]. - While supportive care can manage symptoms, the underlying brain damage and cognitive deficits are generally **not reversible**. *Neurodegenerative disorder* - This is a broad category of conditions, including **Alzheimer's disease** and **Parkinson's disease**, that involve progressive loss of neurons and are characterized by irreversible cognitive decline [2], [4]. - The brain damage associated with these conditions is permanent and worsens over time.

Q: A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?

Suppressed TSH with elevated thyroid hormone levels. Suppressed TSH with elevated thyroid hormone levels - The patient's symptoms of **fatigue** (despite being warm) and **difficulty gaining weight**, coupled with her body feeling **warm**, are classic signs of **hyperthyroidism**. [1] - In hyperthyroidism, the thyroid gland produces **excessive thyroid hormones (T3 and T4)**, which in turn **suppresses TSH** production from the pituitary gland through negative feedback. [2] *Elevated TSH with normal thyroid hormone levels* - This pattern is characteristic of **subclinical hypothyroidism**, where the thyroid gland is beginning to fail, leading to increased TSH to maintain normal thyroid hormone levels. [3] - The patient's symptoms of feeling warm and difficulty gaining weight are inconsistent with hypothyroidism. [1] *Elevated TSH with low thyroid hormone levels* - This indicates **primary hypothyroidism**, where the thyroid gland is underactive and produces insufficient thyroid hormones, leading to a compensatory rise in TSH. [2] - Hypothyroidism typically presents with **weight gain**, **cold intolerance**, and fatigue, which contradict the patient's presentation. [1] *Normal TSH with abnormal thyroid hormone levels* - This scenario usually suggests **central hypothyroidism** (pituitary or hypothalamic dysfunction affecting TSH production) or **thyroid hormone resistance**. [3] - While possible in some rare cases, it does not fit the typical clinical picture of hyperthyroidism presented by the patient's symptoms.

Q: In comparison to a normal healthy person, in the evening time, which of these will have an elevated ACTH as well as elevated Cortisol?

Cushing's disease. **_Cushing's disease_** * In **Cushing's disease**, there is an **ACTH-producing pituitary adenoma** that leads to excessive ACTH secretion, which in turn stimulates the adrenal glands to produce high levels of cortisol. * This results in **chronically elevated cortisol levels** throughout the day, including the evening, and an inappropriately elevated ACTH due to increased production from the pituitary. *Addison's disease* * **Addison's disease** is characterized by **primary adrenal insufficiency**, meaning the adrenal glands cannot produce sufficient cortisol despite adequate ACTH stimulation. * While ACTH would be significantly **elevated** due to a lack of negative feedback from cortisol, the **cortisol levels would be low** or normal in response to the adrenal gland dysfunction. *Transient state after exercise (evening time)* * During and immediately after **intense exercise**, both ACTH and cortisol levels can transiently increase as part of the body's stress response. * However, these elevations are typically **transient** and would not represent a sustained, pathologically elevated state in the evening in the same way as Cushing's disease, and levels would usually normalize relatively quickly. *Normal healthy person (evening time)* * In a normal healthy person, ACTH and cortisol levels exhibit a **diurnal rhythm**, with the highest levels in the morning and the lowest levels in the late evening/night. * Therefore, in the evening, both **ACTH and cortisol levels would naturally be low** as part of the physiological circadian rhythm, not elevated.

Q: What is the first line of treatment for osteoporosis in postmenopausal women?

Bisphosphonates. ***Bisphosphonates*** - **Bisphosphonates** are the **first-line therapy** for osteoporosis in postmenopausal women due to their proven efficacy in reducing the risk of fragility fractures [1]. - They work by inhibiting **osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density [1]. *Ulipristal* - **Ulipristal** is a **selective progesterone receptor modulator** primarily used as an emergency contraceptive or for the treatment of uterine fibroids. - It has no role in the direct treatment or prevention of osteoporosis. *Estrogen* - **Estrogen therapy** can prevent bone loss but is generally not considered first-line for osteoporosis due to potential risks like increased incidence of **venous thromboembolism**, stroke, and certain cancers [1]. - It is typically reserved for women with severe menopausal symptoms who also need osteoporosis prevention [1]. *Calcium and vitamin D supplementation* - While essential for **bone health**, **calcium and vitamin D supplementation** alone is not sufficient to treat established osteoporosis [2]. - They are crucial adjuncts to pharmacotherapy, ensuring adequate building blocks for bone formation, but do not directly address the underlying bone loss mechanism effectively enough as a monotherapy for osteoporosis [1].

