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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

1. A 28-year-old woman was referred with an 8-year history of progressive weight gain, hypertension and abdominal striae. She had no family history of note and was not taking any medication.
On examination, her blood pressure was 158/86 mmHg. There was central obesity with abdominal striae. There was mild proximal myopathy of the lower limbs.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium3.4 mmol/L (3.5-4.9)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol180 nmol/L (<50)
An MR scan of pituitary showed an invasive adenoma extending laterally into the cavernous sinuses bilaterally. Superiorly, the adenoma was in contact with, but not distorting, the optic chiasm. Formal visual field examination was normal.
What is the most appropriate next step in management?

A) adrenolytic therapy
B) somatostatin agonist therapy
C) pituitary radiotherapy
D) bilateral adrenalectomy
E) trans-sphenoidal hypophysectomy

2. A 54-year-old man was referred from the urology department with erectile dysfunction.
On examination, he had normal secondary sexual characteristics. Testicular volume was
estimated at 15 mL bilaterally.
Investigations:
random plasma glucose8.0 mmol/L
serum testosterone8.1 nmol/L (9.0-35.0) plasma follicle-stimulating hormone3.4 U/L (1.0-7.0) plasma luteinising hormone4.7 U/L (1.0-10.0) serum prolactin410 mU/L (<360)
What is the most appropriate next step in management?

A) check for macroprolactinaemia
B) prescribe sildenafil
C) serum testosterone (09.00 h)
D) fasting plasma glucose
E) prescribe testosterone replacement

3. A 72-year-old woman presented with a painless swelling in the front of the neck, which she had first noticed 2-3 months previously. She was otherwise well, with no symptoms of mass effect in her neck, and was not taking any medication.
On examination, her thyroid gland was moderately enlarged, and felt uniformly nodular. There was no associated lymphadenopathy. Her pulse was 78 beats per minute and regular, and there were no signs of thyrotoxicosis.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T424.8 pmol/L (10.0-22.0)
serum free T310.3 pmol/L (3.0-7.0)
technetium-99m scan of thyroid (20-min uptake)patchy uptake in both thyroid lobes
What is the most appropriate management?

A) radioiodine
B) repeat thyroid function tests after 6 months
C) partial thyroidectomy
D) total thyroidectomy
E) carbimazole plus levothyroxine

4. A 54-year-old woman attended clinic for routine follow-up. She had Cushing's syndrome secondary to ectopic adrenocorticotropic hormone syndrome with no primary source identified.
She had declined bilateral adrenalectomy. Routine medication included metyrapone 500 mg three times daily, ketoconazole 200 mg once daily and hydrocortisone 10 mg in the morning and 5 mg in the evening.
Metyrapone inhibits the action of which enzyme in steroidogenesis?

A) 5?-reductase
B) 11?-hydroxylase
C) 21-hydroxylase
D) 17?-hydroxylase
E) 3?-hydroxysteroid dehydrogenase

5. A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no
oedema.
Investigations:
serum sodium118 mmol/L (137-144)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine72 umol/L (60-110)
random serum cortisol (08.00 h on day of review)480 nmol/L
serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0)
random urinary sodium60 mmol/L
What is the most appropriate interpretation of these data?

A) the urinary sodium concentration is diagnostic of cerebral salt wasting
B) they are consistent with syndrome of inappropriate antidiuresis
C) intravascular volume depletion
D) the diagnosis would be helped by measurement of plasma vasopressin concentration
E) a short tetracosactide (Synacthen@) test (250 micrograms) is required to exclude secondary hypoadrenalism

Solutions: