TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD
OWNER: EMILLYCHARLOTTE
COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISHED: SEPTEMBER 2024
ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION
2024-2025 ACTUAL EXAM 100 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
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
,TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD
OWNER: EMILLYCHARLOTTE
COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISHED: SEPTEMBER 2024
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
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
,TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD
OWNER: EMILLYCHARLOTTE
COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISHED: SEPTEMBER 2024
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
, TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD
OWNER: EMILLYCHARLOTTE
COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED
FIRST PUBLISHED: SEPTEMBER 2024
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
