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A chromophobe adenoma of the pituitary would be expected in which of the following?
(Please select 1 option)
Acromegaly
Cushing's disease
Non-functioning pituitary tumour
Prolactinoma
TSH secreting tumour
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
Work Smart
A chromophobe adenoma of the pituitary would be expected in which of the following?
(Please select 1 option)
Acromegaly Incorrect answer selected
Cushing's disease
Non-functioning pituitary tumour This is the correct answer
Prolactinoma
TSH secreting tumour
A chromophobe adenoma refers to no uptake of dye within the tumourous specimen.
This occurs in the non-secretory/non-functioning pituitarytumours.
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
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A 39-year-old male presents with gynaecomastia.
Which of the following is the most likely cause of his gynaecomastia?
(Please select 1 option)
Congenital adrenal hyperplasia (CAH)
Hypopituitarism
Hypothyroidism
Prolactinoma
Seminoma
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A 39-year-old male presents with gynaecomastia.
Which of the following is the most likely cause of his gynaecomastia?
(Please select 1 option)
Congenital adrenal hyperplasia (CAH) Incorrect answer selected
Hypopituitarism
Hypothyroidism
Prolactinoma
Seminoma This is the correct answer
Gynaecomastia is due to a perturbation in the testosterone to oestradiol ratio.
Neither hyperprolactinaemia nor hypopituitarism disturb this ratio and are rarely associated with
gynaecomastia.
Unlike hyperthyroidism, hypothyroidism is not a cause. CAH is not a cause.
However, gynaecomastia may be a presenting symptom of a seminoma and may arise due to human chorionic
gonadotropin (HCG) secretion.
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Regarding testosterone, which of the following statements is correct?
(Please select 1 option)
Acts via cell surface receptors
Acts via G-protein second messengers
In the circulation is mostly bound to albumin
Is a steroid hormone
Is manufactured through the breakdown of oestradiol
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
Work Smart
Regarding testosterone, which of the following statements is correct?
(Please select 1 option)
Acts via cell surface receptors Incorrect answer selected
Acts via G-protein second messengers
In the circulation is mostly bound to albumin
Is a steroid hormone This is the correct answer
Is manufactured through the breakdown of oestradiol
Testosterone is a steroid hormone and can be converted to oestradiol.
It binds to intracellular receptors and is mostly bound to sex-hormone binding globulin.
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Which of the following antibodies are typically found in auto-immune adrenalitis (Addison's disease)?
(Please select 1 option)
Anti-21 hydroxylase antibody
Anti-nuclear antibody
Anti-peroxidase antibody
Anti-rho antibody
Anti-tryptophan hydroxylase antibody
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Which of the following antibodies are typically found in auto-immune adrenalitis (Addison's disease)?
(Please select 1 option)
Anti-21 hydroxylase antibody Correct
Anti-nuclear antibody
Anti-peroxidase antibody
Anti-rho antibody
Anti-tryptophan hydroxylase antibody
21 Hydroxylase is the enzyme involved in the cholesterol steroid pathway and has been found to be present in
approximately 80% of cases.
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Which of the following is a feature of Cushing's syndrome?
(Please select 1 option)
Calcium pyrophosphate arthropathy
Fibrous dysplasia
Osteoarthritis
Osteomalacia
Vertebral collapse
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
Work Smart
Which of the following is a feature of Cushing's syndrome?
(Please select 1 option)
Calcium pyrophosphate arthropathy Incorrect answer selected
Fibrous dysplasia
Osteoarthritis
Osteomalacia
Vertebral collapse This is the correct answer
Vertebral collapse may be due to osteoporosis.
Osteoarthritis and gout would be unusual with elevated corticosteroid concentrations.
Osteomalacia is not a feature.
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Which of the following is a likely presenting feature of Cushing's syndrome?
