Pituitary Gland Questions
Normal Laboratory Reference values
| Laboratory Test | Normal Range in US Units | Normal Range in SI Units | To Convert U.S. to SI Units |
| ALT (Alanine aminotransferase) | F 7-30 units/L | F 0.12-0.50 µkat/L | x 0.01667 |
| M 10-55 units/L | M 0.17-0.92 µkat/L | ||
| Albumin | 3.1 – 4.3 g/dL | 31 – 43 g/L | x 10 |
| Alkaline Phosphatase | F 30-100 units/L M 45-115 units/L | F 0.5-1.67 µkat/L M 0.75-1.92 µkat/L | x 0.01667 |
| Amylase (Serum) | 53-123 units/L | 0.88-2.05 nkat/L | x 0.01667 |
| AST (Aspartate aminotransferase) | F 9-25 units/L | F 0.15-0.42 µkat/L | x 0.01667 |
| M 10-40 units/L | M 0.17-0.67 µkat/L | ||
| Basophils | 0-3% of lymphocytes | 0.0-0.03 fraction of white blood cells | x 0.01 |
| Bilirubin – Direct | 0.0-0.4 mg/dL | 0-7 µmol/L | x 17.1 |
| Bilirubin – Total | 0.0-1.0 mg/dL | 0-17 µmol/L | |
| Blood pressure | Normal: 120/70 to 120/80 millimeters of mercury (mmHg). Top number is systolic pressure, when heart is pumping. Bottom number is diastolic pressure when heart is at rest. Blood pressure can be too low (hypotension) or too high (hypertension). | No conversion | |
| C peptide | 0.5-2.0 ng/mL | 0.17-0.66 nmol/L | x 0.33 |
| Calcium, serum | 8.5-10.5 mg/dL | 2.1-2.6 mmol/L | x 0.25 |
| Calcium, urine | 0-300 mg/24hr | 0.0-7.5 mmol/24hr | x 0.025 |
| CO2 (Bicarbonate) | 20-32 mmol/L | 20-32 mmol/L | No conversion |
| Chloride | 95-108 mmol/L | 95-108 mmol/L | No conversion |
| Cholesterol, Total | <200 mg/dL | <5.17 mmol/L | x 0.02586 |
| Marginal | 200-239 mg/dL | 5.17-6.18 mmol/L | |
| High | >239 mg/dl | >6.18 mmol/L | |
| Cholesterol, LDL | <100 mg/dL | <2.59 mmol/L | |
| Marginal | 100-159 mg/dL | 2.59-4.14 mmol/L | |
| High | 160-189 mg/dL | 4.14 – 4.89 mmol/L | |
| Very High | >190 mg/dL | >4.91 mmol/L | |
| Cholesterol, HDL | >60 mg/dL | >1.55 mmol/L | |
| Moderate | 40-60 mg/dL | 1.03-1.55 mmol/L | |
| Low (heart risk) | <40 mg/dL | <1.03 mmol/L | |
| Cortisol: serum free (urine) | 0-25 µg/dL (depends on time of day) | 0-690 nmol/L | x 27.59 |
| 20-70 µg/dL | 55-193 nmol/24hr | x 2.759 | |
| Creatine kinase | F 40-150 units/L M 60-400 units/L | F 0.67-2.50 µkat/L M 1.00-6.67 µkat/L | x 0.01667 |
| Creatinine (urine) | F 0.6-1.8 g/day M 0.8-2.4 g/day | F 5.3-15.9 mmol/day M 7.1-21.2 mmol/day | x 88.4 |
| DHEA | F 130-980 ng/dL M 180-1250 ng/dL | F 4.5-34.0 nmol/L M 6.24-43.3 nmol/L | x 0.03467 |
| DHEA Sulfate | F Pre-menopause: 12-535 µg/dL | F Pre-menopause: 120-5350 µg/L | x 10 |
| F Post-menopause: 30-260 µg/dL | F Post-menopause: 300-2600 µg/L | ||
| M 10-619 µg/dL | M 100-6190 µg/L | ||
| Eosinophils | 0-8% of white blood cells | 0.0-0.8 fraction of white blood cells | x 0.01 |
| Erythrocyte sedimentation rate (Sed Rate) | F £ 30 mm/h M £ 20 mm/h | F £ 30 mm/h M £ 20 mm/h | No conversion |
| Folate | 3.1-17.5 ng/mL | 7.0-39.7 nmol/L | x 2.266 |
| Glucose, urine | <0.05 g/dl | <0.003 mmol/L | x 0.05551 |
| Glucose, plasma | 70-110 mg/dL | 3.9-6.1 mmol/L | |
| Gamma glutamyl transferase (GGT) | F £ 45 U/L M £ 65 U/L | F £ 45 U/L M £ 65 U/L | No conversion |
| Laboratory Test | Normal Range in U.S. Units | Normal Range in SI Units | To Convert US to SI Units |
| Hematocrit | F 36.0-46.0% of red blood cells | F 0.36-0.46 fraction of red blood cells | x 0.01 |
| M 37.0-49.0% of red blood cells | M 0.37-0.49 fraction of red blood cells | ||
| Hemoglobin | F 12.0-16.0 g/dL M 13.0-18.0 g/dL | F 7.4-9.9 mmol/L M 8.1-11.2 mmol/L | x 0.6206 |
| Lactate dehydrogenase (LDH) (total) | £ 270 U/L | £ 4.5 µkat/L | X 0.016667 |
| Lactic acid | 0.5-2.2 mmol/L | 0.5-2.2 mmol/L | No conversion |
| Leukocytes (WBC) | 4.5-11.0 x 103/mm3 | 4.5-11.0 x 109/liter | No conversion |
| Lymphocytes | 16-46% of white blood cells | 0.16-0.46 fraction of white blood cells | x 0.01 |
| Mean corpuscular hemoglobin (MCH) | 25.0-35.0 pg/cell | 25.0-35.0 pg/cell | No conversion |
| Mean corpuscular hemoglobin concentration (MCHC) | 31.0-37.0 g/dL | 310-370 g/L | x 10 |
| Mean corpuscular volume (MCV) | F 78-102 µm3 M 78-100 µm3 | F 78-102 fl M 78-100 fl | No conversion |
| Monocytes | 4-11% of white blood cells | 0.04-0.11 fraction of white blood cells | x 0.01 |
| Neutrophils | 45-75% of white blood cells | 0.45-0.75 fraction of white blood cells | x 0.01 |
| Phosphorus | 2.5-4.5 mg/dL | 0.81-1.45 mmol/L | X 0.323 |
| Platelets (Thrombocytes) | 130-400 x 103/µL | 130-400 x 109/L | No conversion |
| Potassium | 3.4-5.0 mmol/L | 3.4-5.0 mmol/liter | No conversion |
| Red Blood Cell Count (RBC) | F 3.9-5.2 x 106/µL M 4.4–5.8 x 106/µL | F 3.9-5.2 x 1012/L M W 4.4-5.8 x 1012/L | No conversion |
| Sodium | 135-145 mmol/liter | 135-145 mmol/liter | No conversion |
| Testosterone, total (morning sample) | F 6-86 ng/dL | F 0.21-2.98 nmol/liter | x 0.03467 |
| M 270-1070 ng/dL | M 9.36-37.10 nmol/liter | ||
| Testosterone, Age 20-40
Unbound Age 41-60
Age 61-80 | F 0.6-3.1 pg/mL M 15.0-40.0 pg/mL | F 20.8-107.5 pmol/liter M 520-1387 pmol/liter | x 34.67 |
| F 0.4-2.5 pg/mL M 13.0-35.0 pg/mL | F 13.9-86.7 pmol/liter M 451-1213 pmol/liter | ||