Q: A 26 year old female after her delivery develops features of headache, nausea, visual complaints, fatigue. What is the most probable diagnosis?

Sheehan's syndrome. ***Sheehan's syndrome*** - This syndrome is caused by **ischemic necrosis of the pituitary gland** due to severe postpartum hemorrhage or hypovolemic shock, leading to **pituitary dysfunction** [1]. - Symptoms like **headache, nausea, visual complaints, and fatigue** are consistent with panhypopituitarism developing after delivery, often presenting in the postpartum period due to the large, vulnerable pregnancy-enlarged pituitary [1]. *Waterhouse-Friderichsen syndrome* - This is a rare, life-threatening condition caused by overwhelming **bacterial infection (often meningococcal)**, leading to **adrenal gland hemorrhage** and acute adrenal insufficiency. - It presents with rapid onset of fever, petechial rash, hypotension, and shock, which are not described in the patient's symptoms. *Hyperprolactinemia* - While hyperprolactinemia can cause headaches and visual disturbances (if due to a pituitary tumor) [1], it typically presents with **galactorrhea**, **amenorrhea**, or **oligomenorrhea**, and is not directly linked to the postpartum period unless caused by a new or existing pituitary adenoma. - It does not account for the widespread pituitary failure implied by the patient's general fatigue and other symptoms after delivery, which is more characteristic of Sheehan's [2]. *Pituitary adenoma* - A pituitary adenoma can cause headaches, visual disturbances (due to **mass effect on the optic chiasm**) [1], and hormone deficiencies or excesses, but its onset is not specifically tied to the postpartum period like Sheehan's syndrome. - While it's a possibility for these symptoms, the history of recent delivery strongly points to Sheehan's syndrome over a newly symptomatic or pre-existing pituitary adenoma without specific features like galactorrhea or Cushing's symptoms that would hint at a specific type of adenoma.

Q: VMA is elevated in which of the following condition?

Pheochromocytoma. Pheochromocytoma - Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive amounts of catecholamines (epinephrine and norepinephrine). - Vanillylmandelic acid (VMA) is a breakdown product of these catecholamines [1], so its levels are elevated in the urine of patients with pheochromocytoma. Tuberous sclerosis - Tuberous sclerosis is a genetic disorder characterized by the growth of numerous non-cancerous tumors in various organs. - While it can be associated with renal angiomyolipomas or brain lesions, it does not directly cause elevated VMA levels. Addison disease - Addison disease is characterized by adrenal insufficiency [2], meaning the adrenal glands produce insufficient amounts of hormones like cortisol and aldosterone. - This condition is not associated with the overproduction of catecholamines or elevated VMA. Conn Syndrome - Conn syndrome (primary hyperaldosteronism) is due to an overproduction of aldosterone by the adrenal glands, often caused by an adrenal adenoma [3]. - Aldosterone is a mineralocorticoid, and its overproduction does not lead to increased catecholamine metabolism or elevated VMA levels.

Q: A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?

Cortisol deficiency. ***Cortisol deficiency*** - Following **bilateral adrenalectomy**, the body loses its primary source of **cortisol**, a critical hormone for maintaining blood pressure and energy levels. [1] - The symptoms of **lethargy, fatigue, loss of appetite, and hypotension** are classic signs of **acute adrenal insufficiency** or **adrenal crisis** due to cortisol deficiency. [1] *Cardiogenic shock* - This condition involves severe pump failure of the heart, leading to **reduced cardiac output**. - While hypotension is present, the symptom complex of fatigue and loss of appetite shortly after adrenal surgery points away from primary cardiac dysfunction in the absence of preceding cardiac events. *Septic shock* - Characterized by hypotension, signs of infection, and organ dysfunction due to a systemic inflammatory response. - There is no mention of fever, leukocytosis, or other signs of infection in the patient's presentation. *Hypovolemic shock* - Caused by a significant reduction in circulating blood volume, often due to hemorrhage or severe dehydration. - The question explicitly states "No evidence of loss of volume," ruling out hypovolemic shock.

