From the information presented in this chapter, which of the following statements best defines

Which of the following are common symptoms of hypothyroidism?

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

Question 2 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.

Which of the following are signs of acromegaly?

Question 3 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.

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

Question 4 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.

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

Question 5 Explanation: 

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

Which is a more sensitive measure of thyroid function?

Question 6 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.

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

Which of the following does the adrenal cortex produce?

Question 8 Explanation: 

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

In males which hormone stimulates Leydig cells to produce testosterone?

What is the most common cause of hyperthyroidism?

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

Question 11 Explanation: 

The posterior pituitary gland is responsible for storing oxytocin and vasopressin.

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

Question 12 Explanation: 

The prevalence of acromegaly is equally distributed between sexes.

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

Question 13 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.

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

Question 14 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.

Which one of the following is acromegaly caused by?

Question 15 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.

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

Question 16 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.

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

Question 17 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.

In regard to the investigation of hyperthyroidism, which one of the following antibodies is specific to Grave's disease?

Question 18 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.

Which of the following are Sertoli cells responsible for producing?

What do Leydig cells produce?

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

Question 21 Explanation: 

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

Which of the following statements best describes diabetes insipidus?

Question 22 Explanation: 

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

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

Question 23 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.

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

Question 24 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.

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

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

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

What is Addison's disease?

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

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

Question 30 Explanation: 

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

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

Question 31 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.

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

Question 32 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.

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

Which of the following are common symptoms of hyperthyroidism?

Question 34 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.

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

Question 35 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

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

Question 36 Explanation: 

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

Which of the following are symptoms of acromegaly?

Question 37 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

Which of the following are causes of nephrogenic diabetes insipidus?

Question 38 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.

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

Question 39 Explanation: 

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

Which age group does acromegaly most commonly affect?

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.

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

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