| F 0.2-2.0 pg/mL M 12.0-28.0 pg/mL | F 6.9-69.3 pmol/liter M 416-971 pmol/liter | ||
| Triglycerides Normal (fasting) Borderline High Very High | 40-150 mg/dL 150-200 mg/dL 200-500 mg/dL >500 mg/dL | 0.45-1.69 mmol/liter 1.69-2.26 mmol/liter 2.26-5.65 mmol/liter >5.65 mmol/liter | x 0.01129 |
| Urea, plasma (BUN) | 8-25 mg/dL | 2.9-8.9 mmol/liter | x 0.357 |
| Urinalysis: pH Specific gravity | 5.0-9.0 | 5.0-9.0 | No conversion |
| 1.001-1.035 | 1.001-1.035 | ||
| WBC (White blood cells, Leukocytes) | 4.5-11.0 x 103/mm3 | 4.5-11.0 x 109/liter | No conversion |
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- 1. Question
A 45-year-old man with an incidental finding of a 3mm anterior pituitary adenoma is referred to you. Patient has no clinical features based on history and physical examination, to suggest a functional pituitary lesion such as a prolactinoma, acromegaly, TSHoma or Cushing’s disease. What will be the next step in your clinical evaluation?
CorrectIncorrect - 2. Question
Which of these is NOT part of the diagnostic criteria for the syndrome of inappropriate ADH secretion?
CorrectIncorrect - 3. Question
45-year-old Caucasian male with symptoms suggestive of hypogonadism and bitemporal hemianopsia on confrontation was diagnosed with a macroprolactinoma impinging on the optic chiasm. Patient’s visual field defects completely resolved three weeks after initiating dopaminergic agonist therapy. Serum prolactin levels improved to the lower limit of the normal reference range and remained stable within 5 weeks of starting treatment. He was noted to have deterioration of his visual fields five months after initiating dopaminergic agonist therapy.
An urgent CT scan to exclude pituitary hemorrhage or infarction showed a large central empty sella. Serum prolactin levels were within the normal reference range. A dedicated pituitary MRI was remarkable for herniation of the optic chiasm into the pituitary fossa. Urgent visual field testing demonstrated recurrence of bitemporal hemianopsia. The patient was referred to the neurosurgical service. However, the consulting neurosurgeon advised against acute neurosurgical intervention. What did he recommend?
CorrectIncorrect - 4. Question
Which of these is not a cause of central diabetes insipidus?
CorrectIncorrect - 5. Question
A 25-year-old female with amenorrhea and expressive galactorrhea. Anterior pituitary hormonal function testing was unremarkable except for an elevated prolactin level, high TSH and a low free T4. Pituitary MRI revealed a large intrasellar mass expanding beyond the sella. There was homogenous contrast enhancement of the entire pituitary gland, suggestive of pituitary hyperplasia. What is the primary diagnosis?
CorrectIncorrect - 6. Question
A patient with type 2 diabetes mellitus and acromegaly is started on pegvisomant by his treating endocrinologist. Which of these clinical features is not expected after the initiation of this medication
CorrectIncorrect - 7. Question
A 40-year-old male with a history of mild obstructive sleep apnea, resistant hypertension and diabetes mellitus. The patient was diagnosed with acromegaly. His IGF-1 levels were more than 3 times the upper limit of normal and failure of the oral glucose tolerance challenge test. A dedicated pituitary MRI revealed 7mm anterior pituitary adenoma. What is the next step in management?
CorrectIncorrect - 8. Question
Which of these drug-drug interaction scenarios is inaccurate with regards to the management of panhypopituitarism?
CorrectIncorrect - 9. Question
A 52-year-old woman with a history of depression, hypertension and poorly controlled diabetes mellitus presented to his primary care doctor’s office with a 3-month history of progressive headaches and blurred vision. His medications include venlafaxine, multiple daily injections of insulin, metformin, aspirin, lisinopril, and amlodipine. Physical exam was remarkable for numerous skin tags, malocclusion of the jaw and proximal myopathy. His IGF-1 level was normal, but due to the high index of suspicion for acromegaly, his primary care doctor referred him to an endocrinologist for further evaluation. Repeat serum IGF-1 was this time low (below the reference range), dynamic testing with a 75gram oral glucose load, was however significant for a nonsuppressed growth hormone level of 3ng/mL (normal suppression is <1ng/mL at 2hours). What is the cause of these laboratory findings?
CorrectIncorrect - 10. Question
An 18-year-old man with isolated growth hormone deficiency transitions from pediatric to adult endocrinology care. He received GH replacement during childhood. He reports stagnation of growth despite being on GH replacement therapy. He is concerned about the utility of ongoing therapy. What is the next step in the management of this patient?
CorrectIncorrect - 11. Question
There are multiple adjunctive therapies in the management of acromegaly. Which of these pairs comparing a form of treatment with its associated side effect is inaccurate?
