Endocrinology Quiz

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Dr Lewis Potter August 22, 2011

Put your knowledge to the test with this endocrinology quiz.

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Endocrinology quiz
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Question 1

In males which hormone stimulates Sertoli cells to produce androgen binding globulin
(ABG)?

A Luteinizing hormone (LH)

B Follicle stimulating hormone (FSH)

C Gonadotrophin releasing hormone (GnRH)

D Oxytocin

Question 1 Explanation: 
FSH stimulates Sertoli cells to produce androgen binding globulin. This substance binds to
testosterone and keeps it at high concentrations in the seminiferous tubules within the
testes. This is important as high levels are required here for successful spermatogenesis.

Question 2

Which of the following are causes of nephrogenic diabetes insipidus?

A Mutations in the vasopressin (ADH) receptor gene

B Mutations in vasopressin gene

C Sheehan's syndrome

D Lithium

E Post obstructive uropathy

F Amyloidosis

G Atenolol

Question 2 Explanation: 
Nephrogenic diabetes insipidus involves the inability of the kidneys to respond appropriately
to vasopressin (ADH). Anything which impairs the kidney's ability to respond to ADH has the
potential to cause nephrogenic diabetes insipidus.

Question 3

Which one of the following is acromegaly caused by?

A Overproduction of growth hormone (GH)

B Overproduction of vasopressin (antidiuretic hormone)

C Overproduction of adrenocorticotropic hormone (ACTH)

D Overproduction of gonadotrophin releasing hormone (GnRH)

Question 3 Explanation: 
Acromegaly occurs as a result of overproduction of growth hormone. The increased levels of
this hormone causes increased proliferation of a number of tissues which results in the
characteristic features of acromegaly.
 Question 4

What is the most common cause of Cushing's syndrome?

A Ectopic ACTH production

B Adrenal adenoma

C Pituitary adenoma

D Glucocorticoid treatment (iatrogenic)

Question 4 Explanation: 
The most common cause of Cushing's syndrome is the long term use of glucocorticoid
treatments (steroids). These treatments are commonly used to suppress inflammation in
many diseases. If these treatments are used long term they can result in the development of
Cushing's syndrome. As a result, most steroid treatments are only given for short durations
with the smallest dose possible.

Question 5

Which of the following statements correctly describes the pathophysiology of Cushing's

disease?

A Cushing’s disease results from a benign adrenal adenoma secreting excess ACTH.
High levels of ACTH in turn cause increased production of cortisol from the adrenal
cortex.

B Cushing’s disease results from a benign adrenal adenoma secreting excess levels of
cortisol.

C Cushing’s disease results from a benign pituitary adenoma secreting excess levels of
cortisol.

D Cushing’s disease results from a benign pituitary adenoma secreting excess ACTH.
High levels of ACTH in turn causes increased production of cortisol from the adrenal
cortex.

Question 6

Which of the following is the underlying problem in neurogenic diabetes insipidus?

 A Lack of prolactin

B Lack of vasopressin (antidiuretic hormone)

C Overproduction of prolactin

D Overproduction of oxytocin

E Lack of oxytocin

F Overproduction of vasopressin (antidiuretic hormone)

Question 6 Explanation: 
In neurogenic diabetes insipidus the underlying pathology involves the lack of vasopressin
production by the posterior pituitary.

Question 7

Which one of the following hormones binds to the pituitary and stimulates the release of
luteinizing hormone (LH) and follicle stimulating hormone (FSH)?

A Gonadotrophin releasing hormone (GnRH)

B Adrenocorticotropic hormone (ACTH)

C Corticotropic releasing hormone (CRH)

Question 7 Explanation: 
1. The hypothalamus secretes GnRH 2. GnRH travels down to the anterior pituitary gland 3. It
binds to receptors in the pituitary gland 4. This causes release of LH and FSH

Question 8

What is the most common cause of hyperthyroidism?

A Toxic multinodular goitre

B Toxic thyroid adenoma

C Thyroiditis

D Grave's disease
 Question 9

Which one of the following is the main function of aldosterone?

A Decrease in blood volume

B Increase in blood volume

Question 9 Explanation: 
Aldosterone causes reabsorption of sodium and water as well as causing excretion of
potassium. This results in an increase in blood volume.

Question 10

What is the most common cause for the overproduction of growth hormone in acromegaly?

