Advanced Endocrine Disorders and Diagnostic Insights Quiz

1. Pituitary adenoma secreting GH increases risk of which cancers?diagnosis?What is Most common cause of death in these patients?Acromegaly vs Gigantism?

Gigantism is when GH secreting hormone mainly affects bone density and structure.

Most common cause of death in patients with pituitary tumor secreting GH is respiratory failure.

Increased GH>Increased cell growth of proliferation>Increased risk of lung cancer.

2. A boy with dwarfism (Laron syndrome) presents with short stature, small head circumference, prominent forehead, saddle nose, and micropenis. Despite these physical characteristics, his growth hormone (GH) levels are increased. Why might his GH levels be increased?

Excessive consumption of GH supplements

Due to a pituitary tumor secreting excess GH

Genetic mutation leading to GH hypersecretion

The boy's physical characteristics suggest dwarfism (Laron syndrome), which is characterized by GH insensitivity. Therefore, the incorrect answers proposing excess GH production, supplementation, or genetic mutation do not align with the underlying condition causing his increased GH levels.

Explanation

The boy's physical characteristics suggest dwarfism (Laron syndrome), which is characterized by GH insensitivity. Therefore, the incorrect answers proposing excess GH production, supplementation, or genetic mutation do not align with the underlying condition causing his increased GH levels.

3. Autosomal Dominant condition that causes LOSS of Function of G-protein coupled calcium receptors in parathyroid glands, what changes you expect in serum PTH, Calcium, Magnesium, and Urine calcium? How can you differ this condition from hyperparathyroidism?

In the correct answer, the explanation provided clarifies how the loss of function of G-protein coupled calcium receptors affects serum PTH, Calcium, Magnesium, and Urine calcium levels in comparison to hyperparathyroidism. The incorrect answers present alternative scenarios that do not align with the described condition.

Explanation

In the correct answer, the explanation provided clarifies how the loss of function of G-protein coupled calcium receptors affects serum PTH, Calcium, Magnesium, and Urine calcium levels in comparison to hyperparathyroidism. The incorrect answers present alternative scenarios that do not align with the described condition.

4. Diabetes insipidus (either central or nephrogenic) causes a net loss of only water, leading to euvoemic hypernatremia. What changes would you expect in plasma osmolality/sodium levels, extracellular fluid (ECF) volume, and intracellular fluid (ICF) volume? How can this understanding help explain the use of thiazides for treatment, and what about indomethacin?

DI causes a net loss of both water and sodium, leading to hypovolemic hyponatremia.

Thiazide diuretics are used to promote retention of water and sodium in the body.

Plasma osmolality decreases due to an increase in total body water.

The correct answer highlights the key concept of DI causing a net loss of only water, leading to hypernatremia. Thiazides are used to promote volume loss, while indomethacin can constrict the afferent arteriole to increase proximal tubule reabsorption.

Explanation

The correct answer highlights the key concept of DI causing a net loss of only water, leading to hypernatremia. Thiazides are used to promote volume loss, while indomethacin can constrict the afferent arteriole to increase proximal tubule reabsorption.

5. What type of hypertrophy is the most common cause of death in patients with GH-secreting adenoma?

Hyperplastic hypertrophy causing ARRHYTHMOGENIC cardiomyopathy

Symmetric hypertrophy causing RESTRICTIVE cardiomyopathy

*Eccentric hypertophy>DILATED cardiomyopathy.

Concentric hypertrophy causing HYPERTROPHIC cardiomyopathy

Patients with GH-secreting adenoma typically develop eccentric hypertrophy, leading to dilated cardiomyopathy, which can result in heart failure and increased mortality rates.

Explanation

Patients with GH-secreting adenoma typically develop eccentric hypertrophy, leading to dilated cardiomyopathy, which can result in heart failure and increased mortality rates.

6. How can you differentiate between psychogenic polydypsia and SIADH in a patient with decreased urine osmolarity?

Order a brain CT scan to identify structural abnormalities in psychogenic polydypsia, while in SIADH focus on monitoring fluid intake

Administer vasopressin antagonist medication in both psychogenic polydypsia and SIADH to observe their response

7. What is the target of autoimmune destruction in adrenal gland, the most common cause of Addison disease (chronic primary adrenal insufficiency) in the Western world?

Target of destruction is insulin-producing beta cells in the pancreas.