CorrectIncorrect - 12. Question
An 82-year-old woman with metastatic melanoma presents to the emergency room with nausea, colicky abdominal pain, and postural dizziness. He completed his third cycle of ipilimumab 1 week ago. There is evidence of anterior pituitary hormonal insufficiencies involving the cortisol, thyroid, gonadal and growth hormone axes. In addition, he is noted to have central diabetes insipidus. A dedicated pituitary MRI is remarkable for diffuse enlargement of the pituitary gland and stalk. What is the most likely diagnosis?
CorrectIncorrect - 13. Question
A 32-year-old female with known acromegaly on long term medical therapy reports to her endocrinologist’s office due to missing her period recently. She is 9 weeks pregnant and has well-controlled acromegaly on long term lanreotide therapy. Which of these possible considerations by her endocrinologist is inaccurate?
CorrectIncorrect - 14. Question
A 48-year-old Hispanic man presents to the emergency room with nausea, abdominal pain, postural dizziness, and polyuria. He is diagnosed with central hypothyroidism, central hypocortisolemia, and central diabetes insipidus. An MRI of the pituitary gland shows a sellar mass. What is the most likely diagnosis?
CorrectIncorrect - 15. Question
A 25-year-old man with a diagnosis of adult growth hormone deficiency which occurred after closed head trauma presents to your office to discuss growth hormone replacement therapy. Which of these is not an expected effect of growth hormone replacement therapy?
CorrectIncorrect - 16. Question
A patient is status post pituitary adenomectomy for Cushing’s disease. The neurosurgery resident forgot to place orders for steroids in the postoperative period. 6 hours after surgery the covering neurosurgical intern is paged due to progressively worsening dizziness in the patients. The patient is noted to be hypotensive and tachycardic. She is promptly resuscitated with intravenous crystalloids. What should the covering surgical resident do next?
CorrectIncorrect - 17. Question
A 26-year-old female with a past medical history of rheumatoid arthritis, Sjogren’s syndrome and poorly controlled type 2 diabetes mellitus is referred to the endocrinology practice for management of diabetes. The patient has a 2-year history of fatigue and general malaise. Her medications include prednisone 10mg daily, methotrexate 15mg per week, SQ Lantus 80units twice a day and SQ Humalog insulin 40units with each meal. Physical exam was significant for a dorsocervical hump, facial plethora, thick violaceous abdominal striae and intense pigmentation of her palmar creases and gingiva. Interestingly, she had a BMI of 17 and was unable to get up from a seated position without assistance.
What is the most likely diagnosis of this patient?
CorrectIncorrect - 18. Question
Patient with pituitary-dependent Cushings undergoes bilateral adrenalectomy due to refractory disease. His current medications include hydrocortisone and fludrocortisone. The patient developed progressively worsening headaches and was noted to have an ACTH level >3 times the upper limit of normal.
What is the diagnosis?
CorrectIncorrect - 19. Question
There are multiple adjunctive therapies in the management of Cushing’s disease. Which of these pairs comparing a form of treatment with its associated side effect is inaccurate?
CorrectIncorrect - 20. Question
Which of these differential diagnoses of Cushing’s syndrome is not an indication for bilateral adrenalectomy?
CorrectIncorrect - 21. Question
Testing of Cushing’s syndrome can be limited in specific patient populations. Which of these pairs comparing particular patient populations and Cushing’s screening test is incorrect?
CorrectIncorrect - 22. Question
A 23-year-old with a co-secreting TSH and GH tumor undergoes extensive transsphenoidal surgery. He was noted to be polyuric within the first 24hours; this was attributed to postoperative diuresis. Polyuria resolved within 48hours; however, the patient developed moderate asymptomatic hyponatremia which was managed with salt tablets and fluid restriction from postoperative day 4 to 7. The endocrinology service was consulted 1 week after TSS due to significant hypernatremia (Plasma sodium of 154mEq).
Fluid input 3 Liters and Output 7 Liters over the preceding 24hours Plasma osmolarity of 320mOsm/kg of H2O Urine osmolarity 20mOsm/kg of H2O, S.G of <1.005, urine dipstick negative for glucose
What is the diagnosis of this patient?
CorrectIncorrect - 23. Question
A 26-year-old female with central diabetes insipidus, well controlled with PO desmopressin 0.1mg q12h presents to her endocrinologist’s office. The Patient has remained eunatremic for several months on this stable dose of DDAVP. She presented to the ED after an episode of tonic-clonic seizures. Her current medications include oral ciprofloxacin for an acute urinary tract infection, ibuprofen prn, and desmopressin. Her plasma sodium was 116mEq (135-145mEq), plasma osmolarity 268 (280-295mOsm/kg), Urine osmolarity of 126mOsm/kg and Urine sodium of 50mmol/L. What is the most likely cause of this patient’s acute presentation?
CorrectIncorrect - 24. Question
Category: Board Review Endocrinology
A 42-year-old male presents with excessive thirst, frequent urination, and nocturia. His laboratory results show a normal plasma sodium concentration. Which is the most appropriate treatment for this patient, who is suspected to have arginine vasopressin deficiency (AVP-D)?
CorrectIncorrectThe most common treatment for AVP-D is an ADH analog.
- 25. Question
Category: Board Review Endocrinology
In patients with partial AVP-D and mild to moderate polyuria and nocturia, which treatment option may be effective when combined with a low-solute diet?
CorrectIncorrectThis treatment option may be effective in controlling symptoms when combined with a low-solute diet.
- 26. Question
Category: Board Review Endocrinology
What determines urine output in untreated AVP-D patients with a fixed urine osmolality?
CorrectIncorrectThis factor is mainly composed of sodium salts and urea, and it is called the renal solute load.
- 27. Question
Category: Board Review Endocrinology
A 35-year-old female is being treated for arginine vasopressin deficiency (AVP-D) with desmopressin. What is the initial aim of therapy?
CorrectIncorrectThe initial therapeutic goal for AVP-D is focused on improving the patient's sleep quality.
- 28. Question
Category: Board Review Endocrinology
In patients treated with desmopressin for AVP-D, what is the potential risk associated with water retention?
CorrectIncorrectThis electrolyte imbalance is associated with water retention in patients treated with desmopressin for AVP-D.
- 29. Question
Category: Board Review Endocrinology
When should the serum sodium concentration be measured in a patient who has just started desmopressin therapy for AVP-D?
