ENDOCRINOLOGY BOARDS ABIM EXAM LATEST
VERSION 2023-2024 ACTUAL EXAM 180 QUESTIONS
AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+
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
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
Check PRL - often cosecreted in 25%
Treatment of acromegaly - ANSWER-Treat everyone, even if not symptomatic
Transsphenoidal surgery
Somatastatin analogs (octreotide) +/- dopamine agonists (bromocriptine, cabergoline) - adjuvant tx if
can't do surgery or residual tumor
Gonadotroph adenomas - ANSWER-Present as: mass effect, no hormones OR mass effect,
hypogonadism/partial panhypopit OR mass effect with gonadatropin excess (rare)
Dx - increased free alpha subunits of FSH/LH
Rx - symptoms - transsphenoidal surgery
Asymptomatic - observe with serial exam, imaging
***pts with pit radiation need monitoring of hypothalamus function for the rest of life
Effect of hypothyroidism on the pituitary - ANSWER-Severe primary hypothyroidism ->increase
TRH+TSH->growth of pituitary thyrotrophs, can look like thyroid tumor;
TRH suppresses dopamine -> increase prolactin, so can look like a prolactinoma - will see high TSH, TRH,
PRL
Treat the hypothyroidism, PRL will decrease
Metastasis to the pituitary - ANSWER-usually posterior pituitary, presents as diabetes insipidus
Breast, lung CA, lymphoma, leukemia go to pituitary