A Pituitary adenoma

B Pituitary lesion

C Hypothalamic lesion

D Hyperplasia of the pituitary stalk

Question 10 Explanation: 
In around 99% of cases, acromegaly is caused by a pituitary adenoma, specifically
overgrowth of the somatotrope cells which are responsible for growth hormone production.
In very rare cases acromegaly can be caused by ectopic production of growth hormone by
carcinoid tumours.

Question 11

What is Addison's disease?

A Addison's disease involves the underproduction of androgens by the adrenal medulla.

B Addison's disease involves the overproduction of cortisol and aldosterone by the

adrenal cortex.

C Addison's disease involves the overproduction of androgens by the adrenal medulla.

 D Addison’s disease is a long-term endocrine disorder in which the adrenal glands do not
produce enough steroid hormones.

Question 12

Which of the following causes of Cushing's syndrome does the phrase "Cushing's disease"
specifically refer to?

A Ectopic ACTH production

B Pituitary adenoma

C Adrenal adenoma

D Iatrogenic

Question 12 Explanation: 
Cushing's disease refers specifically to Cushing's syndrome occurring as a result of a
pituitary adenoma.

Question 13

What of the following statements best describes a toxic thyroid adenoma?

A An autoimmune disease directed against thyroid stimulating hormone (TSH)

receptors. The autoantibodies stimulate the TSH receptors causing increased T3 and
T4 production

B A malignant tumour of the thyroid gland which produces excessive amounts of thyroid
hormones. These arise from the follicular cells of the thyroid gland.

C Inflammation of the thyroid gland due to lymphocytic infiltration causing stored thyroid
hormones to be released into the circulation leading to hyperthyroidism.

D A benign tumour of the thyroid gland which produces excessive amounts of thyroid
hormones. These arise from the follicular cells of the thyroid.

Question 14

In males which hormone stimulates Leydig cells to produce testosterone?

 A Luteinizing hormone (LH)

B Follicle stimulating hormone (FSH)

Question 15

Which of the following are symptoms of Addison's disease?

A Hyperpigmentation

B Weight gain

C Moon face

D Striae

E Diplopia

F Postural hypotension

G Fatigue

H Weight loss

Question 15 Explanation: 
The lack of cortisol results in significant weight loss in the majority of patients. Patients
often feel very unwell and lethargic. Some patients also exhibit hyperpigmentation of their
skin (often mistaken as a "healthy" tan). Some patients also experience postural hypotension
due to the lack of aldosterone.

Question 16

Which of the following hormones are produced in the anterior pituitary gland?

A Growth hormone (GH)

B Luteinizing hormone (LH)

C Prolactin

D Follicle-stimulating hormone (FSH)

 E Thyroid-stimulating hormone (TSH)

F Oxytocin

G Vasopressin (antidiuretic hormone)

H Adrenocorticotrophic hormone (ACTH)

Question 16 Explanation: 
The anterior pituitary is responsible for producing a large number of different hormones.
Each of these hormones is produced by a subset of specialised cells within the anterior
pituitary.

Question 17

Which of the following investigations is the gold standard for diagnosing acromegaly?

A Growth hormone measurement

B Growth hormone releasing hormone measurement

C Oral glucose tolerance test + Growth hormone measurement

D Serum IGF1 measurement

Question 17 Explanation: 
Serum IGF 1 measurement is useful to screen for acromegaly however is not ideal for
diagnosis. Measuring growth hormone alone is not useful as it is secreted in a pulsatile
matter therefore levels vary greatly throughout the day. The oral glucose tolerance test
combined with growth hormone measurement is the ideal combination of investigations to
make the diagnosis.

Question 18

Which of the following are common symptoms of hypothyroidism?

A Oily skin

B Weight loss

C Excessive hair growth

 D Hyporeflexia

E Weight gain

F Hair loss

G Dry skin

Question 19

Which one of the following statements best defines dipsogenic diabetes insipidus?

A Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk

causing malfunction of the hunger mechanism.

B Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus

causing malfunction of the thirst mechanism.

C Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk

causing malfunction of the thirst mechanism.

D Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary gland

causing malfunction of the thirst mechanism.

Question 19 Explanation: 
Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus causing
malfunction of the thirst mechanism. As a result, the individual is excessively thirsty
regardless of their fluid status. The individual, therefore, consumes large volumes of fluid
which suppresses the secretion of vasopressin and increases urine output.

Question 20

Which of the following are Sertoli cells responsible for producing?

A Testosterone

B Oestrogen

C Androgen binding globulin (ABG)

D Gonadotrophin releasing hormone (GnRH)

 Question 21

Which of the following statements best describes Hashimoto's thyroiditis?