CorrectIncorrectThis measurement should be done shortly after the initiation of desmopressin therapy for AVP-D.
- 30. Question
Category: Board Review Endocrinology
What is the primary cause of AVP-D in patients following neurosurgery or trauma?
CorrectIncorrect - 31. Question
Category: Board Review Endocrinology
A patient with AVP-D is being switched from intranasal desmopressin to the oral tablet form. What is the initial recommended dose of the oral tablet?
CorrectIncorrectThe initial dose of the oral tablet form is one-half of a 0.1 mg tablet.
- 32. Question
Category: Board Review Endocrinology
What is a potential issue with administering oral desmopressin with meals?
CorrectIncorrectThis issue affects the absorption of the oral desmopressin when taken concurrently with food.
- 33. Question
Category: Board Review Endocrinology
Which desmopressin formulation is preferred by patients due to its ease of administration but may not provide an adequate response in all cases?
CorrectIncorrectThis formulation is taken by mouth and is easier for patients to administer.
- 34. Question
Category: Board Review Endocrinology
In pregnant patients with AVP-D, is desmopressin considered safe for both the mother and the fetus?
CorrectIncorrectConsider the safety of desmopressin for both
- 35. Question
Category: Board Review Endocrinology
In patients with AVP-D, which medication is preferred for its safety and effectiveness compared to other drugs like thiazide diuretics, chlorpropamide, carbamazepine, and NSAIDs?
CorrectIncorrectThis medication is a synthetic analogue of antidiuretic hormone (ADH) and is effective in controlling polyuria.
- 36. Question
Category: Board Review Endocrinology
How do thiazide diuretics help reduce urine output in patients with AVP-D?
CorrectIncorrectThese diuretics induce mild volume depletion, which in turn affects sodium and water reabsorption.
- 37. Question
Category: Board Review Endocrinology
Which class of drugs can increase urinary concentrating ability by inhibiting the renal synthesis of prostaglandins in patients with AVP-D?
CorrectIncorrectThese drugs inhibit the synthesis of a specific class of compounds that antagonize ADH.
- 38. Question
Category: Board Review Endocrinology
A 50-year-old male patient presents with hyponatremia and is diagnosed with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). What is the initial mainstay therapy for this patient?
CorrectIncorrectThe mainstay of therapy for SIADH involves limiting fluid intake.
- 39. Question
Category: Board Review Endocrinology
In patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), what is the role of treating the underlying disease?
CorrectIncorrectAddressing the cause of SIADH can have a positive impact on hyponatremia.
- 40. Question
Category: Board Review Endocrinology
Why is fluid restriction alone unlikely to increase the serum sodium concentration in SIADH if the concentration of sodium plus potassium in the urine equals or exceeds the serum sodium concentration?
CorrectIncorrectThe balance between urine solute excretion and serum sodium concentration plays a crucial role in the effectiveness of fluid restriction in SIADH.
- 41. Question
Category: Board Review Endocrinology
In patients with SIADH, how does low dietary protein intake affect hyponatremia?
CorrectIncorrect - 42. Question
Category: Board Review Endocrinology
A 45-year-old female presents to the emergency department with a severe headache, vomiting, and confusion. Her blood pressure is 150/95 mmHg, and her heart rate is 110 bpm. A CT scan reveals a subarachnoid hemorrhage. Laboratory results show serum sodium of 125 mEq/L. What is the most appropriate treatment for hyponatremia in this patient?
CorrectIncorrectIn patients with subarachnoid hemorrhage, fluid restriction may promote cerebral vasospasm. Consider the effects of hyponatremia on brain swelling and cerebral perfusion.
- 43. Question
Category: Board Review Endocrinology
A 60-year-old male presents to the emergency department with confusion, lethargy, and a recent seizure. His laboratory results show serum sodium of 110 mEq/L. The patient is diagnosed with severe hyponatremia due to SIADH. What is the main reason isotonic saline should not be used to treat this patient's hyponatremia?
CorrectIncorrectConsider the electrolyte concentration of the fluids being given and the urine electrolyte concentration in patients with SIADH.
- 44. Question
Category: Board Review Endocrinology
A 50-year-old female with SIADH and hyponatremia receives hypertonic saline. After the administration, there is an initial large rise in the serum sodium concentration that falls over time as the administered sodium is excreted. What can be done to maintain the elevated serum sodium level in this patient?
CorrectIncorrect - 45. Question
Category: Board Review Endocrinology
A 52-year-old woman presents with hyponatremia (serum sodium of 123 mEq/L) due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient has no significant history of heart, liver, or kidney disease. Which is the most appropriate initial treatment for this patient?
CorrectIncorrectConsider the effectiveness and side effects of each treatment option for SIADH-related hyponatremia.
- 46. Question
Category: Board Review Endocrinology
Which of the following drugs can cause nephrogenic diabetes insipidus in patients with bipolar disorder?
CorrectIncorrectConsider which drug is commonly used in the treatment of bipolar disorder and its side effects.
- 47. Question
Category: Board Review Endocrinology
What is the recommended initial rate of correction for chronic hyponatremia in asymptomatic patients with SIADH?
CorrectIncorrectConsider the recommended rate of correction to prevent complications from overly rapid correction of hyponatremia.
- 48. Question
Category: Board Review Endocrinology
A 58-year-old man presents with dizziness, forgetfulness, and confusion. His serum sodium concentration is 118 mEq/L, and it is suspected that he has developed hyponatremia due to SIADH. What is the initial approach for this patient with mild-to-moderate symptoms?
CorrectIncorrectConsider the severity of the patient's symptoms and the most appropriate way to gradually raise the serum sodium concentration.
- 49. Question
Category: Board Review Endocrinology
A 62-year-old woman with severe hyponatremic symptoms (serum sodium below 120 mEq/L) requires rapid correction of serum sodium to prevent possibly irreversible neurologic injury. What is the most appropriate treatment?
CorrectIncorrectFocus on the treatment that can rapidly raise the serum sodium and improve neurologic manifestations in patients with severe symptomatic hyponatremia.
- 50. Question
Category: Board Review Endocrinology
In patients with severe hyponatremia correcting too rapidly, what can be done to prevent further short-term elevation in serum sodium or relowering the serum sodium?
CorrectIncorrectConsider the options that can effectively prevent further elevation or relowering of serum sodium in patients who are correcting too rapidly.
