Welcome to your 5. 🧬 Adrenal & Neuroendocrine Disorders Arena — 60 Integrated MCQs
1.
A woman with endogenous Cushing syndrome is treated with a glucocorticoid receptor antagonist. Her metabolic features improve, but serum cortisol remains elevated. Which principle best explains this finding?
2.
A patient with hypercortisolism is treated with ketoconazole. Cortisol production decreases because the drug interferes with several adrenal steroidogenic enzymes. Which consequence may also occur because androgen synthesis is reduced?
3.
A 48-year-old woman has fatigue, weight loss, hyponatremia and low serum cortisol. The clinician is uncertain whether the disorder is primary or secondary. Which single additional measurement is most useful for localizing the defect?
4.
A 36-year-old woman presents with fatigue, weight loss and dizziness. She has no skin pigmentation. Serum cortisol is low, ACTH is low, potassium is normal and sodium is reduced. Which mechanism best explains the sodium abnormality?
5.
A 55-year-old man presents with sudden severe weakness, vomiting, hypotension and altered consciousness after bilateral adrenal hemorrhage. Which classification best describes his endocrine disorder?
6.
A patient receiving aminoglutethimide for adrenal steroid suppression develops excessive reduction of adrenal hormone production. Which feature of its mechanism explains why several steroid pathways can be affected?
7.
A woman with autoimmune Addison disease is receiving long-term hormone replacement. Her postural symptoms and serum potassium remain abnormal despite adequate glucocorticoid replacement. Which component of treatment most directly addresses this problem?
8.
A 34-year-old woman presents with chronic weakness, anorexia and weight loss. She has marked pigmentation and postural hypotension. Before treatment, which laboratory pattern would most strongly support loss of both glucocorticoid and mineralocorticoid function?
9.
A 38-year-old woman has an adrenal medullary mass removed after episodes of severe hypertension. Histology shows nests of chromaffin cells with nuclear pleomorphism. No vascular invasion is identified. Which finding would most reliably establish malignant behavior?
10.
A 46-year-old patient has a suspected pancreatic neuroendocrine tumor that is not clearly localized on routine cross-sectional imaging. The tumor is believed to be well differentiated and to express neuroendocrine receptors. Which investigation can provide additional functional localization?
11.
A 36-year-old man has recurrent hypertensive episodes and palpitations. After biochemical confirmation of pheochromocytoma, he is started on appropriate preoperative therapy. A beta blocker is added later because tachycardia persists. What is the therapeutic purpose of giving the first drug before the beta blocker?
12.
A 57-year-old woman with metastatic intestinal neuroendocrine tumor develops progressive exertional dyspnea and peripheral edema after years of secretory symptoms. Echocardiography shows severe tricuspid valve dysfunction. Which pathological process most likely produced the cardiac lesion?
13.
A 32-year-old woman has hypercalcemia from multigland parathyroid disease and a pancreatic gastrinoma. Imaging later demonstrates a pituitary lesion. Several first-degree relatives have endocrine tumors. Which genetic abnormality best fits this pattern?
14.
A 45-year-old man undergoes investigation for adrenal insufficiency. Morning cortisol is low and ACTH is markedly elevated. An ACTH stimulation test produces little increase in serum cortisol. Which interpretation is most appropriate?
15.
A patient with chronic primary adrenal insufficiency misses several days of replacement therapy because of severe gastroenteritis. Which combination of physiological disturbances most directly places the patient at risk of circulatory collapse?
16.
A 60-year-old patient has a well-differentiated small-intestinal neuroendocrine tumor. CT shows a fibrotic mesenteric mass tethering adjacent bowel loops. He develops intermittent abdominal pain and features of partial obstruction. Which process best explains these findings?
17.
Histopathological assessment of a pancreatic neuroendocrine tumor confirms neuroendocrine differentiation. The pathologist also evaluates mitotic activity and Ki-67 expression. What is the main purpose of these additional measurements?
18.
A patient with pituitary disease has cortisol deficiency and central hypothyroidism. Both deficiencies require treatment. Which management principle is most important before substantially increasing thyroid hormone replacement?
19.
