Pituitary Gland (Endocrinology Board Exam)

A 35-year-old woman presents with a 9-month history of irregular menstrual cycles and occasional milky discharge from her breasts. She also reports intermittent headaches and slightly blurred vision. Her past medical history includes hypothyroidism, well-controlled on levothyroxine 75 mcg daily. On examination, blood pressure is 118/76 mm Hg, heart rate is 78/min, and there are no focal neurological deficits. Laboratory studies show:Serum prolactin: 98 ng/mL (normal: 5–20 ng/mL)TSH: 1.3 mIU/L (reference range: 0.5–4.5 mIU/L)Free T4: 1.1 ng/dL (reference range: 0.8–1.8 ng/dL)Which of the following is the best next step in management?

A 29-year-old man presents with decreased libido, erectile dysfunction, and chronic fatigue for the past eight months. He has no significant past medical history. On physical exam, he has mild bilateral gynecomastia. Vital signs are stable. Laboratory results show:Serum prolactin: 65 ng/mL (normal: <20 ng/mL)Total testosterone: 200 ng/dL (reference range: 280–800 ng/dL)TSH: 2.1 mIU/L (reference range: 0.5–4.5 mIU/L)Which of the following is the most appropriate next step in management?

A 42-year-old woman with a known microprolactinoma (6 mm) returns for follow-up. She has been on bromocriptine 2.5 mg twice daily for four months. She complains of persistent nausea and occasional dizziness. Despite treatment, her serum prolactin is 80 ng/mL (previously 90 ng/mL). She continues to have amenorrhea and intermittent galactorrhea. MRI of the sella turcica shows stable tumor size with no suprasellar extension.Which of the following is the best next step in management?

A 39-year-old woman with a macroprolactinoma (1.3 cm) returns for evaluation. She has been on cabergoline 0.5 mg twice weekly for six months. Her headaches and breast discharge have improved, but her menses remain infrequent. Recent labs show a serum prolactin level of 30 ng/mL (previously 120 ng/mL). Follow-up MRI shows the tumor is now 1.1 cm with no suprasellar extension. She reports no visual field disturbances.Which of the following is the most appropriate next step in management?

A 27-year-old woman who is 3 months postpartum presents with persistent galactorrhea and absent menses since childbirth. She breastfed for only 2 weeks and then switched to formula feeding. Her past medical history is unremarkable. Laboratory results show:Serum prolactin: 85 ng/mL (normal: 5–20 ng/mL)TSH: 1.6 mIU/L (reference range: 0.5–4.5 mIU/L)Serum beta-hCG: negativePhysical examination reveals no visual field deficits. She denies headache or other neurologic symptoms.Which of the following is the best next step in management?

A 52-year-old man presents with abrupt onset of severe headache and blurry peripheral vision for the past 24 hours. He has had long-standing elevated prolactin levels (500–800 ng/mL range) but declined any treatment. Current exam reveals bitemporal hemianopsia and a blood pressure of 140/88 mm Hg. An urgent MRI of the brain shows a 2.5-cm pituitary lesion with evidence of hemorrhage.Which of the following is the best next step in management?

A 34-year-old woman presents with a 5-month history of amenorrhea and fatigue. She also mentions occasional nipple discharge. Review of systems reveals that she started a new antipsychotic medication (risperidone) 6 months ago. Laboratory studies show:Serum prolactin: 50 ng/mL (normal: 5–20 ng/mL)Serum beta-hCG: negativeTSH: 1.8 mIU/L (0.5–4.5 mIU/L)She has no headaches or vision changes. Physical exam is otherwise unremarkable.Which of the following is the most appropriate initial approach to manage her hyperprolactinemia?

A 39-year-old man presents with progressive changes in facial appearance and an increase in his shoe and ring sizes over the past 2 years. He also reports fatigue, joint pain, and occasional headaches. On examination, he has coarse facial features, mild macroglossia, and enlarged hands (difficult ring removal). Blood pressure is 150/88 mm Hg. Laboratory testing reveals:Fasting plasma glucose: 116 mg/dL (reference: 70–99 mg/dL)IGF-1: 780 ng/mL (reference: 100–300 ng/mL, age-adjusted)Which of the following is the most appropriate next step in establishing the diagnosis?