A A destructive autoimmune disease caused by auto-reactive antibodies against

thyroglobulin.

B Inflammation of the thyroid gland as the result of a virus. The disease is often
preceded by an upper respiratory tract infection.

C Iodine deficiency

Question 22

Which of the following hormones are stored in the posterior pituitary gland?

A Oxytocin

B Prolactin

C Adrenocorticotropic hormone (ACTH)

D Growth hormone (GH)

E Luteinizing hormone (LH)

F Vasopressin (antidiuretic hormone)

G Follicle stimulating hormone (FSH)

H Thyroid stimulating hormone (TSH)

Question 22 Explanation: 
The posterior pituitary gland is responsible for storing oxytocin and vasopressin.

Question 23

Which of the following statements regarding Cushing's syndrome is correct?

A Women are more likely to develop Cushing's syndrome

 B The incidence of Cushing's syndrome is distributed equally between sexes

C Men are more likely to develop Cushing's syndrome

Question 24

Which of the following are correct regarding the effects of increased levels of growth
hormone in acromegaly?

A Increased levels of growth hormone stimulate increased production of insulin like

growth factor one (IGF1) from the liver

B Increased levels of growth hormone stimulate increased production of insulin like

growth factor one (IGF1) from the adrenal glands

C Increased levels of growth hormone stimulate increased production of vasopressin

from the liver

D Increased levels of growth hormone stimulate increased production of vasopressin

from the adrenal glands

Question 24 Explanation: 
The increased levels of growth hormone stimulate overproduction of IGF1 from the liver.
IGF1 stimulates overgrowth of tissues and alters blood glucose / lipid metabolism.

Question 25

Which of the following are signs of acromegaly?

A Visual field defects (e.g. bi-temporal hemianopia)

B Crowded teeth

C Oily skin

D Increased jaw prominence

E Decrease in tongue size (microglossia)

F Enlargement of feet

G Enlargement of the hands and fingers

 H Enlargement of tongue (macroglossia)

I Prominent supraorbital ridge

J Decrease in foot size

Question 25 Explanation: 
The signs of acromegaly can be very obvious if the disease has been active for a significant
amount of time. The changes in facial features and voice can be very disturbing for the
patient as these are most often irreversible.

Question 26

Which of the following hormones are produced by the adrenal cortex?

A 5-DHEA

B Norepinephrine (noradrenaline)

C Aldosterone

D Epinephrine (adrenaline)

E Cortisol

Question 26 Explanation: 
The adrenal cortex produces cortisol, aldosterone and weak androgens such as 5-DHEA.
Adrenaline and noradrenaline are instead produced by the adrenal medulla.

Question 27

Which of the following are symptoms of acromegaly?

A Visual changes (double vision, reduced vision, tunnel vision)

B Diarrhoea

C Deepening voice

D Headache

E Vomiting
 F Abdominal distention

G Paresthesia and weakness in the hands

H Increased finger ring size

I Excessive sweating (hyperhidrosis)

J Widespread rash

Question 27 Explanation: 
The symptoms of acromegaly can manifest in many different and seemingly unrelated ways.
As a result, patients initially often don't realise the link between their symptoms

Question 28

Which of the following does the adrenal cortex produce?

A Noradrenaline

B Adrenaline

C Aldosterone

D Cortisol

Question 28 Explanation: 
The adrenal cortex is responsible for the production of both cortisol and aldosterone.
Adrenaline and noradrenaline are produced by the adrenal medulla.

Question 29

Which one of the following statements describes the underlying pathology of Grave's
disease?

A A benign tumour of the thyroid gland which produces excessive amounts of thyroid
hormones.

B Consumption of ground beef which has been contaminated with thyroid tissue. The
thyroid tissue contains metabolically active thyroid hormones which causes
hyperthyroidism.
 C An autoimmune disease directed against thyroid stimulating hormone (TSH)
receptors. The autoantibodies stimulate the TSH receptors causing increased T3 and
T4 production.

D Inflammation of the thyroid gland due to lymphocytic infiltration causes the stored
thyroid hormones to be released into the circulation leading to hyperthyroidism.

Question 30

Which one of the following statements is true regarding the prevalence of acromegaly?

A Acromegaly effects a similar number of men and women

B Acromegaly affects twice as many men than it does women

C Acromegaly affects twice as many women than men

Question 30 Explanation: 
The prevalence of acromegaly is equally distributed between sexes.

