1. Acromegaly is most frequently diagnosed in:
- Middle-aged adults
- Children ages 2 to 5
- Adults age 65 and older
2. Grave’s disease is:
- The most common cause of hypothyroidism
- The most common cause of hyperparathyroidism
- The most common cause of hyperthyroidism
- The most common cause of adrenal insufficiency
3. Symptoms of Grave’s ophthalmopathy include all of the following except:
- Bulging eyeballs
- Dry, irritated eyes and puffy eyelids
- Light sensitivity
4. An ACTH stimulation test is commonly used to diagnose:
- Grave’s disease
- Adrenal insufficiency and Addison’s disease
- Cystic fibrosis
- Hashimoto’s disease
5. All of the following are symptoms of Cushing’s syndrome except:
- Severe fatigue and weakness
- Hypertension and elevated blood glucose
- A protruding hump between the shoulders
- Hair loss
6. Which of the following conditions is caused by long-term exposure to high levels of cortisol?
- Addison’s disease
- Crohn’s disease
- Adrenal insufficiency
- Cushing’s syndrome
7. A “sweat test” or newborn screening may be used to detect:
- Cystic fibrosis
- Adrenal insufficiency
- Grave’s disease
8. Hashimoto’s disease is:
- Chronic inflammation of the thyroid gland
- Diagnosed most frequently in Asian-Americans and Pacific Islanders
- A form of hyperthyroidism
- A rare form of hypothyroidism
9. Persons at increased risk of developing Hashimoto’s disease include all of the following except:
- Persons with vitiligo
- Persons with rheumatoid arthritis
- Persons with Addison’s disease
10. All of the following statements about Hashimoto’s disease are true except:
- Many patients are entirely asymptomatic
- Not all patients become hypothyroid
- Most cases of obesity are attributable to Hashimoto’s disease
- Hypothyroidism may be subclinical
11. The most common benign tumor of the pituitary gland is a:
- Carcinoid tumor
- Islet cell tumor
12. Symptoms of polycystic ovarian syndrome (PCOS) may include all of the following except:
- Pelvic pain
- Acne, oily skin, and dandruff
- Weight Loss
13. Women with PCOS are at increased risk for all of the following except:
- Cardiovascular disease
- Metabolic syndrome
14. All of the following organs may be affected by multiple endocrine neoplasia type 1 except:
- Parathyroid glands
- Pancreas and Duodenum
- Pituitary gland
15. What is the treatment for hyperparathyroidism?
- Synthetic thyroid hormone
- Desiccated thyroid hormone
- Surgical removal of the glands
- Calcium and phosphate
16. The most common causes of death in people with cystic fibrosis is:
- Opportunistic infection
- Lung cancer
- Respiratory failure
17. Untreated hyperthyroidism during pregnancy may result in all of the following except:
- Premature birth and miscarriage
- Low birthweight
18. Short stature and undeveloped ovaries suggest which of the following disorders:
- Polycystic ovarian syndrome
- Grave’s disease
- Turner syndrome
19. Endocrine disorders may be triggered by all of the following except:
- Chemicals in the food chain and environment
- Cell phone use
20. An analysis of data from the Women’s Health Initiative questioned the use of which therapy to prevent heart disease?
- Synthetic thyroid hormone
- Oral contraceptives
- Weight-loss drugs
- Postmenopausal hormone replacement therapy
Answers and Explanations
Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone. Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences of acromegaly include type 2 diabetes, hypertension and increased risk of cardiovascular disease, arthritis and colon polyps.
Grave’s disease is an autoimmune disorder characterized by an enlarged thyroid gland and overproduction of thyroid hormones producing symptoms of hyperthyroidism such as rapid heartbeat, heat intolerance, agitation or irritability, weight loss, and trouble sleeping. It usually presents in persons age 20 to 40 and it is much more common in women than in men.
Grave’s ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-mentioned symptoms, Grave’s ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the eyes. About one-quarter of persons with Grave’s disease develop Grave’s ophthalmopathy. The condition is frequently self-limiting, resolving without treatment over the course of a year or two.
The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic adrenal insufficiency or Addison’s disease generally do not respond with the expected increase in cortisol levels. An abnormal ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.