A 45-year-old woman with confirmed acromegaly due to a 1.2 cm GH-secreting pituitary adenoma undergoes transsphenoidal surgery. Three months postoperatively, her serum IGF-1 remains elevated at 450 ng/mL (reference: 100–300 ng/mL, age-adjusted). A repeat pituitary MRI shows a small residual intrasellar lesion. She complains of persistent sweating, acral enlargement, and fatigue.Which of the following is the best next step in her management?

A 28-year-old woman presents with a 1-year history of progressive weight gain, irregular menses, easy bruising, and fatigue. Examination shows centripetal obesity, purplish abdominal striae, mild proximal muscle weakness, and a round “moon” face. Her blood pressure is 150/90 mm Hg. Laboratory tests reveal:Serum cortisol after 1 mg overnight dexamethasone suppression: 12 µg/dL (reference: <1.8 µg/dL)Serum ACTH: 60 pg/mL (reference: 10–60 pg/mL)Which of the following is the best next step in distinguishing between pituitary (Cushing’s disease) and ectopic sources of ACTH?

A 35-year-old man is diagnosed with persistent Cushing’s disease (CD) despite prior transsphenoidal resection of a pituitary microadenoma. He has persistent hypertension, hyperglycemia, and elevated 24-hour urinary free cortisol. A repeat MRI shows no visible remnant tumor. He prefers to avoid radiation if possible. Which of the following is the most appropriate next step?

A 42-year-old man is being evaluated for persistent acromegaly despite prior transsphenoidal resection of a GH-secreting pituitary macroadenoma. His serum IGF-1 remains elevated (3.0 × upper limit of normal) and repeat MRI shows a small suprasellar extension. He complains of persistent arthralgias and headaches.Which of the following is the most appropriate next step in management?

A 35-year-old woman presents with mild hypercortisolism that has fluctuated over several months. She reports episodes of facial rounding, weight gain, and menstrual irregularities that spontaneously improve for weeks at a time. Recent labs show:24-hour urinary free cortisol (UFC): intermittently elevatedLate-night salivary cortisol: elevated on two tests, normal on two other testsSerum ACTH: high-normalWhich of the following is the most likely explanation for these findings?

A 50-year-old man with recurrent Cushing’s disease underwent transsphenoidal resection twice, and pituitary MRI still shows a small remnant lesion. Over the past year, his hypercortisolism has been controlled with ketoconazole 600 mg/day, but now he reports severe fatigue, nausea, and elevated liver enzymes. Laboratory tests show:AST: 150 U/L (reference: <40 U/L)ALT: 162 U/L (reference: <40 U/L)Bilirubin: 3 mg/dL (reference: 0.3–1.2 mg/dL)The patient has persistent hyperglycemia and hypertension.He wishes to stop ketoconazole due to side effects. Which of the following is the most appropriate next step?

A 48-year-old man presents with chronic headaches and progressive loss of peripheral vision over the past 6 months. MRI reveals a 2.5 cm sellar mass extending into the suprasellar region without evidence of hormone hypersecretion on preliminary labs. Which of the following findings would most strongly suggest that this is a non-functioning pituitary adenoma?

A 55-year-old woman is diagnosed with a 1.8 cm non-functioning pituitary macroadenoma. She has mild headaches but no visual deficits and normal pituitary function. Which of the following is the best initial management approach?

A 62-year-old man underwent transsphenoidal surgery for a large non-functioning pituitary macroadenoma that was causing bitemporal hemianopsia. Postoperatively, imaging shows a small residual tumor, and pathology indicates a gonadotroph subtype with a Ki-67 labeling index of 4%. Which of the following is the best statement regarding his prognosis or treatment plan?

A 60-year-old woman presents 10 years after transsphenoidal resection of a non-functioning pituitary macroadenoma. She has been well until recently, when she developed new headaches and mild visual changes. MRI reveals regrowth of the residual tumor with suprasellar extension approaching the optic chiasm. She has stable pituitary hormone function on testing. Which of the following is the most appropriate next step?

A 42-year-old woman presents with a 1-year history of fatigue, 5 kg weight loss, and low blood pressure. She also notes that her hair has become thinner, especially in the axillary and pubic regions. Examination reveals low serum sodium. Which of the following hormone deficiencies is most urgently addressed first?

