ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION 2023-2024 ACTUAL EXAM 180 QUESTIONS AND
CORRECT DETAILED ANSWERS
What are primary, secondary, and tertiary disease? - (answer) Primary - problem with the gland that
secretes the hormone (ie: thyroid doesn't produce thyroid hormone)
Secondary - problem is the gland that controls the primary gland (ie. pituitary doesn't produce TSH to
stimulate the thyroid)
Tertiary - problem with the gland that controls the secondary gland that controls the primary gland (ie.
hypothalamus not producing TRH ->no TSH from pituitary -> no T3/T4 from thyroid)
How does the hypothalamus control the pituitary? - (answer) Controls the anterior pituitary via
hormones
Controls the posterior pituitary via neurohypophysis - direct nerve stimulation
Posterior pituitary functions - (answer) Secrete ADH and oxytocin
ADH regulation - (answer) Anterior pituitary - osmoreceptors to control ADH release and thirst
Increased release rapidly with elevated osmolarity
Also see increased release with nausea
ADH osmolar release set point is affected by:
Lower set point (release at lower osm) with pregnancy and pre-menses
Higher set point with chronic hypovolemia, acute HTN, corticosteroids
Anterior pituitary - hormones and controls (6 hormones) - (answer) 1. ACTH - peak 3-4 am, nadir 10-
11pm; stimulates corticosteroids and androgens from adrenals; increase with corticotropin releasing
hormone, physical/psych stress
2. Growth hormone - GHRH increases, somatastatin decreases, both from hypothalamus
3. LH & FSH - produced by gonadotrophs; increased by pulsatile secretion of GnRH from hypothalamus;
Inhibin from ovary & testes decreases FSH (only) production
4. PRL - tonic inhibition from hypothalamic dopamine; increase with sleep, stress, lactation, nipple
stimulation; Metaclopramine, phenothiazines (decrease dopamine) increase PRL; Hypothyroid modestly
increases PRL
5. TSH - stim by TRH from hypothalamus, inhibited by T3, T4, somatastatin
,ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION 2023-2024 ACTUAL EXAM 180 QUESTIONS AND
CORRECT DETAILED ANSWERS
Pituitary adenoma cell types - (answer) 1. Lactotrophs - secrete PRL; tied, most common
macroademona
2. Gonadotrophs -tied, most common macroademona; presents as mass effect +/- silent or panhypopit
or gonadotropin hypersecretion
3. Somatotrophs- acromegaly
4. Corticotrophs - cushings
5. Thyrotrophs - hyperthyroidism (least common)
6. Mixed (somatotrophs+lactotrophs) - acromegaly + hyperPRL
Mass effect sx of pituitary mass - (answer) HA, diplopia, visual field defect, seizures; occasionally can
get CNS rhinorrhea
Dx of pituitary adenoma - (answer) Sx first
Check MRI
Labs - PRL, IGF-1 (for acromegaly), 24 hr urine free cortisol or 1mg overnight dexamethasone
suppression test (for excess) or ACTH stim test (for deficiency), TSH, FT4, alpha subunit of FSH, LH
(confirms pituitary origin)
If mass on MRI, but all labs normal, likely a non-pituitary tumor - craniopharyngioma, meningioma,
eosinophilic granuloma, histiocytosis X, pituitary mets
Empty sella syndrome - (answer) Can be misread and be normal
multiparous women in 90% - pituitary compressed by CSF, but functions normally
No treatment if no hormone abnormalities
Symptoms and labs in prolactinoma - (answer) Most common functional tumors; usually
microadenomas, can be space occupying lesions
Elevated PRL->decreased release of GnRH->decreased LH/FSH-> decreased libido, ED in men,
amennorhea and hirsutism in females; Increased size=increased PRL, so if > 1cm and PRL<100, it's not a
prolactinoma
Men present later->only decreased libido, so present as space occupying lesion (visual field defects)
Can cause galactorrhea in women, decreased bone mineralization
, ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION 2023-2024 ACTUAL EXAM 180 QUESTIONS AND
CORRECT DETAILED ANSWERS
Causes of increased PRL - (answer) Prolactinoma, phenothiazines, amitriptyline, metaclopramide (all
decreased dopamine), estrogen (inhibits dopamine->elevated PRL in pregnancy), hypothyroidism
Treatment for prolactinoma - (answer) Begin treatment when neuro sx from size or sx of
hypogonadism
Medical - dopamine agonists: Cabergoline and bromocriptine
Cabergoline -better tolerated, less nausea, 2x/wk dosing; increased valve dz if high doses,
contraindicated with valve dz, known lung dz, retroperitoneal fibrosis
Surgery - is can't tolerate meds; trtanssphenoidal; ofter rucurs
Radiation- to eradicate residual tumor post-surgery
Treating prolactinoma in pregnancy - (answer) Stop meds
Observe for sx, do visual field testing
1/3 enlarge in pregnancy - if enlarges enough to cause sx, restart bromocriptine (safe in pregnancy)
Growth hormone regulation - (answer) Suppressed - hyperglycemia, somatastatin, chronic steroids
Stimulated by - hypoglycemia, estrogens
GH -> liver -> IGF-1 ->effects
Acromegaly sx - (answer) Insidious onset, usually 10+yr to dx
Enlarged hands, feet, coarse facial features, deepened voice, carpal tunnel, acanthosis nigricans, skin
tags; jaw growth causing dental abnormalities
Cardiac - ischemic HD, cardiomyopathy, diastolic HF, HTN, LVH; increased risk of CVA, DM, OSA, colon
polyps, malignancy
Untreated, lifespan reduced 10+ yrs
Dx of acromegaly - (answer) 99% seen by pituitary ademona on CT or MRI
Check high age adjusted IGF-1 level to screen
Confirm - GH doesn't suppress to <1 with glucose load
CORRECT DETAILED ANSWERS
What are primary, secondary, and tertiary disease? - (answer) Primary - problem with the gland that
secretes the hormone (ie: thyroid doesn't produce thyroid hormone)
Secondary - problem is the gland that controls the primary gland (ie. pituitary doesn't produce TSH to
stimulate the thyroid)
Tertiary - problem with the gland that controls the secondary gland that controls the primary gland (ie.
