HPT Axis And Disorder Clinical Case

Question 1

Clinical Case Question

Answer 1

Answer

Question 2

A 45-year-old woman presents with irregular menstruation, galactorrhea, and infertility. Serum prolactin is elevated. What is the most likely diagnosis?

Answer 2

Prolactinoma.

Question 3

A 55-year-old man with uncontrolled hypertension has episodes of palpitations, headache, and sweating. His plasma metanephrines are elevated. What is the diagnosis?

Answer 3

Pheochromocytoma.

Question 4

A 30-year-old woman presents with amenorrhea, fatigue, and cold intolerance. TSH and free T4 are both low. What is the most likely diagnosis?

Answer 4

Secondary hypothyroidism due to pituitary dysfunction.

Question 5

A 50-year-old woman with a history of prolonged corticosteroid use presents with fatigue, weight loss, and hypotension. What is the likely diagnosis?

Answer 5

Secondary adrenal insufficiency due to chronic steroid use.

Question 6

A 25-year-old man has a large pituitary adenoma and complains of tunnel vision. What is the likely visual defect?

Answer 6

Bitemporal hemianopia due to optic chiasm compression.

Question 7

A 7-year-old boy presents with short stature and delayed bone age. GH levels are low, and IGF-1 is decreased. What is the most likely diagnosis?

Answer 7

Growth hormone deficiency.

Question 8

A 65-year-old man with a pituitary tumor presents with coarse facial features, enlarged hands, and glucose intolerance. What is the diagnosis?

Answer 8

Acromegaly due to excess GH secretion.

Question 9

A 40-year-old woman presents with excessive thirst and urination. Serum sodium is high, and urine osmolality is low. What is the most likely diagnosis?

Answer 9

Diabetes insipidus.

Question 10

A patient with a history of traumatic brain injury develops polyuria and polydipsia. Water deprivation test shows no increase in urine osmolality. What is the diagnosis?

Answer 10

Central diabetes insipidus.

Question 11

A 28-year-old woman presents with fatigue, nausea, and hyperpigmentation. Serum cortisol is low, and ACTH is high. What is the diagnosis?

Answer 11

Primary adrenal insufficiency (Addison’s disease).

Question 12

A 45-year-old man presents with hypertension, hypokalemia, and metabolic alkalosis. Plasma aldosterone is high, and renin is low. What is the likely diagnosis?

Answer 12

Primary hyperaldosteronism (Conn’s syndrome).

Question 13

A 50-year-old man presents with persistent headaches and decreased libido. Serum testosterone and LH are low. What is the most likely diagnosis?

Answer 13

Hypogonadotropic hypogonadism due to pituitary dysfunction.

Question 14

A 60-year-old man presents with lethargy, weight gain, and cold intolerance. TSH is low, and free T4 is low. What is the diagnosis?

Answer 14

Secondary hypothyroidism.

Question 15

A 30-year-old man presents with episodic hypertension and a family history of multiple endocrine neoplasia type 2A. What condition should be suspected?

Answer 15

Pheochromocytoma.

Question 16

A 22-year-old woman presents with irregular periods, acne, and hirsutism. Serum testosterone and DHEA-S are elevated. What is the likely diagnosis?

Answer 16

Androgen-secreting adrenal tumor.

Question 17

A 10-year-old girl presents with early breast development and pubic hair growth. What condition should be suspected?

Answer 17

Precocious puberty due to hypothalamic-pituitary axis activation.

Question 18

A 40-year-old man presents with obesity, moon facies, and proximal muscle weakness. His 24-hour urine cortisol is elevated. What is the most likely diagnosis?

Answer 18

Cushing’s syndrome.

Question 19

A patient with suspected Cushing’s syndrome has undetectable ACTH. What is the likely cause?

Answer 19

Adrenal adenoma (ACTH-independent Cushing’s syndrome).

Question 20

A 50-year-old woman presents with severe postpartum hemorrhage and later develops fatigue, amenorrhea, and low cortisol levels. What is the likely diagnosis?

Answer 20

Sheehan’s syndrome (postpartum pituitary infarction).

Question 21

A 70-year-old man presents with severe hyponatremia, confusion, and euvolemia. His urine osmolality is inappropriately high. What is the diagnosis?

Answer 21

SIADH (Syndrome of Inappropriate ADH Secretion).

Question 22

A 16-year-old boy presents with delayed puberty, anosmia, and low testosterone levels. What is the most likely diagnosis?

Answer 22

Kallmann syndrome (congenital GnRH deficiency).

Question 23

A 45-year-old woman presents with galactorrhea, infertility, and headache. MRI shows a pituitary mass. What is the likely diagnosis?

Answer 23

Prolactinoma.

Question 24

A 5-year-old girl presents with rapid growth, early pubic hair, and advanced bone age. What is the most likely diagnosis?

Answer 24

Congenital adrenal hyperplasia (CAH).

Question 25

A patient with a non-functioning pituitary adenoma develops secondary adrenal insufficiency. What hormone is deficient?

Answer 25

ACTH.

Question 26

A 28-year-old woman with a history of hypothalamic dysfunction presents with polyuria, polydipsia, and dilute urine. What test is used to confirm the diagnosis?

Answer 26

Water deprivation test.

Question 27

A 60-year-old man with a history of small cell lung cancer develops severe hyponatremia. Urine osmolality is high despite low plasma osmolality. What is the diagnosis?

Answer 27

SIADH.

Question 28

A 35-year-old woman presents with recurrent kidney stones, constipation, and depression. Serum calcium is high, and PTH is elevated. What is the likely diagnosis?

Answer 28

Primary hyperparathyroidism.

Question 29

A 30-year-old woman presents with easy bruising, weight gain, and hypertension. Low-dose dexamethasone suppression test fails to suppress cortisol. What is the likely diagnosis?

Answer 29

Cushing’s syndrome.

Question 30

A patient with pituitary surgery develops low cortisol levels but normal aldosterone. What is the likely cause?

Answer 30

Secondary adrenal insufficiency due to ACTH deficiency.

Question 31

A 50-year-old man presents with headaches, visual field defects, and low levels of pituitary hormones. MRI shows a large sellar mass. What is the diagnosis?

Answer 31

Non-functioning pituitary adenoma.

Question 32

A 45-year-old woman with recurrent DVTs has elevated ACTH and cortisol levels. What is the suspected condition?

Answer 32

Cushing’s disease (ACTH-secreting pituitary adenoma).

Question 33

A 12-year-old boy presents with short stature and delayed puberty. GH levels are low. What is the likely diagnosis?

Answer 33

Growth hormone deficiency.

Question 34

A 70-year-old man presents with fatigue, hypotension, and hyperpigmentation. ACTH is high, and cortisol is low. What is the diagnosis?

Answer 34

Primary adrenal insufficiency (Addison’s disease).

Question 35

A 30-year-old woman presents with infertility and high FSH and LH levels. What is the likely diagnosis?

Answer 35

Primary ovarian failure.

Question 36

A 35-year-old man presents with headache, sweating, and hypertension. Plasma metanephrines are elevated. What is the most likely diagnosis?

Answer 36

Pheochromocytoma.

Question 37

A 40-year-old woman presents with an enlarging pituitary mass and bitemporal hemianopia. What is the best initial imaging modality?

Answer 37

MRI of the pituitary.