A 60-year-old man has panhypopituitarism following resection of a macroadenoma. He receives hydrocortisone 20 mg/d, levothyroxine 100 μg/d, and monthly testosterone injections. Laboratory follow-up reveals normal free T4 and adequate clinical responses. Which measure is least informative in monitoring his replacement therapies?

A 53-year-old woman is newly diagnosed with hypopituitarism from an autoimmune hypophysitis. She has low cortisol, T4, LH, and FSH, as well as profound fatigue and amenorrhea. Which statement about her therapy initiation is most accurate?

A 36-year-old male with hypopituitarism due to pituitary apoplexy wants to improve his quality of life. He is already on adequate glucocorticoid, thyroid, and testosterone replacements. He complains of low stamina, increased fat mass, and poor exercise performance. Which of the following therapies is most likely to help these specific complaints?

A 38-year-old woman with a history of postpartum hemorrhage five years ago has struggled with low blood pressure, fatigue, and an inability to produce breast milk immediately following delivery. She also reports losing body hair and experiencing poor stress tolerance. Which of the following best describes her likely diagnosis?

A 30-year-old man presents with recent onset of low libido and erectile dysfunction. Physical examination reveals sparse body hair and small, soft testicles. Serum labs show low testosterone and inappropriately low LH and FSH. Other pituitary hormones (TSH, ACTH) are normal. MRI of the sella is unremarkable. What is the most likely next step to establish the cause of his isolated hypogonadotropic hypogonadism?

A 50-year-old man has evidence of non-functioning pituitary macroadenoma with low T4, low TSH, low cortisol, and low ACTH. He is started on hydrocortisone and levothyroxine. Which of the following findings would be most characteristic of secondary (central) hypothyroidism during follow-up?

A 35-year-old female with a history of traumatic brain injury is found to have partial hypopituitarism, including secondary adrenal insufficiency and GH deficiency. She has been on hydrocortisone therapy for several months. Her main complaints are decreased muscle mass, higher body fat, and reduced exercise tolerance. Which test is most appropriate to confirm adult GH deficiency before beginning GH replacement?

A 29-year-old man with known Langerhans cell histiocytosis (an infiltrative disease) presents with persistent thirst, nocturia, and polyuria for the past month. He also has borderline low free T4 with an inappropriately normal TSH. Recent MRI shows thickening of the pituitary stalk. Which new hormone deficiency is most likely responsible for his symptoms?

A 56-year-old man with a large, non-functioning pituitary macroadenoma presents with repeated episodes of early morning dizziness, near-syncope, and low blood pressure. He has mild hyponatremia but normal serum potassium. Which of the following diagnoses best explains these findings?

A 35-year-old woman in her postpartum period presents with new-onset headache, partial bitemporal hemianopsia, and mild hyperprolactinemia. MRI reveals an enlarged, homogeneously enhancing pituitary gland without evidence of an adenoma. Which of the following diagnoses is most suggestive given her clinical presentation?

A 24-year-old man is found to have central diabetes insipidus and an enhancing lesion thickening the pituitary stalk on MRI. His serum alpha-fetoprotein (αFP) and beta-hCG are both normal. Workup for tuberculosis and sarcoidosis is negative. Which of the following diagnoses remains high on the differential and would most likely respond favorably to glucocorticoids?

A 52-year-old female with headache, bitemporal hemianopsia, and adrenal insufficiency is diagnosed with hypophysitis on MRI. She starts on high-dose oral glucocorticoids but experiences persistent mass effect, severe headaches, and cranial nerve palsies despite therapy. Which of the following is the most appropriate next step in management?

A 60-year-old male with metastatic melanoma develops sudden headache, nausea, and dizziness after his third infusion of ipilimumab (anti-CTLA-4). Labs show low cortisol and low TSH with a mildly enlarged, homogeneously enhancing pituitary gland on MRI. Which statement best describes the management of this patient’s condition?

A 35-year-old woman presents 2 months postpartum with severe headache, double vision, and mild hyperprolactinemia. MRI shows a symmetrically enlarged pituitary gland with strong homogeneous enhancement and minimal stalk thickening. Laboratory tests reveal low ACTH and cortisol, but normal T4 and TSH. Which of the following diagnoses is most likely?