(Please select 1 option)
Diabetes insipidus
Lichen planus
Mononeuritis multiplex
Necrosis of the femoral head
Polymyositis
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Which of the following is a likely presenting feature of Cushing's syndrome?
(Please select 1 option)
Diabetes insipidus Incorrect answer selected
Lichen planus
Mononeuritis multiplex
Necrosis of the femoral head This is the correct answer
Polymyositis
Cases of Cushing's syndrome have presented with necrosis of the femoral head due to osteoporosis.
Diabetes insipidus would be very unusual, whereas diabetes mellitus may occur in 30%.
Lichen planus is treated with corticosteroids, as is polymyositis.
Mononeuritis multiplex is not a feature.
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Work Smart
Adult growth hormone deficiency (GHD) is confirmed by which of the following?
(Please select 1 option)
A low IGF-1 concentration
A low IGF binding protein-3 (IGFBP3) concentration
A peak growth hormone concentration of 6 mU/l (2 microg/l) with insulin-induced hypoglycaemia
An undetectable random growth hormone concentration.
Suppression of GH below 2 mU/l (1.3 microg/l) with an oral glucose tolerance test
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
Work Smart
Adult growth hormone deficiency (GHD) is confirmed by which of the following?
(Please select 1 option)
A low IGF-1 concentration Incorrect answer selected
A low IGF binding protein-3 (IGFBP3) concentration
A peak growth hormone concentration of 6 mU/l (2 microg/l) with insulin-induced hypoglycaemia This is the
correct answer
An undetectable random growth hormone concentration.
Suppression of GH below 2 mU/l (1.3 microg/l) with an oral glucose tolerance test
The diagnosis of adult GHD depends on a peak GH response of less than 9 mU/l to insulin-induced
hypoglycaemia.
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A 16-year-old male presents with lethargy. He takes no medication and has generally been otherwise well.
Examination reveals that he is obese with a BMI of 36.4 kg/m and a blood pressure of 120/72 mmHg.
There are no abnormalities of the cardiovascular, respiratory or abdominal systems.
Investigations reveal:
Sodium 141 mmol/L (137-144)
Potassium 2.8 mmol/L (3.5-4.9)
Urea 5.6 mmol/L (2.5-7.5)
Creatinine 76 µmol/L (60-110)
What is the most likely diagnosis?
(Please select 1 option)
Apparent mineralocorticoid excess
Bartter's syndrome
Conn's syndrome
Cushing's syndrome
Hypokalaemic periodic paralysis
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A 16-year-old male presents with lethargy. He takes no medication and has generally been otherwise well.
Examination reveals that he is obese with a BMI of 36.4 kg/m and a blood pressure of 120/72 mmHg.
There are no abnormalities of the cardiovascular, respiratory or abdominal systems.
Investigations reveal:
Sodium 141 mmol/L (137-144)
Potassium 2.8 mmol/L (3.5-4.9)
Urea 5.6 mmol/L (2.5-7.5)
Creatinine 76 µmol/L (60-110)
What is the most likely diagnosis?
(Please select 1 option)
Apparent mineralocorticoid excess Incorrect answer selected
Bartter's syndrome This is the correct answer
Conn's syndrome
Cushing's syndrome
Hypokalaemic periodic paralysis
Bartter's syndrome is an autosomal recessive renal disorder, caused by a number of different mutations.
Presentation is often in childhood with gastrointestinal upset, failure to thrive and polyuria, but it can present in
adolescence also.
The classic abnormalities seen on bloods are hypokalaemic alkalosis and elevated renin and aldosterone
levels. The blood pressure is usually normal, and oedema is not a classic sign. Hyponatraemia and
hypochloraemia may also be present. Urinary sodium, potassium and chloride are raised.
Treatment is aimed at preventing potassium wasting, for example with spironolactone and electrolyte
supplements. Indomethacin is also effective, by inhibiting excess prostaglandin synthesis.