- 51. Question
Category: Board Review Endocrinology
A 55-year-old woman presents with dizziness, confusion, and lethargy. Her serum sodium concentration is found to be 118 mEq/L. What is the initial treatment approach for this patient with symptomatic hyponatremia due to SIADH?
CorrectIncorrectConsider the severity of the patient's symptoms and the need for rapid correction.
- 52. Question
Category: Board Review Endocrinology
In patients with SIADH who are undergoing maintenance therapy, which of the following drugs is NOT recommended?
CorrectIncorrectConsider the potential side effects and limitations of the medication.
- 53. Question
Category: Board Review Endocrinology
In patients with asymptomatic hyponatremia due to SIADH, what is the suggested goal fluid intake?
CorrectIncorrectConsider the level of fluid restriction needed to maintain serum sodium concentration in asymptomatic patients.
- 54. Question
Category: Board Review Endocrinology
A 63-year-old man presents with mild hyponatremia (serum sodium 128 mEq/L) that is stable over several days despite variations in sodium and water intake. What should be suspected in this patient?
CorrectIncorrectConsider the stability of the patient's hyponatremia and the possible underlying mechanisms.
- 55. Question
Category: Board Review Endocrinology
Which of the following tests can help confirm the diagnosis of a reset osmostat in a patient with mild hyponatremia?
CorrectIncorrectConsider the test that evaluates the patient's ability to excrete water.
- 56. Question
Category: Board Review Endocrinology
In patients with a reset osmostat, what is the primary focus of treatment?
CorrectIncorrectConsider the best approach for managing the patient's condition without causing unnecessary side effects.
- 57. Question
Category: Board Review Endocrinology
A 12-year-old girl presents with short stature, and her height is 2 standard deviations below the mean for her age and sex. Her height velocity is normal, and her bone age is consistent with her chronological age. What is the most likely cause of her short stature?
CorrectIncorrectConsider the normal height velocity and consistent bone age with the chronological age.
- 58. Question
Category: Board Review Endocrinology
Which hormone promotes linear growth by stimulating growth hormone and IGF-1 secretion but also accelerates chondrocyte senescence, leading to the fusion of growth plates and cessation of linear growth?
CorrectIncorrectConsider the hormone responsible for growth plate fusion and cessation of linear growth.
- 59. Question
Category: Board Review Endocrinology
In children with short stature and normal height velocity, which condition is characterized by a bone age that is delayed compared to the chronological age?
CorrectIncorrectConsider the condition that involves a delay in both growth and puberty development.
- 60. Question
Category: Board Review Endocrinology
In the clinical setting, why does growth hormone have variable effects on growth in children with short stature?
CorrectIncorrect - 61. Question
Category: Board Review Endocrinology
A 14-year-old boy presents with short stature and delayed puberty. He has a family history of delayed growth and puberty in his father. What is the most likely diagnosis for this patient?
CorrectIncorrectConsider the patient's delayed puberty and family history of delayed growth.
- 62. Question
Category: Board Review Endocrinology
Which condition is characterized by short stature below 2 standard deviations of the mean for age, in the absence of any endocrine, metabolic, or other diagnosis?
CorrectIncorrectConsider the condition with short stature in the absence of an identifiable cause.
- 63. Question
Category: Board Review Endocrinology
Most infants born small for gestational age (SGA) experience catch-up growth by what age?
CorrectIncorrectConsider when catch-up growth typically occurs for most SGA infants.
- 64. Question
Category: Board Review Endocrinology
In children with idiopathic short stature (ISS), what is the expected result if a growth hormone stimulation test is performed?
CorrectIncorrectConsider the relationship between growth hormone deficiency and idiopathic short stature.
- 65. Question
Category: Board Review Endocrinology
In which of the following cases should testing for acromegaly be considered?
CorrectIncorrectConsider the combination of conditions associated with acromegaly.
- 66. Question
Category: Board Review Endocrinology
What is the best single test for the diagnosis of acromegaly?
CorrectIncorrectThis test reflects integrated growth hormone secretion during the preceding day or longer.
- 67. Question
Category: Board Review Endocrinology
Which of the following conditions can cause lower serum IGF-1 concentrations and potentially result in a missed diagnosis of acromegaly?
CorrectIncorrectConsider conditions that may lower serum IGF-1 concentrations.
- 68. Question
Category: Board Review Endocrinology
What percentage of patients with acromegaly have visual defects at presentation, according to recent estimates?
CorrectIncorrectConsider the change in presentation rates over time.
- 69. Question
Category: Board Review Endocrinology
A 45-year-old male patient presents with coarse facial features, enlarged hands and feet, and uncontrolled type 2 diabetes. Which of the following is the most appropriate initial test to diagnose acromegaly?
CorrectIncorrectConsider the test that provides excellent discrimination from normal individuals and does not vary significantly from hour to hour.
- 70. Question
Category: Board Review Endocrinology
What is the criterion for the diagnosis of acromegaly during an oral glucose tolerance test (OGTT)?
CorrectIncorrectConsider the GH concentration that does not decrease in patients with acromegaly during an OGTT.
- 71. Question
Category: Board Review Endocrinology
A 40-year-old female presents with signs of acromegaly, and her IGF-1 levels are elevated. What is the next step in determining the cause of her excess growth hormone secretion?
CorrectIncorrectConsider the imaging modality that is most helpful in identifying a somatotroph adenoma of the pituitary.
- 72. Question
Category: Board Review Endocrinology
A 35-year-old woman presents with symptoms suggestive of acromegaly. Which test is considered the gold standard for establishing the diagnosis of acromegaly?
CorrectIncorrectThe gold standard test for establishing the diagnosis of acromegaly involves measuring serum GH before and two hours after glucose administration.
- 73. Question
Category: Board Review Endocrinology
Which syndrome is NOT associated with gigantism?
CorrectIncorrectThis syndrome is a genetic disorder affecting connective tissue, leading to tall stature and long limbs, but it is not associated with excess growth hormone secretion or gigantism.
- 74. Question
Category: Board Review Endocrinology
What is the most common cause of acromegaly?
CorrectIncorrectThe most common cause of acromegaly is characterized by excess growth hormone secretion.