A 45-year-old man develops new severe headache, blurred vision, and mild hypernatremia. MRI reveals a suprasellar cystic lesion with rim enhancement and infiltration of lipid-laden macrophages suspected from prior biopsy. Which form of hypophysitis best fits this description?

A 52-year-old patient with metastatic melanoma on ipilimumab (anti-CTLA-4) develops a new, persistent headache and fatigue. Lab tests show low morning cortisol, low ACTH, and normal serum sodium. MRI shows slight pituitary enlargement and homogeneous contrast enhancement but no mass. Which best describes the initial management?

A 40-year-old woman has a 3-month history of severe headache, bitemporal hemianopsia, and mild central hypothyroidism. MRI suggests an intrasellar mass with a thickened stalk and a “T2 dark rim” sign. Serum IgG4 level is normal. Biopsy demonstrates dense lymphoplasmacytic infiltrates without granulomas. Which of the following is the most likely final pathology?

A 45-year-old man presents with persistent thirst and large volumes of dilute urine over several months. His laboratory workup confirms hypotonic polyuria, and a water deprivation test shows failure to concentrate urine. After administration of desmopressin (DDAVP), urine osmolality rises significantly. Which type of diabetes insipidus does this finding most strongly suggest?

A 55-year-old woman with a known history of sarcoidosis develops polyuria exceeding 8 liters/day and serum sodium of 151 mmol/L (normal: 135–145 mmol/L). MRI of the hypothalamic-pituitary region shows thickening of the pituitary stalk and absence of the normal posterior pituitary “bright spot.” Which diagnosis best explains her symptoms and imaging findings?

A 28-year-old woman has persistently elevated urine output (~5 L/day) and borderline low serum sodium (133 mmol/L). Her water deprivation test results in significant urine concentration (over 700 mOsm/kg), and copeptin levels are high. MRI shows a normal pituitary gland with an intact bright spot. Which diagnosis is most consistent with these findings?

A 60-year-old man on chronic lithium therapy for bipolar disorder presents with polyuria (about 6 L/day) and polydipsia. Laboratory tests show serum sodium of 146 mmol/L and inappropriately dilute urine (osmolality ~200 mOsm/kg) during hypernatremia. After desmopressin administration, urine osmolality remains low (<10% increase). Which statement best summarizes the management approach?

A 29-year-old pregnant woman in her third trimester complains of frequent urination, nocturia, and excessive thirst for the last month. Her serum sodium is 146 mmol/L (reference: 135–145 mmol/L), and 24-hour urine output is 6 L with a low urine osmolality of 200 mOsm/kg. After a standard water deprivation test, urine concentration remains low. Which of the following diagnoses is most likely?

A 64-year-old man has been experiencing a gradually increasing urine output of approximately 5–6 liters per day over six months. Labs show a mildly elevated serum sodium of 147 mmol/L and a low urine osmolality of 230 mOsm/kg. An MRI of the sella turcica reveals no abnormalities, including a normal posterior “bright spot.” After water deprivation, his urine osmolality remains below 300 mOsm/kg, but copeptin measurement is significantly elevated. Which condition best fits these findings?

A 38-year-old man is hospitalized for suspected diabetes insipidus after receiving a head trauma in a car accident two weeks ago. He produces 10–12 liters of urine daily, and his serum sodium is 153 mmol/L (reference: 135–145 mmol/L). Which of the following findings on a water deprivation test followed by desmopressin administration would confirm central (pituitary) diabetes insipidus?

A 16-year-old female with a known history of Langerhans cell histiocytosis develops polyuria and polydipsia. Her serum sodium is 149 mmol/L, and random copeptin levels are very low despite obvious hypernatremia. MRI shows thickening of the pituitary stalk. Which of the following treatment strategies is the most appropriate initial approach?

A 68-year-old woman presents with mild confusion and fatigue. Lab tests reveal a serum sodium concentration of 125 mmol/L and plasma osmolality of 260 mOsm/kg. Urinalysis shows urine sodium of 60 mmol/L and urine osmolality of 450 mOsm/kg. She has no evidence of edema, heart failure, or cirrhosis. Which of the following diagnoses best explains her euvolemic hyponatremia?