A 42-year-old woman with chronic adrenal insufficiency presents with increasing fatigue, nausea and postural dizziness. She has diffuse pigmentation of the buccal mucosa and palmar creases. Serum cortisol is reduced. Which additional finding would best establish that the defect is at the adrenal rather than pituitary level?
20.
A patient presents with weakness, vomiting, abdominal discomfort and hypotension. Laboratory testing shows hyponatremia and hyperkalemia. Which sequence best explains the development of these electrolyte abnormalities?
21.
A 34-year-old patient with a family history of MEN2 has medullary thyroid carcinoma and an adrenal mass. Biochemical testing confirms catecholamine excess. Thyroid surgery is also planned. Which management principle is most appropriate?
22.
A patient with a gastro-entero-pancreatic neuroendocrine tumor has liver metastases and persistent hormone-related symptoms. Histology shows a well-differentiated tumor, and receptor imaging is positive. Which principle should guide further treatment planning?
23.
A 47-year-old woman with endogenous hypercortisolism has no obvious adrenal mass on initial examination. Before localization imaging is pursued, which diagnostic principle is most appropriate?
24.
A newborn girl has virilized external genitalia, dehydration, hypotension and hyperkalaemia. Congenital adrenal hyperplasia is suspected. Which hormonal disturbance most directly explains the circulatory and electrolyte abnormalities?
25.
A 41-year-old woman has recurrent fasting confusion and sweating. During a symptomatic episode, plasma glucose is low while both insulin and C-peptide are inappropriately elevated. Which interpretation is most appropriate?
26.
A patient with a destructive pituitary lesion has low ACTH and low cortisol. Several months later, an ACTH stimulation test shows a reduced cortisol response. Which explanation best accounts for this finding?
27.
A 55-year-old man is found to have a pancreatic neuroendocrine tumor after investigation of abdominal discomfort and weight loss. He has no recognizable hormone-excess syndrome, and liver metastases are present at diagnosis. Which characteristic best explains the relatively late presentation?
28.
A 50-year-old man with known Addison disease develops fever and persistent vomiting due to an acute infection. He becomes confused and his blood pressure falls markedly. What is the most appropriate immediate management principle?
29.
A 52-year-old woman with bilateral adrenal hyperplasia is started on spironolactone. Several months later she develops menstrual irregularity. Which property of the drug best explains this adverse effect?
30.
A patient with Cushing syndrome develops fasting hyperglycaemia despite no previous history of diabetes. Which mechanism contributes most directly to this metabolic abnormality?
31.
A 39-year-old man has confirmed ACTH-dependent Cushing syndrome. Cortisol shows significant suppression during a high-dose dexamethasone suppression test. Which source is most consistent with this response?
32.
Two patients have similar degrees of cortisol deficiency. Patient X has autoimmune destruction of both adrenal cortices, while patient Y has ACTH deficiency from a pituitary lesion. Which finding is most likely to be substantially more prominent in patient X because of loss of mineralocorticoid function?
33.
A 41-year-old woman is being investigated for suspected Addison disease after developing progressive fatigue, postural hypotension and pigmentation. Low cortisol with elevated ACTH confirms primary adrenal failure. Which next investigation is most appropriate for identifying a structural adrenal cause when infection, hemorrhage or malignancy is suspected?
34.
A 45-year-old man has resistant hypertension. Laboratory testing shows increased aldosterone activity with suppressed renin. CT demonstrates small nodules in both adrenal glands. Which investigation is most useful when deciding whether one or both adrenal glands are responsible before surgery?
35.
A 47-year-old woman has progressive virilization, central obesity and hypertension. Imaging reveals a large irregular adrenal cortical mass with heterogeneous areas of hemorrhage and necrosis. Which diagnosis is most likely?
36.
A 33-year-old woman with Addison disease remains hypotensive and dehydrated during an acute adrenal crisis. Which two abnormalities act together most directly to produce this cardiovascular deterioration?
37.
A child with congenital adrenal hyperplasia receives long-term glucocorticoid replacement. In addition to replacing deficient hormone activity, what is an important therapeutic effect of this treatment?
38.
A patient with primary hyperaldosteronism has persistent hypertension but no generalized edema. Which physiological response best explains the relative absence of marked edema?
39.
