Endocrinology
Final Test Review
(Questions & Solutions)
2025
1
, ADRENAL DISORDERS (5 Questions)
1. A 38-year-old woman develops progressive weight gain, hypertension,
purple striae, and glucose intolerance. Morning cortisol is elevated and
diurnal rhythm is lost. Which test best distinguishes Cushing disease from
ectopic ACTH secretion?
A) High-dose dexamethasone suppression test
B) Serum DHEA-S level
C) Plasma renin activity
D) 24-hour urinary metanephrines
ANS: A
Rationale: In Cushing disease (pituitary ACTH), high-dose dexamethasone
suppresses cortisol, whereas ectopic ACTH sources do not suppress.
2. A 25-year-old man with episodic headaches, sweating, and tachycardia
has a 2-cm adrenal mass and elevated plasma free metanephrines. Best
initial therapy?
A) Phenoxybenzamine before surgery
B) Immediate adrenalectomy
C) Spironolactone
D) High-dose corticosteroids
ANS: A
Rationale: α-blockade with phenoxybenzamine before surgery prevents
perioperative hypertensive crises in pheochromocytoma.
3. A 50-year-old with hyperpigmentation, fatigue, and weight loss has
low cortisol, high ACTH, and 21-hydroxylase antibodies. Diagnosis?
A) Primary adrenal insufficiency (Addison’s)
B) Secondary adrenal insufficiency
C) Congenital adrenal hyperplasia
D) Cushing syndrome
ANS: A
Rationale: Autoimmune destruction of adrenals causes primary
2
, insufficiency, leading to high ACTH and hyperpigmentation.
4. A critically ill patient on long-term steroid therapy is stressed by
surgery and develops hypotension and hypoglycemia despite ongoing
corticosteroids. Best management?
A) IV hydrocortisone stress dosing
B) Taper steroids rapidly
C) Add fludrocortisone only
D) Begin fludrocortisone stress dosing
ANS: A
Rationale: Acute adrenal crisis in chronic steroid users requires high-dose
IV hydrocortisone to cover stress demands.
5. A newborn with salt wasting, virilization, and 17-hydroxyprogesterone
of 5,000 ng/dL suggests:
A) 21-hydroxylase deficiency
B) 11β-hydroxylase deficiency
C) Cushing syndrome
D) Addison’s disease
ANS: A
Rationale: Markedly elevated 17-hydroxyprogesterone in a salt-wasting
infant is classic for 21-hydroxylase–deficient congenital adrenal
hyperplasia.
---
DIABETES MELLITUS (5 Questions)
6. A 45-year-old with obesity and family history of T2DM has fasting
glucose 128 mg/dL and HbA1c 6.8%. Next step?
A) Start metformin and lifestyle modification
B) Insulin therapy
C) Sulfonylurea monotherapy only
D) Recheck in one year
ANS: A
Rationale: T2DM (HbA1c ≥6.5% or fasting ≥126) is managed first-line with
3
Final Test Review
(Questions & Solutions)
2025
1
, ADRENAL DISORDERS (5 Questions)
1. A 38-year-old woman develops progressive weight gain, hypertension,
purple striae, and glucose intolerance. Morning cortisol is elevated and
diurnal rhythm is lost. Which test best distinguishes Cushing disease from
ectopic ACTH secretion?
A) High-dose dexamethasone suppression test
B) Serum DHEA-S level
C) Plasma renin activity
D) 24-hour urinary metanephrines
ANS: A
Rationale: In Cushing disease (pituitary ACTH), high-dose dexamethasone
suppresses cortisol, whereas ectopic ACTH sources do not suppress.
2. A 25-year-old man with episodic headaches, sweating, and tachycardia
has a 2-cm adrenal mass and elevated plasma free metanephrines. Best
initial therapy?
A) Phenoxybenzamine before surgery
B) Immediate adrenalectomy
C) Spironolactone
D) High-dose corticosteroids
ANS: A
Rationale: α-blockade with phenoxybenzamine before surgery prevents
perioperative hypertensive crises in pheochromocytoma.
3. A 50-year-old with hyperpigmentation, fatigue, and weight loss has
low cortisol, high ACTH, and 21-hydroxylase antibodies. Diagnosis?
A) Primary adrenal insufficiency (Addison’s)
B) Secondary adrenal insufficiency
C) Congenital adrenal hyperplasia
D) Cushing syndrome
ANS: A
Rationale: Autoimmune destruction of adrenals causes primary
2
, insufficiency, leading to high ACTH and hyperpigmentation.
4. A critically ill patient on long-term steroid therapy is stressed by
surgery and develops hypotension and hypoglycemia despite ongoing
corticosteroids. Best management?
A) IV hydrocortisone stress dosing
B) Taper steroids rapidly
C) Add fludrocortisone only
D) Begin fludrocortisone stress dosing
ANS: A
Rationale: Acute adrenal crisis in chronic steroid users requires high-dose
IV hydrocortisone to cover stress demands.
5. A newborn with salt wasting, virilization, and 17-hydroxyprogesterone
of 5,000 ng/dL suggests:
A) 21-hydroxylase deficiency
B) 11β-hydroxylase deficiency
C) Cushing syndrome
D) Addison’s disease
ANS: A
Rationale: Markedly elevated 17-hydroxyprogesterone in a salt-wasting
infant is classic for 21-hydroxylase–deficient congenital adrenal
hyperplasia.
---
DIABETES MELLITUS (5 Questions)
6. A 45-year-old with obesity and family history of T2DM has fasting
glucose 128 mg/dL and HbA1c 6.8%. Next step?
A) Start metformin and lifestyle modification
B) Insulin therapy
C) Sulfonylurea monotherapy only
D) Recheck in one year
ANS: A
Rationale: T2DM (HbA1c ≥6.5% or fasting ≥126) is managed first-line with
3