A 72-year-old man with a known small-cell lung carcinoma is hospitalized for confusion. His labs show serum sodium 117 mmol/L, plasma osmolality 250 mOsm/kg, and urine osmolality 500 mOsm/kg. After excluding thyroid and adrenal insufficiency, SIAD is strongly suspected. Which initial step in managing his severe symptomatic hyponatremia is most appropriate?

A 56-year-old female has mild chronic hyponatremia (serum sodium 128 mmol/L) attributed to SIAD from a lung mass. She has no neurological symptoms, and her serum osmolality is 265 mOsm/kg with urine osmolality of 550 mOsm/kg. Which of the following is the most appropriate first-line long-term management option?

A 63-year-old patient with SIADH experiences a rapid correction of serum sodium from 108 mmol/L to 124 mmol/L within the first 24 hours of hypertonic saline treatment. Two days later, he develops progressive dysarthria, dysphagia, and mental status changes. An MRI of the brain suggests pontine demyelination. Which best explains the cause of his neurological deterioration?

A 13-year-old boy presents with progressive vision loss, morning headaches, and increased thirst with large urine output. MRI reveals a suprasellar, multilobulated cystic mass containing calcifications. Which diagnosis is most consistent with these findings?

A 30-year-old woman had massive postpartum hemorrhage requiring blood transfusions. She now complains of inability to breastfeed (agalactia), persistent fatigue, and loss of axillary hair. Which mechanism best explains her pituitary dysfunction?

A 56-year-old woman has a large suprasellar mass on MRI that was partially resected. Histopathology confirms an adamantinomatous craniopharyngioma. Postoperatively, she has persistent polyuria and polydipsia, along with mild hypothyroidism. Which explanation best accounts for her new endocrine deficits?

A 62-year-old patient with a known non-functioning pituitary macroadenoma suddenly develops a severe headache, acute vision loss, and cranial nerve III palsy. Blood pressure is stable, but labs show cortisol deficiency. MRI reveals hemorrhage within the tumor mass, causing marked expansion. Which diagnosis is most likely in this acute presentation?

A 26-year-old woman experiences massive postpartum hemorrhage and subsequently requires blood transfusions. Several weeks later, she notices she cannot produce breast milk, feels constant fatigue, and has lost pubic and axillary hair. Which of the following mechanisms best explains her condition?

A 40-year-old man with a long-standing pituitary macroadenoma suddenly presents to the emergency room with a severe headache described as “thunderclap,” blurred vision, and drooping of the right eyelid (ptosis). Serum labs reveal acute adrenal insufficiency. Which diagnosis best accounts for this abrupt presentation?

A 12-year-old girl presents with progressive visual field deficits, stunted growth, and morning headaches. Imaging reveals a suprasellar mass filled with cholesterol-rich fluid, showing calcifications on CT. Which of the following best describes the pathophysiology and presentation of this tumor?

A 14-year-old boy shows markedly accelerated linear growth, significantly exceeding his peers. He has large hands and feet, mild frontal bossing, and headaches. Laboratory evaluation finds that his growth hormone (GH) is not suppressed after oral glucose load, and IGF-1 is markedly elevated. Which of the following diagnoses best explains his condition?

A 38-year-old man complains of shoes no longer fitting, enlargement of his jawline, and oily skin. He has elevated fasting blood glucose and mild hypertension. Lab tests show elevated IGF-1 and GH that fails to suppress after an oral glucose tolerance test. Which of the following is the most likely diagnosis?

A 50-year-old woman reports amenorrhea and galactorrhea for the past year. MRI reveals a 7-mm intrasellar lesion. Serum prolactin is 220 ng/mL (normal <30 ng/mL), and IGF-1 is normal. Which diagnosis best fits these findings?

A 17-year-old male has been diagnosed with pituitary gigantism due to a GH-secreting macroadenoma. Despite transsphenoidal surgery, his GH levels remain mildly elevated and tumor remnants are visible on MRI. Which additional therapy is most appropriate to reduce GH secretion?