Cushing’s syndrome also may cause fragile, thin skin prone to bruises and stretch marks on the abdomen and thighs as well as excessive thirst and urination and mood changes such as depression and anxiety. Women who suffer from high levels of cortisol often have irregular menstrual cycles or amenorrhea and present with hair on their faces, necks, chests, abdomens, and thighs.
Cushing’s syndrome is a form of hypercortisolism. Risk factors for Cushing’s syndrome are obesity, diabetes, and hypertension. Cushing’s syndrome is most frequently diagnosed in persons ages 20 to 50 who have characteristic round faces, upper body obesity, large necks, and relatively thin limbs.
Cystic fibrosis is the most common inherited fatal disease of children and young adults in the United States. Cystic fibrosis is usually diagnosed by the time an affected child is three years old. Often, the only signs are a persistent cough, a large appetite but poor weight gain, an extremely salty taste to the skin, and large, foul-smelling bowel movements. A simple sweat test is currently the standard diagnostic test. The test measures the amount of salt in the sweat; abnormally high levels are the hallmark of the disorder.
Hashimoto’s disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60. When treatment is indicated, synthetic T4 is administered.
Along with the above-mentioned groups, persons with type 1 diabetes and persons suffering from pernicious anemia (insufficient vitamin b12) are at increased risk of developing Hashimoto’s disease. Because it tends to run in families, there is likely a genetic susceptibility as well. Environmental factors such as excessive iodine consumption and selected drugs also have been implicated as potential risk factors.
Although weight gain may be a symptom of Hashimoto’s disease, the majority of obese people have normal thyroid function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto’s disease include fatigue, cold intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.
Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into the blood or mechanically by pressing on surrounding tissues. In women, symptoms may include menstrual irregularities and infertility; in men erectile dysfunction and libido may be impaired.
In addition to the above-mentioned symptoms, PCOS may cause menstrual irregularities, thinning hair or male-pattern baldness, thick skin or dark patches of skin and excessive hair growth on the face, chest, abdomen, thumbs and toes.
Women with PCOS produce excessive amounts of androgens and do not release ova during ovulation, which seriously compromises their ability to conceive. Although women with PCOS can become pregnant, often by using assistive reproductive technology, they are at increased risk for miscarriage.
Multiple endocrine neoplasia type 1, also known as Werner’s syndrome, is a heritable disorder that causes tumors in endocrine glands and the duodenum. Although the tumors associated with multiple endocrine neoplasia type 1 are generally benign, they can produce symptoms chemically by releasing excessive amounts of hormones or mechanically by pressing on adjacent tissue.
When hyperparathyroidism requires treatment, surgery is the treatment of choice and is considered curative for 95% of cases. Because untreated hyperparathyroidism may elevate blood and urine levels of calcium and deplete phosphorus, bones and teeth may lose the minerals needed to remain strong.
Declining pulmonary function is a hallmark of cystic fibrosis. Drugs such as Pulmozyme (dornase alfa) and Zithromax (azithromycin) can slow the progression of lung disease and mechanical physical therapy devices help CF patients to breathe more easily by loosening and dislodging mucus. For some patients with severe lung damage, lung transplantation is a treatment option.
In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.
Turner syndrome results from a chromosomal abnormality and occurs in an estimated 1 in 2,500 female births. It occurs more frequently in preterm pregnancies. Affected women are shorter than average and are infertile because they lack ovarian function. They also may have webbed necks, broad chests, arms that turn out from the elbow, lymphedema of the hands and feet and skeletal, cardiac, and renal problems.
Endocrine function may be influenced by myriad factors. In addition to the above-mentioned, there is evidence that exposure to naturally occurring and man-made endocrine disruptors such as tributyltin, certain bioaccumulating chlorinated compounds, and phytoestrogens is widespread and in susceptible individuals, may trigger endocrine disorders.
The results of the Women’s Health Initiative study prompted the U.S. Food and Drug Administration (FDA) to advise against using hormone therapy (estrogen-alone or estrogen-plus-progestin) to prevent heart disease. When hormone replacement therapy is used to treat moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy it should used at the lowest doses for the shortest duration needed to achieve treatment objectives.