- 75. Question
Category: Board Review Endocrinology
A 45-year-old male presents with symptoms of acromegaly, including enlarged hands and feet, coarsening of facial features, and joint pain. An MRI reveals a pituitary macroadenoma. What is the recommended initial treatment for this patient?
CorrectIncorrectThe choice of initial treatment depends upon the size and location of the adenoma, the presence of symptoms due to size, and the patient's ability to undergo surgery.
- 76. Question
Category: Board Review Endocrinology
Which of the following is an important goal of therapy for patients with acromegaly?
CorrectIncorrectThe goals of therapy in patients with acromegaly include lowering specific biochemical markers and improving symptoms.
- 77. Question
Category: Board Review Endocrinology
What is the approximate early cure rate for patients with acromegaly who have undergone transsphenoidal surgery for microadenomas?
CorrectIncorrectThe early cure rate for patients with acromegaly varies depending on the size of the adenoma.
- 78. Question
Category: Board Review Endocrinology
What is a potential long-term complication of transsphenoidal surgery in patients with acromegaly?
CorrectIncorrect - 79. Question
Category: Board Review Endocrinology
A 52-year-old female patient has undergone transsphenoidal surgery for acromegaly, but her serum IGF-1 levels remain abnormal with moderate symptoms of GH excess. What is the suggested medical therapy for this patient?
CorrectIncorrectThe choice of medical therapy for patients with residual disease after surgery depends on their symptoms and biochemical abnormalities.
- 80. Question
Category: Board Review Endocrinology
When is primary medical therapy with a long-acting somatostatin analog suggested as the initial step for patients with acromegaly?
CorrectIncorrectThe choice of initial treatment for patients with acromegaly depends on the tumor's characteristics, surgical candidacy, and patient preferences.
- 81. Question
Category: Board Review Endocrinology
Which of the following is an indication for stereotactic radiation therapy in patients with acromegaly?
CorrectIncorrectStereotactic radiation therapy is considered for patients with acromegaly who have specific characteristics or treatment failures.
- 82. Question
Category: Board Review Endocrinology
When should serum IGF-1 levels be measured after initial treatment of acromegaly, whether surgery or medication?
CorrectIncorrectThe timing of measuring serum IGF-1 levels after initial treatment is important for determining the effectiveness of the treatment.
- 83. Question
Category: Board Review Endocrinology
Which of the following is true regarding the post-treatment improvement of sleep apnea in patients with acromegaly?
CorrectIncorrectSleep apnea can show changes after successful treatment of acromegaly, but the degree of improvement can vary among patients.
- 84. Question
Category: Board Review Endocrinology
How often should colonoscopy be performed in patients with acromegaly who have normal IGF-1 levels and no polyps found on baseline colonoscopy?
CorrectIncorrectThe frequency of colonoscopy in patients with acromegaly depends on their IGF-1 levels and the presence of polyps.
- 85. Question
Category: Board Review Endocrinology
Which of the following symptoms of acromegaly is not reversible after successful treatment?
CorrectIncorrectSome symptoms of acromegaly can improve or resolve after successful treatment, while others remain unchanged.
- 86. Question
Category: Board Review Endocrinology
What is the suggested approach for managing serum GH and IGF-1 concentrations in women with known acromegaly before attempting conception?
CorrectIncorrectThe approach to managing serum GH and IGF-1 concentrations in women with acromegaly before conception is essential for reducing pregnancy-related risks.
- 87. Question
Category: Board Review Endocrinology
What is the recommended course of action for medical therapy during pregnancy in women with acromegaly?
CorrectIncorrectMedical therapy during pregnancy in women with acromegaly should be carefully considered, as it can impact both the mother and the baby.
- 88. Question
Category: Board Review Endocrinology
Which of the following pregnancy complications is more common in women with active or uncontrolled acromegaly?
CorrectIncorrectActive or uncontrolled acromegaly during pregnancy can increase the risk of certain pregnancy complications.
- 89. Question
Category: Board Review Endocrinology
When should women with acromegaly who have macroadenomas monitor their visual fields during pregnancy?
CorrectIncorrectMonitoring visual fields in pregnant women with acromegaly and macroadenomas is crucial to ensure no new defects occur during pregnancy.
- 90. Question
Category: Board Review Endocrinology
What is the treatment of choice for patients with somatotroph adenomas that are small, large but still resectable, or large and cause visual impairment?
CorrectIncorrectThe preferred treatment for somatotroph adenomas depends on the size and impact of the adenoma on the patient's well-being.
- 91. Question
Category: Board Review Endocrinology
What are the current goals for surgical cure in patients with acromegaly?
CorrectIncorrectSurgical cure goals for acromegaly involve both serum IGF-1 and GH concentrations.
- 92. Question
Category: Board Review Endocrinology
Which of the following recurrence rates is generally observed in patients with acromegaly who initially achieve surgical cure?
CorrectIncorrectRecurrence rates in acromegaly patients after initial surgical cure are influenced by factors such as incomplete adenoma resection.
- 93. Question
Category: Board Review Endocrinology
Which factor might increase the risk of recurrence in patients with acromegaly after successful surgery?
CorrectIncorrect - 94. Question
Category: Board Review Endocrinology
Which of the following factors enhances the likelihood of a sperm count increase after gonadotropin administration in men with secondary hypogonadism?
CorrectIncorrectThe timing of hypogonadism development plays a role in the likelihood of a sperm count increase after gonadotropin administration.
- 95. Question
Category: Board Review Endocrinology
In patients with secondary hypogonadism due to hypothalamic or pituitary disease who desire fertility, what is the recommended treatment?
CorrectIncorrectThe recommended treatment for patients with secondary hypogonadism due to hypothalamic or pituitary disease who desire fertility involves hormones that stimulate sperm production.
- 96. Question
Category: Board Review Endocrinology
What is the impact of prior testosterone treatment on the time to achieve spermatogenesis in men with hypogonadotropic hypogonadism treated with gonadotropins?
CorrectIncorrectPrior testosterone treatment may affect the response to gonadotropin therapy in men with hypogonadotropic hypogonadism.
- 97. Question
Category: Board Review Endocrinology
A 32-year-old man with secondary hypogonadism desires to become fertile. He has a history of hypogonadism occurring after puberty and has normal-sized testes. Which of the following treatments would be the initial approach for this patient to stimulate sperm production?
CorrectIncorrectConsider the initial treatment for secondary hypogonadism to stimulate sperm production.