A patient with suspected adrenal crisis is severely hypotensive and confused. Blood samples for cortisol and ACTH have not yet been obtained. Which approach best reflects appropriate undergraduate management?
40.
A patient with a metastatic well-differentiated gastro-entero-pancreatic neuroendocrine tumor has persistent flushing and secretory diarrhea. Imaging confirms somatostatin-receptor expression. Which treatment is most useful for controlling the hormone-mediated symptoms?
41.
A patient receiving prolonged systemic glucocorticoid therapy develops recurrent infections with relatively mild inflammatory signs. Which drug effect best explains this presentation?
42.
A 39-year-old woman has progressive fatigue and weight loss. Her morning cortisol is low. ACTH is also low, and MRI demonstrates a pituitary lesion. Which additional finding would most strongly support a central rather than primary adrenal disorder?
43.
A 29-year-old man with biochemically confirmed pheochromocytoma undergoes abdominal imaging. Bilateral adrenal masses are identified, and his father had surgery for an endocrine tumor at a young age. Which additional step is most appropriate?
44.
A 60-year-old man develops secondary adrenal insufficiency after pituitary surgery. He requires glucocorticoid replacement but not routine fludrocortisone. Which anatomical-functional relationship best explains this treatment difference from Addison disease?
45.
A patient with severe inflammatory disease requires a potent glucocorticoid with minimal sodium-retaining activity. Which property makes dexamethasone particularly suitable?
46.
A patient with a functional pancreatic neuroendocrine tumor develops profuse diarrhea, weakness and marked hypokalemia. Before definitive tumor-directed therapy, which immediate management principle is most important?
47.
A patient with MEN1 is found to have more than one pancreatic neuroendocrine lesion during evaluation. Which feature best explains why this differs from many sporadic endocrine tumors?
48.
A patient with an undiagnosed adrenal tumor develops severe hypertension, tachyarrhythmia and acute pulmonary edema during abdominal surgery when the mass is manipulated. Which mechanism best explains this deterioration?
49.
A patient is prescribed prednisone for a systemic inflammatory disorder. Which pharmacokinetic feature is relevant to its clinical use?
50.
A 36-year-old woman has been receiving high-dose systemic glucocorticoids for several months. Her treatment is being reduced gradually rather than stopped abruptly. Which physiological change during prolonged therapy makes gradual withdrawal necessary?
51.
A 44-year-old man with episodic adrenergic symptoms has markedly abnormal catecholamine-related biochemical testing. Which is the most appropriate next step for anatomical localization?
52.
A 42-year-old woman has progressive weight gain, facial fullness, easy bruising, proximal muscle weakness and hypertension. Biochemical testing confirms endogenous hypercortisolism. Plasma ACTH is markedly suppressed. Which source is most likely responsible?
53.
A resected adrenal cortical tumor is large and poorly circumscribed. Histology demonstrates atypical mitoses, necrosis and penetration through the capsule. Which pathological feature has the greatest significance for its biological behavior?
54.
A 47-year-old woman with chronic Addison disease is clinically stable on replacement therapy. She is admitted with severe pneumonia. Why must her glucocorticoid requirement be reconsidered during this illness?
55.
A 9-year-old boy has rapid linear growth, early development of secondary sexual characteristics and advanced skeletal maturation due to excess adrenal androgen production. What long-term growth outcome may result if the disorder is untreated?
56.
A patient with recurrent peptic ulceration has markedly increased gastrin secretion from a neuroendocrine tumor. He also has persistent diarrhea. Which mechanism best explains the gastrointestinal manifestations?
57.
A 58-year-old man with a pituitary mass develops fatigue, weight loss and reduced serum cortisol. His blood pressure is mildly reduced, but he has no salt craving or pigmentation and his potassium is normal. Which physiological feature best explains this pattern?
58.
A 58-year-old woman treated with systemic glucocorticoids for several months develops vertebral compression fractures. Which pharmacological effect contributes most to this complication?
59.
A woman with longstanding hypercortisolism develops broad violaceous abdominal striae and easy bruising. Which tissue effect best explains these findings?
60.
A patient with severe endogenous Cushing syndrome is treated with a drug that reduces cortisol synthesis. During therapy, acne and worsening hirsutism develop because androgenic steroid precursors accumulate. Which drug is most likely responsible?