Apparent mineralocorticoid excess is a rare form of pseudohyperaldosteronism which is associated with early
onset severe hypertension, which is not present in this case.
In Cushing's disease/syndrome the patient is often hypertensive rather than normotensive as described here.
Proximal muscle wasting is often marked and is often commented on in the stem in combination with a
description of the truncal obesity. This level of hypokalaemia is also unusual in Cushing's.
Conn's syndrome presents with hypertension in addition to hypokalaemia and alkalosis.
Hypokalaemic periodic paralysis is a rare channelopathy characterised by intermittent weakness and paralysis
with corresponding falls in the potassium levels in the blood. The presentation described here does not fit with
this diagnosis.
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
Work Smart
A 52-year-old female presents with tiredness.
There are no specific abnormalities noted on examination, but investigations reveal:
T4 21.1 pmol/L (10-22)
T3 5.2 pmol/L (5-10)
TSH 0.05 mU/L (0.4-5)
Thyroid autoantibody titres are all undetectable.
What diagnosis do these results suggest?
(Please select 1 option)
DeQuervain's thyroidits
Graves' disease
Hashimoto's thyroiditis
Sick euthyroid syndrome
Solitary toxic nodule
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
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A 52-year-old female presents with tiredness.
There are no specific abnormalities noted on examination, but investigations reveal:
T4 21.1 pmol/L (10-22)
T3 5.2 pmol/L (5-10)
TSH 0.05 mU/L (0.4-5)
Thyroid autoantibody titres are all undetectable.
What diagnosis do these results suggest?
(Please select 1 option)
DeQuervain's thyroidits Incorrect answer selected
Graves' disease
Hashimoto's thyroiditis
Sick euthyroid syndrome
Solitary toxic nodule This is the correct answer
This patient has subclinical hyperthyroidism and, in the absence of thyroid auto-antibodies, the most probable
explanation of these thyroid function abnormalities is a solitary toxic nodule.
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Work Smart Work Hard Mock Tests Group Learning 2 Revision Advice Tags Learning Journal
Work Smart
A 32-year-old woman presents with a four month history of amenorrhoea.
She takes no specific therapy. She has two children and her husband has had a vasectomy.
Examination reveals an obese individual but no other abnormality.
Investigations show:
Serum oestradiol 100 pmol/L (130-500)
Serum LH 2.1 mU/L (3.0-6.6)
Serum FSH 2.2 mU/L (3.3-10.1)
Serum prolactin 800 mU/L (50-500)
Serum testosterone 2.1 pmol/L (<3.0)
Which investigation is the most appropriate?
(Please select 1 option)
17 hydroxy-progesterone
Insulin tolerance test
Magnetic resonance imaging (MRI) of the pituitary
Pregnancy test
Urine free cortisol concentration
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A 32-year-old woman presents with a four month history of amenorrhoea.
She takes no specific therapy. She has two children and her husband has had a vasectomy.
Examination reveals an obese individual but no other abnormality.
Investigations show:
Serum oestradiol 100 pmol/L (130-500)
Serum LH 2.1 mU/L (3.0-6.6)
Serum FSH 2.2 mU/L (3.3-10.1)
Serum prolactin 800 mU/L (50-500)
Serum testosterone 2.1 pmol/L (<3.0)
Which investigation is the most appropriate?
(Please select 1 option)
17 hydroxy-progesterone Incorrect answer selected
Insulin tolerance testMagnetic resonance imaging (MRI) of the pituitary This is the correct answer
Pregnancy test
Urine free cortisol concentration
This patient has hypogonadotrophic hypogonadism as evidenced by suppressed luteinising hormone/follicle-
stimulating hormone (LH/FSH) and a low oestradiol concentration.
This would exclude pregnancy as a cause and polycystic ovarian syndrome is also unlikely.
In the presence of a raised prolactin concentration, a microprolactinoma would be the most likely explanation
for this patient's symptoms and results.
This may be demonstrated by a pituitary MRI scan.
