Pituitary Disorders Quiz Part I

Which pituitary tumor classification is based on cell cytoplasm staining properties as viewed by light microscopy and immunocytochemistry?

In the management of prolactinomas, which of the following is NOT an aim of the treatment?

Which of the following medications is NOT used in the treatment of acromegaly?

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?

Which factor is the best predictor of the efficacy of dopamine agonists in acromegaly patients?

What is the primary recommended use of pegvisomant in acromegaly patients?

What is the primary marker for disease activity when using pegvisomant in acromegaly patients?

What receptor subtype has pasireotide (SOM 230; Signifor) shown the greatest binding affinity for, compared to octreotide?

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?

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?

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?

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?

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?

Which diagnostic test is less reliable in patients with uncontrolled diabetes mellitus and suspected acromegaly?

In patients with acromegaly, which of the following features can be reversed with treatment if detected early?

What is the most reliable screening method for acromegaly?

Which of the following is the most appropriate initial management for a patient with a pituitary macroadenoma causing optic chiasm displacement and acromegaly?

In a patient diagnosed with acromegaly and a pituitary macroadenoma, which of the following hormones should be measured to evaluate pituitary function?

In the case of acromegaly, which of the following best describes the primary role of somatostatin receptor analogues (SSAs)?

Which of the following findings would indicate central hypothyroidism in a patient with a pituitary macroadenoma?

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?

What is the primary mechanism of action of pegvisomant in the treatment of acromegaly?

In acromegaly patients, which comorbidity is present in approximately 70% of subjects with active disease?

In patients with uncontrolled acromegaly, why is a screening colonoscopy recommended?

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?

What is the main side effect of pasireotide, a somatostatin receptor ligand used to treat Cushing's disease?

Which of the following is a contraindication for the use of mifepristone in the treatment of Cushing's syndrome?

Which of the following is NOT an appropriate method for early identification of corticotroph tumor progression after bilateral adrenalectomy?

What is the primary modality for definitive treatment of Cushing's syndrome?

Which of the following is NOT a potential post-treatment complication of radiation therapy for residual or recurrent tumors in Cushing's disease?

Which of the following is the main mechanism of action of ketoconazole in the treatment of Cushing's disease?

What is the main reason for monitoring liver function studies in a patient receiving ketoconazole for Cushing's disease?

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?

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?

In the context of hypophysitis, which laboratory finding may indicate long-term or permanent panhypopituitarism?

A patient with granulomatous hypophysitis is most likely to present with which of the following symptoms?

Which hypophysitis variant is characterized by necrotizing granulomas formed by histiocytes, multinucleated giant cells, and variable numbers of lymphocytes and plasma cells?

Which of the following clinical presentations is more specific to lymphocytic hypophysitis?

Which treatment approach is most effective for granulomatous hypophysitis with progressive optic chiasmal compression?

Which of the following factors does NOT exclude the diagnosis of hypophysitis?

What is the most common cause of hyperthyroidism in young and middle-aged people?

A patient presents with elevated TSH and elevated free T4 levels. What rare condition might be suspected in this case?

Which drug is a notorious cause of drug-induced thyrotoxicosis, occurring in 3-10% of individuals exposed to it?

What diagnostic test may be helpful in distinguishing between conventional causes of hyperthyroidism and thyroiditis or exogenous thyrotoxicosis?

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.

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.

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.

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.

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.

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.

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?

Which of the following histological patterns is NOT typically seen in thyroid epithelium within struma ovarii?

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?

In cases of malignant struma ovarii, what is the recommended treatment following oophorectomy?