*Target of destruction is CYTOCHROME P450 enzyme-21 hydroxylase.vsTB is most common cause of Addison disease in developing countries.

Target of destruction is vsTB (variable surface antigen Tuberculosis) in developing countries.

Target of destruction is thyroid peroxidase enzyme in the thyroid gland.

8. Which one of the following abnormalities is most closely associated with the woman's disorder?

C. Ectodermal dystrophy

D. Parathyroid hyperplasia

B. Diabetes mellitus

When first described as primary adrenal insufficiency, the most common cause was tuberculosis of the adrenal gland. Now the majority of patients have adrenal autoantibodies and are thought to have autoimmune Addison's disease. Autoimmune adrenalitis may occur with other autoimmune endocrine diseases. Two major patterns of autoimmune polyendocrine syndromes have been described. In addition to autoimmune adrenitis, patients with autoimmune polyendocrine syndrome type (APS1) have chronic mucocutaneous candidiasis and abnormalities of the skin, nails, and teeth (ectodermal dystrophy). APS1 is also known as APECED (autoimmune polyendocrinopathy, candidiasis, and Ectodermal dystrophy). In addition patients have other autoimmune disorders including autoimmune hypoparathyroidism, idiopathic hypogonadism, and pernicious anemia. APS1 result from mutations of the autoimmune regulator (AIRE) gene, the product of which is expressed primarily in the thymus.Autoimmune polyendocrine syndromes type 2 (APS2) is not associated with candidiasis, ectodermal dysplasia, or autoimmune hypoparathyroidism.Instead, autoimmune adrenalitis is present with autoimmune thyroiditis (Hashimoto's thyroiditis) or type 1 diabetes mellitus.

Explanation

When first described as primary adrenal insufficiency, the most common cause was tuberculosis of the adrenal gland. Now the majority of patients have adrenal autoantibodies and are thought to have autoimmune Addison's disease. Autoimmune adrenalitis may occur with other autoimmune endocrine diseases. Two major patterns of autoimmune polyendocrine syndromes have been described. In addition to autoimmune adrenitis, patients with autoimmune polyendocrine syndrome type (APS1) have chronic mucocutaneous candidiasis and abnormalities of the skin, nails, and teeth (ectodermal dystrophy). APS1 is also known as APECED (autoimmune polyendocrinopathy, candidiasis, and Ectodermal dystrophy). In addition patients have other autoimmune disorders including autoimmune hypoparathyroidism, idiopathic hypogonadism, and pernicious anemia. APS1 result from mutations of the autoimmune regulator (AIRE) gene, the product of which is expressed primarily in the thymus.Autoimmune polyendocrine syndromes type 2 (APS2) is not associated with candidiasis, ectodermal dysplasia, or autoimmune hypoparathyroidism.Instead, autoimmune adrenalitis is present with autoimmune thyroiditis (Hashimoto's thyroiditis) or type 1 diabetes mellitus.

9. Why would you get EUVOLEMIC(Normal volume) HYPOnatremia in SIADH?significance of HYPOnatremia?

A. Hypernatremia because of excessive salt intake.

C. Hypervolemia leading to increased sodium levels in the blood.

B. Hypokalemia due to potassium loss in the urine.

The correct answer explains the mechanism of EUVOLEMIC HYPOnatremia in SIADH. Option A is incorrect as it mentions hypernatremia which is the opposite of the scenario described. Option B is incorrect as it refers to hypokalemia which is not directly related to the condition. Option C is incorrect as it discusses hypervolemia which is not characteristic of SIADH-induced HYPOnatremia.

Explanation

The correct answer explains the mechanism of EUVOLEMIC HYPOnatremia in SIADH. Option A is incorrect as it mentions hypernatremia which is the opposite of the scenario described. Option B is incorrect as it refers to hypokalemia which is not directly related to the condition. Option C is incorrect as it discusses hypervolemia which is not characteristic of SIADH-induced HYPOnatremia.

10. Which type of goiter is expected in a patient with a TSH-secreting PITUITARY adenoma?

Cystic enlargement of the gland

Diffuse enlargement of the gland

Multinodular goiter with irregular borders

11. Toxic multinodular goiter causes diffuse vs nodular enlargement?

Fluctuating enlargement

*NODULAR enlargment.

Diffuse enlargement

Cystic enlargement

Toxic multinodular goiter typically presents with nodular enlargement rather than diffuse enlargement.

