Pituitary Disorders Quiz Part I
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- 1. Question
Which pituitary tumor classification is based on cell cytoplasm staining properties as viewed by light microscopy and immunocytochemistry?
CorrectIncorrectThese adenomas also exhibit positive pituitary cell-type immunostaining.
- 2. Question
In the management of prolactinomas, which of the following is NOT an aim of the treatment?
CorrectIncorrectTreatment should aim to restore normal hormonal levels and decrease tumor size, among other goals.
- 3. Question
Which of the following medications is NOT used in the treatment of acromegaly?
CorrectIncorrectThis medication is an orally active alkylating agent used mainly in the management of a different type of brain tumor.
- 4. Question
What is the first-line treatment choice for patients with acromegaly, assuming an experienced surgeon is available and the tumor is visible on MR imaging?
CorrectIncorrect - 5. Question
Which factor is the best predictor of the efficacy of dopamine agonists in acromegaly patients?
CorrectIncorrectLook for the factor that best predicts the efficacy of dopamine agonists.
- 6. Question
What is the primary recommended use of pegvisomant in acromegaly patients?
CorrectIncorrectConsider the specific patient groups for whom pegvisomant is recommended.
- 7. Question
What is the primary marker for disease activity when using pegvisomant in acromegaly patients?
CorrectIncorrectConsider which marker is affected by pegvisomant.
- 8. Question
What receptor subtype has pasireotide (SOM 230; Signifor) shown the greatest binding affinity for, compared to octreotide?
CorrectIncorrectLook for the SSTR subtype with the greatest difference in binding affinity between pasireotide and octreotide.
- 9. Question
A 45-year-old woman with Cushing's disease is being considered for treatment with cabergoline. What is the expected long-term efficacy of cabergoline in selected Cushing's disease patients?
CorrectIncorrectConsider the efficacy of cabergoline observed in small studies.
- 10. Question
A 55-year-old man with Cushing's disease is being treated with mifepristone. Which of the following is a common side effect of mifepristone treatment?
CorrectIncorrectThink about electrolyte imbalances caused by mifepristone.
- 11. Question
A 37-year-old woman with Cushing's disease is being considered for treatment with retinoic acid. What has been shown in animal models regarding retinoic acid and corticotroph secretion and proliferation?
CorrectIncorrectConsider the effects of retinoic acid on corticotroph secretion and proliferation in animal models.
- 12. Question
A 50-year-old man with Cushing's disease is being treated with etomidate. Which of the following is a unique feature of etomidate compared to other adrenal steroidogenesis inhibitors?
CorrectIncorrectConsider the method of administration of etomidate compared to other adrenal steroidogenesis inhibitors.
- 13. Question
A 31-year-old male with a history of absence seizures, migraine headaches, renal calculi, sleep apnea, carpal tunnel syndrome, and hypertension presents with increasing fatigue, anxiety, worsening memory, profuse sweating, new onset of diffuse and generalized joint pains, and increased central adiposity. What hormonal evaluation should be prompted by the combination of his symptoms?
CorrectIncorrectConsider the patient's symptoms and their relation to hormone excess.
- 14. Question
Which diagnostic test is less reliable in patients with uncontrolled diabetes mellitus and suspected acromegaly?
CorrectIncorrectConsider the interference of uncontrolled diabetes mellitus with the diagnostic test for acromegaly.
- 15. Question
In patients with acromegaly, which of the following features can be reversed with treatment if detected early?
CorrectIncorrectConsider which feature is reversible with early detection and treatment.
- 16. Question
What is the most reliable screening method for acromegaly?
CorrectIncorrectConsider the screening method that best correlates with growth hormone excess.
- 17. Question
Which of the following is the most appropriate initial management for a patient with a pituitary macroadenoma causing optic chiasm displacement and acromegaly?
CorrectIncorrectConsider the first-line therapy for acromegaly.
- 18. Question
In a patient diagnosed with acromegaly and a pituitary macroadenoma, which of the following hormones should be measured to evaluate pituitary function?
CorrectIncorrectConsider which hormone is commonly secreted by GH-secreting tumors.
- 19. Question
In the case of acromegaly, which of the following best describes the primary role of somatostatin receptor analogues (SSAs)?
CorrectIncorrectConsider the primary goal of medical therapy in acromegaly.
- 20. Question
Which of the following findings would indicate central hypothyroidism in a patient with a pituitary macroadenoma?
CorrectIncorrect - 21. Question
A patient with acromegaly has poorly controlled disease despite optimization of somatostatin receptor analog (SSA) therapy. What is a possible treatment option to achieve better control?
CorrectIncorrectConsider options that directly address the uncontrolled GH levels.
- 22. Question
What is the primary mechanism of action of pegvisomant in the treatment of acromegaly?