hypothalamus not producing TRH ->no TSH from pituitary -> no T3/T4 from thyroid)
How does the hypothalamus control the pituitary? - (answer) Controls the anterior pituitary via
hormones
Controls the posterior pituitary via neurohypophysis - direct nerve stimulation
Posterior pituitary functions - (answer) Secrete ADH and oxytocin
ADH regulation - (answer) Anterior pituitary - osmoreceptors to control ADH release and thirst
Increased release rapidly with elevated osmolarity
Also see increased release with nausea
ADH osmolar release set point is affected by:
Lower set point (release at lower osm) with pregnancy and pre-menses
Higher set point with chronic hypovolemia, acute HTN, corticosteroids
Anterior pituitary - hormones and controls (6 hormones) - (answer) 1. ACTH - peak 3-4 am, nadir 10-
11pm; stimulates corticosteroids and androgens from adrenals; increase with corticotropin releasing
hormone, physical/psych stress
2. Growth hormone - GHRH increases, somatastatin decreases, both from hypothalamus
3. LH & FSH - produced by gonadotrophs; increased by pulsatile secretion of GnRH from hypothalamus;
Inhibin from ovary & testes decreases FSH (only) production
4. PRL - tonic inhibition from hypothalamic dopamine; increase with sleep, stress, lactation, nipple
stimulation; Metaclopramine, phenothiazines (decrease dopamine) increase PRL; Hypothyroid modestly
increases PRL
5. TSH - stim by TRH from hypothalamus, inhibited by T3, T4, somatastatin
,ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION 2023-2024 ACTUAL EXAM 180 QUESTIONS AND
CORRECT DETAILED ANSWERS
Pituitary adenoma cell types - (answer) 1. Lactotrophs - secrete PRL; tied, most common
macroademona
2. Gonadotrophs -tied, most common macroademona; presents as mass effect +/- silent or panhypopit
or gonadotropin hypersecretion
3. Somatotrophs- acromegaly
4. Corticotrophs - cushings
5. Thyrotrophs - hyperthyroidism (least common)
6. Mixed (somatotrophs+lactotrophs) - acromegaly + hyperPRL
Mass effect sx of pituitary mass - (answer) HA, diplopia, visual field defect, seizures; occasionally can
get CNS rhinorrhea
Dx of pituitary adenoma - (answer) Sx first
Check MRI
Labs - PRL, IGF-1 (for acromegaly), 24 hr urine free cortisol or 1mg overnight dexamethasone
suppression test (for excess) or ACTH stim test (for deficiency), TSH, FT4, alpha subunit of FSH, LH
(confirms pituitary origin)
If mass on MRI, but all labs normal, likely a non-pituitary tumor - craniopharyngioma, meningioma,
eosinophilic granuloma, histiocytosis X, pituitary mets
Empty sella syndrome - (answer) Can be misread and be normal
multiparous women in 90% - pituitary compressed by CSF, but functions normally
No treatment if no hormone abnormalities
Symptoms and labs in prolactinoma - (answer) Most common functional tumors; usually
microadenomas, can be space occupying lesions
Elevated PRL->decreased release of GnRH->decreased LH/FSH-> decreased libido, ED in men,
amennorhea and hirsutism in females; Increased size=increased PRL, so if > 1cm and PRL<100, it's not a
prolactinoma
Men present later->only decreased libido, so present as space occupying lesion (visual field defects)
Can cause galactorrhea in women, decreased bone mineralization
, ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION 2023-2024 ACTUAL EXAM 180 QUESTIONS AND
CORRECT DETAILED ANSWERS
Causes of increased PRL - (answer) Prolactinoma, phenothiazines, amitriptyline, metaclopramide (all
decreased dopamine), estrogen (inhibits dopamine->elevated PRL in pregnancy), hypothyroidism
Treatment for prolactinoma - (answer) Begin treatment when neuro sx from size or sx of
hypogonadism
Medical - dopamine agonists: Cabergoline and bromocriptine
Cabergoline -better tolerated, less nausea, 2x/wk dosing; increased valve dz if high doses,
contraindicated with valve dz, known lung dz, retroperitoneal fibrosis
Surgery - is can't tolerate meds; trtanssphenoidal; ofter rucurs
Radiation- to eradicate residual tumor post-surgery
Treating prolactinoma in pregnancy - (answer) Stop meds
Observe for sx, do visual field testing
1/3 enlarge in pregnancy - if enlarges enough to cause sx, restart bromocriptine (safe in pregnancy)
Growth hormone regulation - (answer) Suppressed - hyperglycemia, somatastatin, chronic steroids
Stimulated by - hypoglycemia, estrogens
GH -> liver -> IGF-1 ->effects
Acromegaly sx - (answer) Insidious onset, usually 10+yr to dx
Enlarged hands, feet, coarse facial features, deepened voice, carpal tunnel, acanthosis nigricans, skin
tags; jaw growth causing dental abnormalities
Cardiac - ischemic HD, cardiomyopathy, diastolic HF, HTN, LVH; increased risk of CVA, DM, OSA, colon
polyps, malignancy
Untreated, lifespan reduced 10+ yrs
Dx of acromegaly - (answer) 99% seen by pituitary ademona on CT or MRI
Check high age adjusted IGF-1 level to screen
Confirm - GH doesn't suppress to <1 with glucose load