Explanation

Toxic multinodular goiter typically presents with nodular enlargement rather than diffuse enlargement.

12. Patient presents with symptoms of HYPOthyroidism, on history taking you note symptoms of HYPERthyroidism that followed 'Flu-like' infection, on examination thyroid is TENDER(SUPER HY), histology shows GRANULOMATOUS inflammation(Look for multinucleated giant cells), ESR is elevated. What is the likely diagnosis and prognosis?

The symptoms and findings suggest thyroid cancer, which may require surgical intervention and long-term management.

This could be indicative of Graves' disease, an autoimmune disorder leading to overactive thyroid.

This is likely a case of Hashimoto's thyroiditis, which is an autoimmune disorder causing chronic inflammation of the thyroid gland.

The correct diagnosis in this scenario is subacute granulomatous (de Quervan) thyroiditis, characterized by painful inflammation of the thyroid gland following a flu-like infection. This condition is self-limiting and has a good prognosis. Hashimoto's thyroiditis, Graves' disease, and thyroid cancer present with different clinical features and outcomes than what is described in the question.

Explanation

The correct diagnosis in this scenario is subacute granulomatous (de Quervan) thyroiditis, characterized by painful inflammation of the thyroid gland following a flu-like infection. This condition is self-limiting and has a good prognosis. Hashimoto's thyroiditis, Graves' disease, and thyroid cancer present with different clinical features and outcomes than what is described in the question.

13. MOST common symptom of Pituitary adenoma? HY anatomy correlate? MOST common type of pituitary adenoma?

The most common type of pituitary adenoma is Somatotroph adenoma

Pituitary adenoma most commonly presents with signs of hyperpituitarism

Bitemporal hemianopia is the most common symptom of Pitutary adenoma

14. Why is HYPERpigmentation extremely characteristic of Addison's disease?

Because it is a common symptom in all types of adrenal insufficiency.

Because it is a side effect of the electrolyte imbalances caused by Addison's disease.

Because patients with Addison's disease have higher levels of cortisol, which leads to increased melanin production.

The correct answer explains the physiological relationship between ACTH, MSH, and melanin production in Addison's disease, as well as the specific association with primary adrenal insufficiency. It also mentions the development of HYPERkalemic metabolic acidosis in these patients due to aldosterone deficiency.

Explanation

The correct answer explains the physiological relationship between ACTH, MSH, and melanin production in Addison's disease, as well as the specific association with primary adrenal insufficiency. It also mentions the development of HYPERkalemic metabolic acidosis in these patients due to aldosterone deficiency.

15. Addisonian crisis(LIFE-THREATENING condition that can manifest with severe hypoglycemia,Hypotension,fever,convulsions,coma) is primarily mediated by lack of which hormone?

Aldosterone

Thyroxine

Insulin

In cases of Addisonian crisis, the lack of cortisol plays a primary role in the life-threatening condition. While aldosterone deficiency is also present in this scenario, the acute lack of cortisol is the main cause. Insulin and thyroxine are not directly related to Addisonian crisis.

Explanation

In cases of Addisonian crisis, the lack of cortisol plays a primary role in the life-threatening condition. While aldosterone deficiency is also present in this scenario, the acute lack of cortisol is the main cause. Insulin and thyroxine are not directly related to Addisonian crisis.

16. What are the results of a Metyrapone test in Addison's disease?

In Addison's disease, a Metyrapone test will show normal cortisol, ACTH, and 11 deoxycortisol levels.

In Addison's disease, a Metyrapone test will show decreased ACTH levels.

In Addison's disease, a Metyrapone test will show increased cortisol levels.

In primary adrenal insufficiency like Addison's disease, the Metyrapone test results in increased ACTH levels due to the lack of negative feedback from cortisol, leading to decreased cortisol levels and low 11 deoxycortisol levels. This is characteristic of a dysfunction in the adrenal gland cells.

Explanation

In primary adrenal insufficiency like Addison's disease, the Metyrapone test results in increased ACTH levels due to the lack of negative feedback from cortisol, leading to decreased cortisol levels and low 11 deoxycortisol levels. This is characteristic of a dysfunction in the adrenal gland cells.

17. Do you expect to see hyperkalemic metabolic acidosis in patient with Addison disease vs Adrenal insufficiency secondary to pituitary apoplexy? what about hyperpigmentation?