A 34-year-old woman presents with weight gain, facial rounding, abdominal striae, and hypertension. Lab tests reveal markedly elevated cortisol levels that fail to suppress with a low-dose dexamethasone test, but an MRI only shows a 4-mm lesion in the pituitary. Inferior petrosal sinus sampling confirms pituitary-dependent Cushing’s syndrome. Which first-line treatment is most appropriate?

A 43-year-old male with a history of failed transsphenoidal surgery for Cushing’s disease undergoes bilateral adrenalectomy to control hypercortisolism. Two years later, he develops severe hyperpigmentation, elevated ACTH (>1000 pg/mL), and a rapidly enlarging pituitary mass on MRI. Which diagnosis best explains these findings?

A 58-year-old woman has a large, clinically nonfunctioning pituitary macroadenoma (3.2 cm) causing headaches and bitemporal hemianopsia. Labs show mild hyperprolactinemia (~70 ng/mL), but no other hormone excess. Which mechanism best accounts for the modestly elevated prolactin?

A 56-year-old man with a 12-mm ACTH-secreting pituitary adenoma (Cushing’s disease) undergoes transsphenoidal surgery. Serum cortisol measured the next morning is undetectable, and he has symptoms of steroid withdrawal. Which best explains this scenario?

A 63-year-old female complains of progressive headaches and visual field deficits. Imaging reveals a 2.5-cm nonfunctioning pituitary macroadenoma with cavernous sinus involvement. She is otherwise stable without acute symptoms. What is the best initial therapy to address her tumor’s mass effect?

A 28-year-old new mother produces adequate milk but struggles to initiate milk flow (“let-down”) during breastfeeding. She experiences breast engorgement and frustration despite repeated attempts. Which is the most likely explanation?

A 24-year-old mother is induced for labor with intravenous oxytocin. Soon, her contractions become regular at 2-minute intervals. Which statement best describes oxytocin’s primary action in labor induction?

A 14-year-old boy with known Langerhans cell histiocytosis develops persistent polyuria and polydipsia. Lab tests show high serum sodium, low urine osmolality, and an MRI reveals thickening of the pituitary stalk. Which endocrine issue is most likely responsible?

A 60-year-old woman with a history of metastatic breast cancer presents with sudden onset of polydipsia and polyuria. Imaging shows a new mass in the posterior pituitary region. Serum sodium is elevated, and her serum osmolality is high. Which explanation best accounts for these findings?

A 17-year-old patient exhibits facial coarsening, enlarged hands, and acromegaloid features. Her GH and IGF-1 levels are within normal limits, and MRI of the pituitary is unremarkable. She has severe insulin resistance requiring high-dose insulin. Which condition best explains this pseudoacromegaly picture?

A 3-year-old is extremely tall for her age, surpassing her midparental height predictions. She has mild developmental delay and advanced bone age but no evidence of GH excess on lab tests. Which diagnosis is most consistent with these findings?

A 20-year-old patient presents with coarse facial features, hypertrichosis, thick lips, and a “bulbous” nose. She also has an enlarged heart on echocardiogram and moderate pericardial effusion. GH/IGF-1 levels and pituitary MRI are normal. Which scenario is most likely?

A 45-year-old with “acromegaloid” features but normal GH/IGF-1 is found to have a skeletal survey showing prominent periosteal thickening, arthralgias, and digital clubbing. Which test is most crucial to confirm the suspected diagnosis?

A 17-year-old boy is referred for “acromegaly-like” bone changes noted on X-ray. He has thickened facial skin, prominent forehead furrows, and clubbing of fingers/toes since childhood, with painful enlarged wrists and ankles. He is quite tall but not overtly bulky. Lab tests show normal GH and IGF-1 levels. Which diagnostic step is most appropriate for confirming the underlying cause?

A 25-year-old woman has coarse facial features, thickened fingers, hypertrichosis, and a strong family history of generalized infant-onset excessive hair growth. She denies headaches or visual problems. Lab tests show normal IGF-1 and normal androgens. Which next step is the best approach for clarifying this diagnosis?

A 5-year-old girl is extraordinarily tall for her age, measuring >+4 SD above mean height, with no other major findings. Family history is unremarkable for tall stature. Which cause should be strongly considered in the differential diagnosis of her extreme height?

