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Self-Assessment Questions

Endocrinology

Diagnosis and Treatment of Pituitary Gland Disorders:
Review Questions


Catherine Anastasopoulou, MD

Dr. Anastasopoulou is a staff endocrinologist at
Albert Einstein Medical Center, Philadelphia, PA.




Choose the single best answer for each question.

1. A 65-year-old woman presents to her primary care physician complaining of persistent headaches. Magnetic resonance imaging (MRI) of the brain shows a 1-cm pituitary mass that extends to the optic chiasm. The patient denies any visual problems and says that her annual eye examination a few months ago was normal. Results of hormonal testing reveal suppressed follicle-stimulating hormone and luteinizing hormone; levels of prolactin, total thyroxine, cortisol, and insulin-like growth factor-1 are normal. What is the next best step in the management of this patient?
  1. Perform a dual-energy x-ray absorptiometry (DEXA) bone density scan
  2. Perform a visual fields test
  3. Refer to a neurosurgeon for surgical removal of the mass
  4. Start estrogen replacement therapy
  5. Treat with bromocryptine
Click here to compare your answer.


2. A 32-year-old woman presents to her primary care physician with palpitations, excessive sweating, and irregular menstrual periods. Physical examination is notable for a pulse of 110 bpm and diffuse nontender enlargement of the thyroid. The physician suspects hyperactive thyroid and orders thyroid function tests, which reveal a thyroid-stimulating hormone (TSH) level of 6 µIU/µL (normal, 0.5-5.0 µIU/µL) and a free thyroxine level of 3.4 ng/dL (normal, 0.71-1.85 ng/dL).What is the best test to confirm the cause of this patient’s problem?

  1. Antithyroid antibodies
  2. MRI of the pituitary gland
  3. Thyroid scan and uptake
  4. Total triiodothyronine
  5. Ultrasound of the thyroid
Click here to compare your answer.


3. A 45-year-old man with impotence is referred by his primary care physician to an endocrinologist. An extensive work-up performed by his physician revealed a prolactin level of 856 ng/µL (normal,
0-15 ng/µL) and a free testosterone level of 125 ng/dL (normal, 260-1000 ng/dL). An MRI of the brain reveals a 5-mm pituitary tumor. Which of the following is first-line treatment for this patient?

  1. Bromocryptine alone
  2. Bromocryptine and testosterone replacement therapy
  3. Bromocryptine and pituitary surgery
  4. Pituitary surgery and radiation therapy
  5. Testosterone replacement therapy alone
Click here to compare your answer.


Questions 4 and 5 refer to the following case.

A patient with acromegaly undergoes surgery to remove a pituitary adenoma, which was thought to have been producing excessive growth hormone. The day after surgery, the patient develops polyuria. The patient’s urine specific gravity is 1.000 (normal, 1.002-1.028).

4. What is the most likely explanation for this patient’s polyuria?
  1. Diabetes insipidus caused by posterior pituitary damage
  2. Diuresis caused by the decrease in growth hormone circulation
  3. Hypercalcemia caused by the anesthetic medication administered during surgery
  4. Hyperglycemia caused by excessive growth hormone
  5. Hypokalemia caused by fluid administration during surgery
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5. What is the best treatment option for this patient?

  1. No treatment is needed
  2. Hydration
  3. Insulin
  4. Pamidronate
  5. Pitressin
Click here to compare your answer.



 

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