18. Patient develops signs of adrenal failure after acute removal of corticosteroids, will he have HYPERkalemia?

No, because adrenal failure always results in hyperkalemia regardless of the cause.

Yes, because acute removal of corticosteroids disrupts normal potassium levels in the body.

Yes, because adrenal failure leads to excessive production of aldosterone causing hyperkalemia.

The correct answer explains that hyperkalemia is not expected in this scenario due to the specific relationship between corticosteroids, ACTH, and aldosterone levels.

Explanation

The correct answer explains that hyperkalemia is not expected in this scenario due to the specific relationship between corticosteroids, ACTH, and aldosterone levels.

19. What is the most common cause of HYPOpituitarism in adults and children?

Adrenocorticotropinoma

Somatotropinoma

Prolactinoma

Prolactinoma can lead to symptoms like galactorrhea before causing hypopituitarism. Somatotropinoma and Adrenocorticotropinoma are less common causes compared to NON-functioning adenoma in adults.

Explanation

Prolactinoma can lead to symptoms like galactorrhea before causing hypopituitarism. Somatotropinoma and Adrenocorticotropinoma are less common causes compared to NON-functioning adenoma in adults.

20. Why might a patient who gave birth to a child recently (cesarean section) present with intolerance to cold, amenorrhea, and inability to breastfeed her child?

Postpartum depression leading to hormonal imbalance

Side effects of medications given during the cesarean section

Autoimmune thyroiditis causing thyroid dysfunction

Sheehan syndrome is a rare condition that occurs due to vascular insufficiency post-delivery, leading to ischemic infarct of the pituitary gland. This results in hormonal imbalances affecting various functions such as intolerance to cold, amenorrhea, and inability to breastfeed. The incorrect answers do not match the specific mechanism and presentation of Sheehan syndrome.

Explanation

Sheehan syndrome is a rare condition that occurs due to vascular insufficiency post-delivery, leading to ischemic infarct of the pituitary gland. This results in hormonal imbalances affecting various functions such as intolerance to cold, amenorrhea, and inability to breastfeed. The incorrect answers do not match the specific mechanism and presentation of Sheehan syndrome.

21. What condition presents with sudden onset of severe headache, photophobia, nuchal rigidity, ocular symptoms like diplopia and bitemporal hemianopsia, and hypotension due to adrenal insufficiency?

Subarachnoid hemorrhage, which can lead to sudden severe headache, photophobia, and nuchal rigidity due to bleeding into the subarachnoid space

Meningitis characterized by inflammation of the meninges and typically presents with severe headaches and nuchal rigidity

Acute angle-closure glaucoma presenting with sudden severe eye pain, blurred vision, and halos around lights

22. What is the first step in the treatment of a patient who develops HYPOPituitarism due to a NON-functional adenoma?

Wait for spontaneous regression of the adenoma

*FIRST try HORMONE REPLACEMENT THERAPY(For whatever is deficienty, like THYROXINE,GH,Corticosteroids,Sex hormones)then remove the mass if necessary.

Start chemotherapy for the patient

Perform immediate surgery to remove the adenoma

The correct first step in the treatment of a patient with HYPOPituitarism due to a NON-functional adenoma is to try HORMONE REPLACEMENT THERAPY before considering surgical removal of the mass, as it helps restore hormone levels and function.

Explanation

The correct first step in the treatment of a patient with HYPOPituitarism due to a NON-functional adenoma is to try HORMONE REPLACEMENT THERAPY before considering surgical removal of the mass, as it helps restore hormone levels and function.

23. If a patient presents with PROXIMAL muscle weakness, what can be inferred about their CK levels and symptoms based on thyroid function?

Proximal muscle weakness is a key indicator of thyroid dysfunction, with HYPOthyroidism being associated with increased CK levels and dyspnea on exertion. It is important to differentiate between hypo- and hyperthyroidism based on CK levels and symptoms to provide appropriate treatment.

Explanation

Proximal muscle weakness is a key indicator of thyroid dysfunction, with HYPOthyroidism being associated with increased CK levels and dyspnea on exertion. It is important to differentiate between hypo- and hyperthyroidism based on CK levels and symptoms to provide appropriate treatment.

24. What is the difference between pretibial myxedema and myxedema anywhere else?

Addison's disease commonly presents with myxedema anywhere else on the body due to adrenal insufficiency.

Cushing's syndrome is associated with pretibial myxedema and presents with hyperpigmentation on the skin.