CorrectIncorrectFocus on the direct impact of pegvisomant on GH and IGF-1.
- 23. Question
In acromegaly patients, which comorbidity is present in approximately 70% of subjects with active disease?
CorrectIncorrectConsider comorbidities that are highly prevalent in acromegaly patients.
- 24. Question
In patients with uncontrolled acromegaly, why is a screening colonoscopy recommended?
CorrectIncorrectConsider the increased risks associated with uncontrolled acromegaly.
- 25. Question
A 35-year-old woman with persistent Cushing's disease and hypothyroidism after transsphenoidal surgery (TSS) has elevated midnight cortisol levels and persistently elevated 24-hour UFCs. Which of the following is NOT a suitable second-line treatment option for her?
CorrectIncorrect - 26. Question
What is the main side effect of pasireotide, a somatostatin receptor ligand used to treat Cushing's disease?
CorrectIncorrectConsider the effects of pasireotide on glucose metabolism.
- 27. Question
Which of the following is a contraindication for the use of mifepristone in the treatment of Cushing's syndrome?
CorrectIncorrectConsider the effects of mifepristone on progesterone receptors.
- 28. Question
Which of the following is NOT an appropriate method for early identification of corticotroph tumor progression after bilateral adrenalectomy?
CorrectIncorrectConsider the diagnostic methods mentioned in the text for identifying corticotroph tumor progression.
- 29. Question
What is the primary modality for definitive treatment of Cushing's syndrome?
CorrectIncorrectConsider the treatment options discussed in the text and their effectiveness as first-line therapy.
- 30. Question
Which of the following is NOT a potential post-treatment complication of radiation therapy for residual or recurrent tumors in Cushing's disease?
CorrectIncorrectConsider the complications mentioned in the text that may result from radiation therapy.
- 31. Question
Which of the following is the main mechanism of action of ketoconazole in the treatment of Cushing's disease?
CorrectIncorrectConsider the effects of ketoconazole on adrenal hormone synthesis.
- 32. Question
What is the main reason for monitoring liver function studies in a patient receiving ketoconazole for Cushing's disease?
CorrectIncorrectConsider the potential side effects of ketoconazole on the liver.
- 33. Question
A 73-year-old woman with a history of hyponatremia, ulcerative colitis, and mitral valve prolapse presents with a severe headache. Imaging reveals a sellar mass. Which of the following is the least likely initial diagnosis based on her presentation and imaging findings?
CorrectIncorrectConsider the rarity and typical presentations of the different conditions that can involve the sellar region.
- 34. Question
A patient with hypophysitis is found to have adrenal insufficiency and central hypothyroidism. Which of the following conditions might have been incorrectly diagnosed in this patient?
CorrectIncorrectConsider the patient's initial diagnosis and how her new findings could have been misinterpreted.
- 35. Question
In the context of hypophysitis, which laboratory finding may indicate long-term or permanent panhypopituitarism?
CorrectIncorrectConsider the hormone levels that may be affected in hypophysitis and their implications on pituitary function.
- 36. Question
A patient with granulomatous hypophysitis is most likely to present with which of the following symptoms?
CorrectIncorrect - 37. Question
Which hypophysitis variant is characterized by necrotizing granulomas formed by histiocytes, multinucleated giant cells, and variable numbers of lymphocytes and plasma cells?
CorrectIncorrectLook for the variant with necrotizing granulomas in its description.
- 38. Question
Which of the following clinical presentations is more specific to lymphocytic hypophysitis?
CorrectIncorrectConsider the unique aspect of lymphocytic hypophysitis in relation to pregnancy or postpartum events.
- 39. Question
Which treatment approach is most effective for granulomatous hypophysitis with progressive optic chiasmal compression?
CorrectIncorrectLook for the treatment that is both diagnostic and therapeutic in cases of optic chiasmal compression.
- 40. Question
Which of the following factors does NOT exclude the diagnosis of hypophysitis?
CorrectIncorrectConsider which factor is mentioned in the text as not excluding the diagnosis.
- 41. Question
What is the most common cause of hyperthyroidism in young and middle-aged people?
CorrectIncorrectThis cause is related to circulating anti-TSH receptor antibodies.
- 42. Question
A patient presents with elevated TSH and elevated free T4 levels. What rare condition might be suspected in this case?
CorrectIncorrectThis condition involves an inappropriate secretion of TSH.
- 43. Question
Which drug is a notorious cause of drug-induced thyrotoxicosis, occurring in 3-10% of individuals exposed to it?
CorrectIncorrectThis drug is often used to treat arrhythmias.
- 44. Question
What diagnostic test may be helpful in distinguishing between conventional causes of hyperthyroidism and thyroiditis or exogenous thyrotoxicosis?
CorrectIncorrectThis test involves the uptake of a radioactive substance by the thyroid gland.