An insulin tolerance test would usually be entirely normal in a microprolactinoma.
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A 35-year-old female is found to have a solitary mass on the chest x ray.
Biopsy confirms this to be a carcinoid tumour of the lung.
Which of the following are likely to be associated with this lesion?
(Please select 1 option)
Carcinoid syndrome
Cushing's syndrome
Hyponatraemia
Pellagra
Pulmonary hypertension
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Work Smart Work Hard Mock Tests Group Learning 3 Revision Advice Tags Learning Journal
Work Smart
A 35-year-old female is found to have a solitary mass on the chest x ray.
Biopsy confirms this to be a carcinoid tumour of the lung.
Which of the following are likely to be associated with this lesion?
(Please select 1 option)
Carcinoid syndrome Incorrect answer selected
Cushing's syndrome This is the correct answer
Hyponatraemia
Pellagra
Pulmonary hypertension
Classical carcinoid syndrome occurs in less than 10% of patients with carcinoid tumours, but occurs most
commonly in those with tumours of the small intestine, appendix and proximal small bowel. Those in the lung
rarely cause carcinoid, but have been associated with ACTH secretion and subsequent Cushing's syndrome.
Other associated conditions where foregut carcinoid tumours are found in the pancreas are associated with
Zollinger-Ellison syndrome and VIPoma.
A bronchial carcinoid tumour has rarely been reported in association with acromegaly (ectopic growth
hormone-releasing hormone [GHRH]).
They may also be found in association with multiple endocrine neoplasia (MEN) type 1 where pancreatic
neuroendocrine tumours predominate.
Related Articles (BMJ)
MRCP Part 1 2007 May
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Work Smart Work Hard Mock Tests Group Learning 3 Revision Advice Tags Learning Journal
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A 37-year-old female presents with galactorrhoea.
She has a history of dyspepsia for which she receives omeprazole.
Examination reveals a BMI of 23.5 kg/m and a small amount of galactorrhoea to expression.
Investigations show:
Prolactin 850 mU/L (50-500)
Oestradiol 88 pmol/L (130-500)
LH 3.2 mU/L (3.5-8)
FSH 2.8 mU/L (3-8)
What disorder should be considered?
(Please select 1 option)
Addison's disease
Drug-induced hyperprolactinaemia
Hyperthyroidism
Hypothyroidism
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Work Smart Work Hard Mock Tests Group Learning 3 Revision Advice Tags Learning Journal
Work Smart
A 37-year-old female presents with galactorrhoea.
She has a history of dyspepsia for which she receives omeprazole.
Examination reveals a BMI of 23.5 kg/m and a small amount of galactorrhoea to expression.
Investigations show:
Prolactin 850 mU/L (50-500)
Oestradiol 88 pmol/L (130-500)
LH 3.2 mU/L (3.5-8)
FSH 2.8 mU/L (3-8)
What disorder should be considered?
(Please select 1 option)
Addison's disease Incorrect answer selected
Drug-induced hyperprolactinaemia
Hyperthyroidism
Hypothyroidism
MEN type 1 This is the correct answer
The presence of hyperprolactinaemiawith hypogonadotrophic hypogonadism suggests a diagnosis of a
microprolactinoma and in combination with the recurrent dyspepsia a diagnosis of multiple endocrine neoplasia
(MEN) type 1 should be considered.
All the findings cannot be explained by omeprazole for which there are some case reports only of
hyperprolactinaemia.
Addison's disease does not cause hyperprolactinaemia and neither hypothyroidism nor hyperthyroidism would
fit this clinical scenario.
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Which of the following is true of IGF-1 concentrations
(Please select 1 option)
Concentrations are elevated in diabetes mellitus
Concentrations are elevated in hepatic cirrhosis
Concentrations are reduced in pregnancy
Concentrations are reduced in starvation
Concentrations are usually elevated in adult growth hormone deficiency
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