Question 31

Which is a more sensitive measure of thyroid function?

A Free T3

B Thyroid stimulating hormone (TSH)

C Free T4

Question 31 Explanation: 
The adequate amount of free T3 and T4 in the blood varies significantly between patients.
As a result, TSH provides a sensitive indicator of whether a patient's individual thyroid
hormone levels are adequate for them. If a patient has the correct amount of T3 & T4, their
TSH value will be normal. However, if the TSH is high or low it suggests that the level of
thyroid hormones is not currently at the correct level for that patient. TSH is, therefore, an
incredibly useful indicator when a patient has hypothyroidism and requires thyroxine. By
monitoring the TSH value you can adjust the dose until TSH normalises, at which point you
can be confident you are providing the patient with the correct amount of thyroid hormones.
 Question 32

In regard to the investigation of hyperthyroidism, which one of the following antibodies is

specific to Grave's disease?

A TSH receptor antibodies

B Thyroglobulin antibody

C Thyroid peroxidase antibody

Question 32 Explanation: 
TSH receptor antibodies are highly specific for Grave's disease. The other two antibodies can
be found in both Grave's and Hashimoto's thyroiditis.

Question 33

Which of the following are causes of Addison's disease?

A Adrenoleukodystrophy

B Autoimmune destruction of the adrenal cortex

C Tuberculosis

D Pyelonephritis

Question 34

Which one of the following statements best describes an Addisonian crisis?

A Dangerously high serum cortisol levels

B Severe adrenal insufficiency resulting in dangerously low serum testosterone levels

C Dangerously high levels of testosterone

D Severe adrenal insufficiency resulting in dangerously low serum cortisol levels

Question 35
Which of the following statements best describes Cushing's syndrome?

A Cushing’s syndrome refers to a disease process caused by abnormally low levels of

aldosterone

B Cushing’s syndrome refers to a disease process caused by abnormally high levels of

aldosterone

C Cushing’s syndrome refers to a disease process caused by abnormally low levels of

cortisol

D Cushing’s syndrome refers to a disease process caused by abnormally high levels of

cortisol

Question 35 Explanation: 
Cushing's syndrome occurs as a result of an individual having abnormally high levels of
cortisol. This can be due to a number of different causes.

Question 36

Which of the following are common symptoms of hyperthyroidism?

A Tremor

B Diarrhoea

C Heat intolerance

D Weight loss

E Urinary frequency

F Weight gain

Question 36 Explanation: 
Hyperthyroidism can present with a wide array of symptoms and these often differ
considerably between patients. However symptoms such as weight loss, tremor, heat
intolerance and diarrhoea are quite common.

Question 37

Which of the following is not a symptom of Cushing's syndrome?

 A Weight gain

B Stretch marks

C Weight loss

D Acne

E Easy bruising

Question 37 Explanation: 
Weight gain, rather than weight loss, is a typical symptom of Cushing's syndrome

Question 38

What do Leydig cells produce?

A Testosterone

B Oestrogen

C Androgen binding globulin

D Semen

Question 39

Which of the following are not causes of neurogenic diabetes insipidus?

A Pituitary adenoma

B Mutatations in the vasopressin gene

C Mutatations in the vasopressin (ADH) receptor gene

D Meningitis

E Trauma

F Sheehan's syndrome

G Polycystic kidney disease

Question 39 Explanation: 
Anything which affects the pituitary and its production of vasopressin can ultimately cause
neurogenic diabetes insipidus. Mutations in the ADH receptor gene and polycystic kidneys
are both causes of nephrogenic diabetes insipidus.

Question 40

Which age group does acromegaly most commonly affect?

A 30-50 years

B 55-70 years

C 10-25 years

D 25-40 years

Question 40 Explanation: 
Most who develop acromegaly are between 30-50 years old. Acromegaly would not develop
in young children as their growth plates have not yet fused, so they would develop gigantism
instead.

Question 41

Which of the following statements best describes diabetes insipidus?

A Diabetes insipidus is a disease characterised by the passage of small volumes of

dilute urine

B Diabetes insipidus is a disease characterised by the passage of large volumes of

concentrated urine

C Diabetes insipidus is a disease characterised by the passage of large volumes of dilute

urine

D Diabetes insipidus is a disease characterised by the passage of small volumes of

concentrated urine

Question 41 Explanation: 
Diabetes insipidus is a disease characterised by the passage of large volumes (>3L/24hrs)
of dilute urine (osmolality <300 mOsmol/Kg).
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