- 45. Question
What percentage of pituitary adenomas are TSH-secreting?A:) A. 0.6-1.5%B:) B. 5-10%C:) C. 20-25%D:) D. 40-45%:Correct: A:MsgCorrect: Correct! TSH-secreting pituitary adenomas account for 0.6-1.5% of all types of pituitary adenomas.:MsgIncorrect: Incorrect. TSH-secreting pituitary adenomas account for 0.6-1.5% of all types of pituitary adenomas.:hint: TSH-secreting pituitary adenomas are considered the least common of all types of pituitary adenomas.
CorrectIncorrect - 46. Question
Which of the following is NOT a feature of TSH-secreting adenomas?A:) A. Insensitivity to negative feedback of thyroid hormonesB:) B. Hypersecretion of TSHC:) C. ExophthalmosD:) D. Diffuse goiters:Correct: C:MsgCorrect: Correct! Exophthalmos is not a feature of TSH-secreting adenomas, but it is a feature of Graves' disease.:MsgIncorrect: Incorrect. Exophthalmos is not a feature of TSH-secreting adenomas, but it is a feature of Graves' disease.:hint: Consider the features associated with Graves' disease and those associated with TSH-secreting adenomas.
CorrectIncorrect - 47. Question
What is the mean age at presentation for patients with TSH-secreting adenomas?A:) A. 25 yearsB:) B. 35 yearsC:) C. 45 yearsD:) D. 55 years:Correct: C:MsgCorrect: Correct! The mean age at presentation for patients with TSH-secreting adenomas is 45 years.:MsgIncorrect: Incorrect. The mean age at presentation for patients with TSH-secreting adenomas is 45 years.:hint: The mean age at presentation for TSH-secreting adenomas ranges from children to the elderly.
CorrectIncorrect - 48. Question
Which test is contraindicated in patients with a history of coronary artery disease or tachyarrhythmia when diagnosing TSH-secreting adenomas?A:) A. MRI with gadoliniumB:) B. TRH stimulation testC:) C. T3 suppression testD:) D. Alpha-subunit/TSH molar ratio measurement:Correct: C:MsgCorrect: Correct! The T3 suppression test is contraindicated in patients with a history of coronary artery disease or tachyarrhythmia.:MsgIncorrect: Incorrect. The T3 suppression test is contraindicated in patients with a history of coronary artery disease or tachyarrhythmia.:hint: Consider the risks associated with each test and the specific patient population mentioned.
CorrectIncorrect - 49. Question
Which of the following is the most commonly used imaging modality for diagnosing TSH-secreting adenomas?A:) A. CT scanB:) B. MRI with gadoliniumC:) C. UltrasoundD:) D. PET scan:Correct: B:MsgCorrect: Correct! MRI with gadolinium is the most commonly used imaging modality for diagnosing TSH-secreting adenomas.:MsgIncorrect: Incorrect. MRI with gadolinium is the most commonly used imaging modality for diagnosing TSH-secreting adenomas.:hint: Think about the imaging techniques that provide the best visualization of the pituitary gland and surrounding structures.
CorrectIncorrect - 50. Question
Which of the following medications is NOT used in the preoperative management of TSH-secreting adenomas to restore euthyroid state?A:) A. Beta blockersB:) B. Antithyroid medicationsC:) C. Somatostatin analogsD:) D. Thiazide diuretics:Correct: D:MsgCorrect: Correct! Thiazide diuretics are not used in the preoperative management of TSH-secreting adenomas to restore euthyroid state.:MsgIncorrect: Incorrect. Thiazide diuretics are not used in the preoperative management of TSH-secreting adenomas to restore euthyroid state.:hint: Consider the medications that directly affect thyroid hormone levels or symptoms of thyrotoxicosis.
CorrectIncorrect - 51. Question
A 48-year-old woman presents with symptoms of hyperthyroidism but has no palpable goiter and minimal thyroidal uptake of radioiodine. What is a rare cause of hyperthyroidism in this patient population?
CorrectIncorrectThis rare cause of hyperthyroidism involves an ovarian tumor containing thyroid tissue.
- 52. Question
Which of the following histological patterns is NOT typically seen in thyroid epithelium within struma ovarii?
CorrectIncorrectConsider the histological patterns that involve thyroid follicles.
- 53. Question
A 55-year-old woman is diagnosed with benign struma ovarii causing hyperthyroidism. After surgical resection of the ovarian tumor, what is the expected outcome for her cervical thyroid gland?
CorrectIncorrectThe cervical thyroid gland was suppressed due to the presence of the struma ovarii.
- 54. Question
In cases of malignant struma ovarii, what is the recommended treatment following oophorectomy?
CorrectIncorrectConsider the treatments that involve both the ovarian tumor and the thyroid gland.