A 64-year-old patient with a suspicious “acromegaloid” phenotype but normal GH/IGF-1 is found to have advanced breast cancer. Imaging shows a lesion in the posterior pituitary. She develops abrupt polyuria and polydipsia. Which scenario best fits this presentation?

A 42-year-old patient has noticeable acral enlargement, changes in facial features, and severe snoring that disrupts sleep. Which initial test is most appropriate to screen for acromegaly?

A patient with elevated IGF-1 has an oral glucose tolerance test. His GH level fails to suppress below 1 μg/L. What is the likely conclusion?

A 35-year-old with acromegaly has moderate symptoms (sweating, joint pain) and a pituitary tumor abutting the optic chiasm. Which immediate intervention is generally preferred for primary therapy?

After pituitary surgery, a patient’s IGF-1 levels remain elevated, and GH is still above 1 μg/L. Which management step is most appropriate for continued acromegaly control?

A 30-year-old woman with acromegaly is planning to conceive and is on a long-acting somatostatin receptor ligand (SRL). According to the guideline, what is typically advised before she tries to become pregnant?

A 50-year-old individual shows enlarged hands, coarsening facial features, and newly diagnosed type 2 diabetes. Which step is generally advised first to screen for acromegaly?

A patient has consistently elevated IGF-1 and incomplete GH suppression after a glucose challenge. An MRI confirms a large pituitary adenoma pressing on the optic chiasm, causing visual field defects. What is typically the most appropriate next intervention?

A patient shows persistent acromegaly after surgery, with moderately high GH levels and notable arthralgias. Which next step is commonly used as add-on therapy to help normalize IGF-1?

Which clinical finding prompts evaluating a patient with pituitary adenoma for possible acromegaly?

A 38-year-old woman with known active acromegaly is hoping to conceive. She is on a monthly depot somatostatin receptor ligand (SRL). What is generally recommended before she attempts pregnancy?

A 42-year-old patient with newly confirmed secondary adrenal insufficiency asks about fludrocortisone. According to standard practice for central adrenal insufficiency, what is the typical recommendation regarding fludrocortisone use?

A patient with acromegaly achieves full biochemical remission after surgery but now has a documented low IGF-1, borderline low GH, and significant symptoms compatible with GH deficiency. How should we confirm the GHD?

A 38-year-old woman with central hypothyroidism is about to start levothyroxine. However, her morning cortisol is borderline and suspicion for central adrenal insufficiency remains. What should be done to avoid risk of adrenal crisis?

A 60-year-old man is receiving 30 mg/day of hydrocortisone for secondary adrenal insufficiency. He has gained weight, and his blood pressure is rising. Which adjustment is typically recommended to lower cardiovascular and metabolic risks?

A 28-year-old female with established adult-onset GH deficiency and normal adrenal function is about to begin GH. Which precaution is advisable regarding her adrenal status?

A woman is found to have hyperprolactinemia but no galactorrhea or menstrual disturbance. She is asymptomatic. Which additional test is recommended to clarify the nature of her elevated prolactin levels?

A patient presents with a macroadenoma and only mildly elevated prolactin (just above normal). Which of the following test procedures should be done to ensure the measured prolactin is accurate?

A patient with drug-induced hyperprolactinemia (due to an antipsychotic) is asymptomatic with normal bone density and normal gonadal function. How should the clinician manage this finding?

A woman with a prolactinoma has been on cabergoline for three years, showing consistently normal prolactin levels and no residual tumor on MRI. She wishes to taper off medication. What does the guideline suggest in this scenario?

A patient is found to have a prolactin-secreting microadenoma, normal gonadal function, and no bothersome symptoms. What is the recommended management approach according to the guideline?

After two years of successful cabergoline therapy for a macroprolactinoma (normal prolactin, shrinkage on MRI), the patient requests pregnancy. Which statement best reflects the guideline’s recommendation about medication continuation?

A woman with macroprolactinoma is pregnant. In her second trimester, she complains of new-onset headaches and slight peripheral vision blurriness. What is the best immediate step?

In a patient with a clinically aggressive prolactinoma that has failed dopamine agonist therapy, surgery, and radiotherapy, which medication has shown promise according to the guideline?