- 98. Question
Category: Board Review Endocrinology
A patient with secondary hypogonadism has been treated with hCG for six months. The serum testosterone concentration is within the normal range, but the sperm count remains low. What should be the next step in treatment?
CorrectIncorrectConsider what treatment should be added when hCG alone is not sufficient to stimulate spermatogenesis.
- 99. Question
Category: Board Review Endocrinology
In the treatment of secondary hypogonadism, what is the primary reason for replacing LH with hCG instead of recombinant human LH?
CorrectIncorrectConsider the differences between hCG and recombinant human LH in terms of half-life.
- 100. Question
Category: Board Review Endocrinology
In a patient with suspected hypopituitarism, a morning serum cortisol level of 2 mcg/dL is observed. What is the most appropriate next step in the diagnostic process?
CorrectIncorrectConsider the range of serum cortisol values when determining the next step in the diagnostic process.
- 101. Question
Category: Board Review Endocrinology
In a patient with a confirmed morning serum cortisol level of ≤3 mcg/dL, what is the most appropriate next step to differentiate between primary and secondary adrenal insufficiency?
CorrectIncorrectIdentify the appropriate test to differentiate between primary and secondary adrenal insufficiency.
- 102. Question
Category: Board Review Endocrinology
In patients with an indeterminate morning serum cortisol value, which test is preferred by many experts due to its availability and ease of administration?
CorrectIncorrectConsider the availability and ease of administration when choosing a test for indeterminate morning serum cortisol values.
- 103. Question
Category: Board Review Endocrinology
What is the rationale for the administration of cosyntropin in the cosyntropin stimulation test?
CorrectIncorrect - 104. Question
Category: Board Review Endocrinology
In a patient with recent ACTH deficiency, which test is particularly useful for evaluating their ACTH reserve?
CorrectIncorrectConsider the specific situation in which the patient has recent ACTH deficiency.
- 105. Question
Category: Board Review Endocrinology
In a normal subject undergoing a metyrapone test, what is the expected change in 8 AM serum 11-deoxycortisol at the end of the 24-hour period?
CorrectIncorrectRecall the expected response of a normal subject to metyrapone administration.
- 106. Question
Category: Board Review Endocrinology
In a patient who has undergone the metyrapone test and has an 8 AM serum 11-deoxycortisol concentration of <10 mcg/dL and serum cortisol concentration of ≥7 mcg/dL, what is the most likely explanation for these results?
CorrectIncorrectConsider the possible reasons for insufficient inhibition by metyrapone.
- 107. Question
Category: Board Review Endocrinology
In patients with pituitary or hypothalamic disease, which test is used to screen for hypothyroidism?
CorrectIncorrectConsider the differences between primary and secondary hypothyroidism.
- 108. Question
Category: Board Review Endocrinology
In a man with hypopituitarism, how can luteinizing hormone (LH) deficiency be best detected?
CorrectIncorrectThink about the relationship between LH and testosterone in males.
- 109. Question
Category: Board Review Endocrinology
In a premenopausal woman with pituitary or hypothalamic disease and oligomenorrhea or amenorrhea, which test should be performed to identify gonadotropin deficiency?
CorrectIncorrectFocus on the hormonal changes associated with menstrual irregularities.
- 110. Question
Category: Board Review Endocrinology
Which test does not help in distinguishing secondary hypogonadism due to pituitary disease from that due to hypothalamic disease?
CorrectIncorrect - 111. Question
Category: Board Review Endocrinology
In adults with organic pituitary disease, which serum measurement can confirm the diagnosis of growth hormone deficiency?
CorrectIncorrectConsider the most reliable serum measurement for confirming growth hormone deficiency.
- 112. Question
Category: Board Review Endocrinology
Which provocative test for growth hormone secretion carries minimal risk but is no longer available in the United States?
CorrectIncorrectConsider the test with minimal risk but limited availability.
- 113. Question
Category: Board Review Endocrinology
In women with severe hypopituitarism due to hypothalamic or pituitary disease, what is the main physiologic role of prolactin?
CorrectIncorrectFocus on the primary function of prolactin in women.
- 114. Question
Category: Board Review Endocrinology
Why is routine testing for prolactin deficiency not currently performed in women without known pituitary disease who are unable to breastfeed?
CorrectIncorrectConsider the challenges in measuring serum prolactin concentrations.
- 115. Question
Category: Board Review Endocrinology
What is the principal risk during pregnancy for a mother with a lactotroph adenoma?
CorrectIncorrectConsider the specific risk related to the lactotroph adenoma during pregnancy.
- 116. Question
Category: Board Review Endocrinology
What is the risk of growth for a lactotroph microadenoma during pregnancy?
CorrectIncorrectConsider the size of the adenoma and the impact on growth risk during pregnancy.
- 117. Question
Category: Board Review Endocrinology
Is there a known risk to the fetus from exposure to dopamine agonists during the first month of pregnancy?
CorrectIncorrectConsider the available evidence regarding fetal exposure to dopamine agonists.
- 118. Question
Category: Board Review Endocrinology
What is the risk of growth for a lactotroph macroadenoma during pregnancy without prior surgery or radiation treatment?
CorrectIncorrectConsider the impact of prior treatment on the risk of growth for a lactotroph macroadenoma during pregnancy.
- 119. Question
Category: Board Review Endocrinology
In women with lactotroph microadenomas, what is the main effect of treatment with a dopamine agonist on their reproductive health?
CorrectIncorrectConsider the primary goal of treatment with a dopamine agonist in women with lactotroph microadenomas.
- 120. Question
Category: Board Review Endocrinology
What is the suggested course of action if a woman with a microadenoma does not ovulate or conceive with dopamine agonist therapy alone?
CorrectIncorrectConsider the additional intervention that can be used to enhance ovulation and conception in women with microadenomas.
- 121. Question
Category: Board Review Endocrinology
In women with lactotroph macroadenomas, what is the recommended initial treatment?
CorrectIncorrectConsider the first-line treatment for women with lactotroph macroadenomas to decrease adenoma size and restore ovulation.
- 122. Question
Category: Board Review Endocrinology
In the management of a woman with a lactotroph macroadenoma, when is it appropriate to attempt pregnancy?
CorrectIncorrectConsider the optimal conditions for pregnancy in a woman with a lactotroph macroadenoma.