Q: A 22-year-old female, Neeta presented to you with complaints of a headache and vomiting for 2 months. She is having amenorrhea but the urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyperprolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed?

Bromocriptine. ***Bromocriptine*** - **Bromocriptine** is a **dopamine agonist** that directly inhibits prolactin secretion from the pituitary gland and can shrink **prolactinomas**. - It is the **first-line medical treatment** for hyperprolactinemia, particularly when surgery is refused or contraindicated. *Ergotamine* - **Ergotamine** is used to treat **migraine headaches** by constricting blood vessels in the brain. - It does not have a primary role in managing pituitary adenomas or hyperprolactinemia. *Sumatriptan* - **Sumatriptan** is a **serotonin receptor agonist** used for the acute treatment of migraine and cluster headaches. - It does not affect prolactin levels or the size of pituitary adenomas. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used to treat **gout** and prevent uric acid kidney stones. - It is unrelated to hyperprolactinemia or pituitary adenomas.

Question 1

A 55 yr old patient presented to the opd with complaint of pain in back. On examination his limbs seemed to be bent with overlying warm and thick skin. Patient also complain of decreased hearing over a few days. On biochemical analysis his serum ALP was raised. X-ray obtained showed the following features. Most probable diagnosis?

Accepted Answer

Pagets disease

Answer

Renal osteodystrophy

Answer

Osteoporosis

Answer

Osteopetrosis

Question 2

Pheochromocytoma is characterized by excessive secretion of:

Accepted Answer

Catecholamines.

Answer

Dopamine.

Answer

Aldosterone.

Answer

Glucocorticoids.

Question 3

Reversible dementia is a feature of:

Accepted Answer

Endocrine disorder

Answer

Frontotemporal dementia

Answer

Vascular dementia

Answer

Neurodegenerative disorder

Question 4

A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?

Accepted Answer

Suppressed TSH with elevated thyroid hormone levels

Answer

Elevated TSH with normal thyroid hormone levels

Answer

Elevated TSH with low thyroid hormone levels

Answer

Normal TSH with abnormal thyroid hormone levels

Question 5

In comparison to a normal healthy person, in the evening time, which of these will have an elevated ACTH as well as elevated Cortisol?

Accepted Answer

Cushing's disease

Answer

Addison's disease

Answer

Transient state after exercise (evening time)

Answer

Normal healthy person (evening time)

Question 6

What is the first line of treatment for osteoporosis in postmenopausal women?

Accepted Answer

Bisphosphonates

Answer

Ulipristal

Answer

Estrogen

Answer

Calcium and vitamin D supplementation

Question 7

A 26 year old female after her delivery develops features of headache, nausea, visual complaints, fatigue. What is the most probable diagnosis?

Accepted Answer

Sheehan's syndrome

Answer

Waterhouse-Friderichsen syndrome

Answer

Hyperprolactinemia

Answer

Pituitary adenoma

Question 8

VMA is elevated in which of the following condition?

Accepted Answer

Pheochromocytoma

Answer

Tuberous sclerosis

Answer

Addison disease

Answer

Conn Syndrome

Question 9

A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?

Accepted Answer

Cortisol deficiency

Answer

Cardiogenic shock

Answer

Septic shock

Answer

Hypovolemic shock

Question 10

A 22-year-old female, Neeta presented to you with complaints of a headache and vomiting for 2 months. She is having amenorrhea but the urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyperprolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed?

Accepted Answer

Bromocriptine

Answer

Ergotamine

Answer

Sumatriptan

Answer

Allopurinol

Endocrinology — MCQs

Endocrinology — MCQs

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