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ADVANCED PATHOPHYSIOLOGY WEEK 11:
ENDOCRINE, REPRODUCTIVE & METABOLIC
DISORDERS – 110 HIGH-YIELD MCQS WITH
RATIONALES | GRADED A+ | FIRST-TIME PASS
# Section 1: Hypothalamic-Pituitary Axis Disorders (1–15)
**1.** A patient presents with central hypogonadism, low TSH, low
ACTH, and a pituitary mass on MRI. Which condition is most likely?
A) Primary adrenal insufficiency
B) Panhypopituitarism
C) Hashimoto’s thyroiditis
D) Hyperprolactinemia alone
**Answer:** B
**Rationale:** Panhypopituitarism involves deficiency of multiple
anterior pituitary hormones due to a mass, infarction (Sheehan’s), or
surgery.
**2.** Prolactinoma, the most common pituitary adenoma, classically
causes:
A) Galactorrhea, hypogonadism, and bitemporal hemianopia if large
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B) Hyperthyroidism and weight loss
C) Hyperpigmentation and hypotension
D) Acromegaly and coarse facies
**Answer:** A
**Rationale:** Prolactin excess inhibits GnRH → hypogonadism;
macroadenomas compress optic chiasm.
**3.** A 45-year-old woman with recent postpartum hemorrhage now
cannot lactate, has fatigue, loss of pubic hair, and hypotension. Most
likely diagnosis:
A) Sheehan syndrome
B) Cushing’s disease
C) Primary hyperparathyroidism
D) Pheochromocytoma
**Answer:** A
**Rationale:** Ischemic necrosis of pituitary after severe obstetric
bleeding → anterior pituitary failure.
**4.** Acromegaly is caused by:
A) Cortisol excess
B) Growth hormone excess after epiphyseal closure
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C) ADH deficiency
D) Prolactin deficiency
**Answer:** B
**Rationale:** GH-secreting pituitary adenoma in adulthood → acral
enlargement, organomegaly, diabetes.
**5.** Diabetes insipidus (central) is characterized by:
A) Hyperglycemia, polyuria, ketonuria
B) Low ADH, dilute urine, hypernatremia, polydipsia
C) High ADH, concentrated urine, hyponatremia
D) Polyphagia, weight loss, acanthosis nigricans
**Answer:** B
**Rationale:** Central DI: lack of ADH → inability to concentrate
urine → large volume dilute urine → thirst, hypernatremia.
**6.** Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
typically presents with:
A) Hypernatremia, concentrated urine, hypotension
B) Hyponatremia, low serum osmolality, high urine osmolality,
euvolemia
C) Hypokalemia, alkalosis, hypertension
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D) Hypercalcemia, polyuria, nephrolithiasis
**Answer:** B
**Rationale:** SIADH: excess ADH → water retention → dilutional
hyponatremia; urine inappropriately concentrated.
**7.** A patient with a pituitary tumor secreting ACTH would develop:
A) Cushing’s disease (pituitary source)
B) Addison’s disease
C) Conn’s syndrome
D) Hyperprolactinemia
**Answer:** A
**Rationale:** Cushing’s disease = ACTH-secreting pituitary adenoma
→ bilateral adrenal hyperplasia → cortisol excess.
**8.** Which lab finding distinguishes central DI from nephrogenic DI?
A) Serum glucose level
B) Response to desmopressin (DDAVP)
C) Urine calcium
D) Plasma renin activity
**Answer:** B
ADVANCED PATHOPHYSIOLOGY WEEK 11:
ENDOCRINE, REPRODUCTIVE & METABOLIC
DISORDERS – 110 HIGH-YIELD MCQS WITH
RATIONALES | GRADED A+ | FIRST-TIME PASS
# Section 1: Hypothalamic-Pituitary Axis Disorders (1–15)
**1.** A patient presents with central hypogonadism, low TSH, low
ACTH, and a pituitary mass on MRI. Which condition is most likely?
A) Primary adrenal insufficiency
B) Panhypopituitarism
C) Hashimoto’s thyroiditis
D) Hyperprolactinemia alone
**Answer:** B
**Rationale:** Panhypopituitarism involves deficiency of multiple
anterior pituitary hormones due to a mass, infarction (Sheehan’s), or
surgery.
**2.** Prolactinoma, the most common pituitary adenoma, classically
causes:
A) Galactorrhea, hypogonadism, and bitemporal hemianopia if large
,2|Page
B) Hyperthyroidism and weight loss
C) Hyperpigmentation and hypotension
D) Acromegaly and coarse facies
**Answer:** A
**Rationale:** Prolactin excess inhibits GnRH → hypogonadism;
macroadenomas compress optic chiasm.
**3.** A 45-year-old woman with recent postpartum hemorrhage now
cannot lactate, has fatigue, loss of pubic hair, and hypotension. Most
likely diagnosis:
A) Sheehan syndrome
B) Cushing’s disease
C) Primary hyperparathyroidism
D) Pheochromocytoma
**Answer:** A
**Rationale:** Ischemic necrosis of pituitary after severe obstetric
bleeding → anterior pituitary failure.
**4.** Acromegaly is caused by:
A) Cortisol excess
B) Growth hormone excess after epiphyseal closure
,3|Page
C) ADH deficiency
D) Prolactin deficiency
**Answer:** B
**Rationale:** GH-secreting pituitary adenoma in adulthood → acral
enlargement, organomegaly, diabetes.
**5.** Diabetes insipidus (central) is characterized by:
A) Hyperglycemia, polyuria, ketonuria
B) Low ADH, dilute urine, hypernatremia, polydipsia
C) High ADH, concentrated urine, hyponatremia
D) Polyphagia, weight loss, acanthosis nigricans
**Answer:** B
**Rationale:** Central DI: lack of ADH → inability to concentrate
urine → large volume dilute urine → thirst, hypernatremia.
**6.** Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
typically presents with:
A) Hypernatremia, concentrated urine, hypotension
B) Hyponatremia, low serum osmolality, high urine osmolality,
euvolemia
C) Hypokalemia, alkalosis, hypertension
, 4|Page
D) Hypercalcemia, polyuria, nephrolithiasis
**Answer:** B
**Rationale:** SIADH: excess ADH → water retention → dilutional
hyponatremia; urine inappropriately concentrated.
**7.** A patient with a pituitary tumor secreting ACTH would develop:
A) Cushing’s disease (pituitary source)
B) Addison’s disease
C) Conn’s syndrome
D) Hyperprolactinemia
**Answer:** A
**Rationale:** Cushing’s disease = ACTH-secreting pituitary adenoma
→ bilateral adrenal hyperplasia → cortisol excess.
**8.** Which lab finding distinguishes central DI from nephrogenic DI?
A) Serum glucose level
B) Response to desmopressin (DDAVP)
C) Urine calcium
D) Plasma renin activity
**Answer:** B