- 123. Question
Category: Board Review Endocrinology
In which of the following situations is transsphenoidal surgery recommended before attempting pregnancy in a woman with a lactotroph macroadenoma?
CorrectIncorrectConsider the indications for transsphenoidal surgery in women with lactotroph macroadenomas.
- 124. Question
Category: Board Review Endocrinology
Which dopamine agonist is preferred by most experts due to its higher efficacy and better tolerability?
CorrectIncorrectConsider the comparison of effectiveness and tolerability between cabergoline and bromocriptine.
- 125. Question
Category: Board Review Endocrinology
What is the starting dose of cabergoline for the treatment of both micro- and macroadenomas?
CorrectIncorrectThink about the initial dosing strategy for cabergoline in treating both micro- and macroadenomas.
- 126. Question
Category: Board Review Endocrinology
What is the recommended monitoring frequency for pregnant women with lactotroph microadenomas?
CorrectIncorrectConsider the monitoring guidelines for pregnant women with lactotroph microadenomas.
- 127. Question
Category: Board Review Endocrinology
During pregnancy, when should visual field testing be performed in women with lactotroph adenomas?
CorrectIncorrectConsider the indications for visual field testing in pregnant women with lactotroph adenomas.
- 128. Question
Category: Board Review Endocrinology
In pregnant women with lactotroph adenomas, when is pituitary MRI without contrast indicated?
CorrectIncorrectThink about the circumstances under which pituitary MRI is recommended for pregnant women with lactotroph adenomas.
- 129. Question
Category: Board Review Endocrinology
If a pregnant woman with a lactotroph adenoma experiences significant adenoma enlargement causing severe symptoms, what is the preferred treatment approach?
CorrectIncorrectConsider the treatment options for pregnant women with lactotroph adenomas experiencing severe symptoms due to adenoma enlargement.
- 130. Question
Category: Board Review Endocrinology
Which of the following symptoms is most indicative of pituitary apoplexy in a pregnant woman with a lactotroph adenoma?
CorrectIncorrectConsider the symptoms of pituitary apoplexy in the context of a pregnant woman with a lactotroph adenoma.
- 131. Question
Category: Board Review Endocrinology
In which of the following scenarios is breastfeeding contraindicated for a woman with a lactotroph adenoma?
CorrectIncorrectConsider the conditions under which breastfeeding is not recommended for women with lactotroph adenomas.
- 132. Question
Category: Board Review Endocrinology
After pregnancy, when should serum prolactin be measured in a woman with a lactotroph adenoma who does not breastfeed?
CorrectIncorrectConsider the recommended timing for measuring serum prolactin after pregnancy in women with lactotroph adenomas who do not breastfeed.
- 133. Question
Category: Board Review Endocrinology
In women with lactotroph adenomas treated with dopamine agonist therapy prior to pregnancy, which of the following factors was associated with a slightly greater recurrence of elevated serum prolactin levels after delivery?
CorrectIncorrect - 134. Question
Category: Board Review Endocrinology
What is the most common type of clinically nonfunctioning pituitary macroadenoma?
CorrectIncorrectConsider the prevalence of different types of clinically nonfunctioning pituitary adenomas.
- 135. Question
Category: Board Review Endocrinology
Which of the following hormones is most frequently secreted by gonadotroph adenomas?
CorrectIncorrectConsider the hormones secreted by gonadotroph adenomas in order of decreasing frequency.
- 136. Question
Category: Board Review Endocrinology
A patient with a sellar mass is found to have elevated alpha subunit levels. What is the significance of this finding?
CorrectIncorrectConsider the role of alpha subunit levels in the evaluation of a sellar mass.
- 137. Question
Category: Board Review Endocrinology
What is the most common symptom that leads a patient with a gonadotroph or other clinically nonfunctioning adenoma to seek medical attention?
CorrectIncorrectConsider the various symptoms associated with gonadotroph or other clinically nonfunctioning adenomas and their frequency.
- 138. Question
Category: Board Review Endocrinology
In patients with a gonadotroph adenoma, which type of visual field loss is most common?
CorrectIncorrectConsider the different types of visual field loss and which one is most commonly associated with gonadotroph adenomas.
- 139. Question
Category: Board Review Endocrinology
Which condition might cause cerebrospinal fluid rhinorrhea in a patient with a pituitary adenoma?
CorrectIncorrectConsider the direction of adenoma extension that could affect the cerebrospinal fluid pathways.
- 140. Question
Category: Board Review Endocrinology
Which of the following factors might trigger pituitary apoplexy in a patient with a pituitary macroadenoma?
CorrectIncorrectConsider the factors that may increase the risk of sudden hemorrhage into a pituitary macroadenoma.
- 141. Question
Category: Board Review Endocrinology
In patients with a sellar mass >1 cm or elevating the optic chiasm, which test should be performed to evaluate potential visual symptoms?
CorrectIncorrectConsider which test is specifically designed to assess visual field abnormalities in patients with sellar masses.
- 142. Question
Category: Board Review Endocrinology
What is the preferred imaging modality for the initial evaluation of suspected pituitary adenomas?
CorrectIncorrectConsider which imaging modality provides the best resolution and visualization of the pituitary region.
- 143. Question
Category: Board Review Endocrinology
In a postmenopausal woman with a sellar mass, which combination of hormonal findings would suggest the presence of a gonadotroph adenoma?
CorrectIncorrectConsider the hormonal profile that is characteristic of gonadotroph adenomas in postmenopausal women.
- 144. Question
Category: Board Review Endocrinology
Which of the following tests should be performed to assess for pituitary hypofunction due to compression of normal pituitary tissue by an adenoma?
CorrectIncorrect - 145. Question
Category: Board Review Endocrinology
Which neuroimaging modality is most useful in detecting calcification in the suprasellar region, which is seen in 60 to 80 percent of patients with craniopharyngioma?
CorrectIncorrectConsider which imaging modality is best suited for visualizing calcification in the brain.
- 146. Question
Category: Board Review Endocrinology
In the preoperative evaluation of a patient with craniopharyngioma, what type of examination is crucial to determine the severity of compression of the optic pathways and establish a presurgical baseline?
CorrectIncorrectConsider which type of examination is specifically focused on the optic pathways.Q3:) Before surgery for craniopharyngioma, which endocrine function should be primarily tested due to the high likelihood of partial hypopituitarism in these patients?
