PANRE Endocrinology 3 — Questions and Answers
Question 1: A 35-year-old woman has galactorrhea, amenorrhea, and a serum prolactin of 180 ng/mL. MRI shows a 12mm pituitary lesion. What is the first-line treatment?
- Transsphenoidal surgery
- Radiation therapy
- Dopamine agonist (cabergoline) (Correct answer)
- Estrogen-progestin therapy
Correct answer: Dopamine agonist (cabergoline)
Dopamine agonists such as cabergoline are first-line treatment for prolactinomas regardless of size, effectively reducing prolactin levels and tumor size.
Question 2: A patient with hypothyroidism is started on levothyroxine. How soon should TSH be rechecked to assess adequacy of dosing?
- 1-2 weeks
- 4-6 weeks
- 6-8 weeks (Correct answer)
- 3-6 months
Correct answer: 6-8 weeks
TSH should be rechecked 6-8 weeks after initiating or changing the dose of levothyroxine, as TSH requires this time to reach a new steady state.
Question 3: Which test best distinguishes central (secondary) diabetes insipidus from nephrogenic diabetes insipidus?
- Serum sodium level
- 24-hour urine volume
- Response to desmopressin (DDAVP) administration (Correct answer)
- Plasma osmolality after water deprivation
Correct answer: Response to desmopressin (DDAVP) administration
Administration of desmopressin (ADH analog) will increase urine concentration in central DI but not in nephrogenic DI where the kidney cannot respond.
Question 4: A 62-year-old man with type 2 diabetes and established cardiovascular disease needs intensified glycemic therapy. Which drug class has demonstrated cardiovascular mortality benefit?
- Sulfonylureas
- SGLT-2 inhibitors (Correct answer)
- Thiazolidinediones
- Alpha-glucosidase inhibitors
Correct answer: SGLT-2 inhibitors
SGLT-2 inhibitors (e.g., empagliflozin, canagliflozin) have demonstrated significant reductions in cardiovascular mortality and heart failure hospitalization in patients with established CVD.
Question 5: What is the most common cause of hypercalcemia in the outpatient setting?
- Malignancy
- Primary hyperparathyroidism (Correct answer)
- Vitamin D toxicity
- Sarcoidosis
Correct answer: Primary hyperparathyroidism
Primary hyperparathyroidism is the most common cause of hypercalcemia in outpatients, often discovered incidentally on routine labs.
Question 6: A patient with Graves disease is treated with methimazole. Which serious adverse effect requires immediate discontinuation?
- Mild rash
- Agranulocytosis (Correct answer)
- Elevated liver enzymes (mild)
- Arthralgia
Correct answer: Agranulocytosis
Agranulocytosis is a rare but life-threatening complication of thionamides; patients with fever or sore throat should stop the drug and get an immediate CBC.
Question 7: In a patient with an adrenal incidentaloma, what initial hormonal workup should be performed?
- ACTH stimulation test only
- 1-mg overnight dexamethasone suppression test and 24-hour urine metanephrines (Correct answer)
- Random aldosterone level only
- MRI-guided biopsy
Correct answer: 1-mg overnight dexamethasone suppression test and 24-hour urine metanephrines
All adrenal incidentalomas should be evaluated for autonomous cortisol production (1-mg dexamethasone suppression test) and pheochromocytoma (urine or plasma metanephrines); aldosterone testing is added if hypertensive.
PANRE Endocrinology 3
A 35-year-old woman has galactorrhea, amenorrhea, and a serum prolactin of 180 ng/mL.
MRI shows a 12mm pituitary lesion.
What is the first-line treatment?