HYPOPITUITARISM

Question 1

What is the most common cause of adult growth hormone deficiency (AGHD)?
A) Genetic mutations in GH secretion
B) Hypothalamic or pituitary somatotrope damage
C) Idiopathic GH deficiency
D) Congenital GH deficiency

Answer 1

Correct Answer: B) Hypothalamic or pituitary somatotrope damage
Rationale: AGHD is typically caused by acquired damage to the hypothalamus or pituitary somatotropes, often as a result of trauma, surgery, or radiation.

Question 2

What is the typical order of hormone loss in hypopituitarism?
A) FSH/LH → TSH → GH → ACTH
B) GH → ACTH → TSH → FSH/LH
C) GH → FSH/LH → TSH → ACTH
D) ACTH → TSH → FSH/LH → GH

Answer 2

Correct Answer: C) GH → FSH/LH → TSH → ACTH
Rationale: In hypopituitarism, the loss of hormones typically occurs in this specific order: GH is lost first, followed by FSH/LH, TSH, and then ACTH.

Question 3

Which laboratory test is considered the most validated for diagnosing AGHD?
A) Age-matched IGF-1 measurement
B) Serum GH levels
C) Insulin-induced hypoglycemia test
D) Oral glucose tolerance test

Answer 3

Correct Answer: C) Insulin-induced hypoglycemia test
Rationale: The insulin-induced hypoglycemia test is the most validated method to distinguish AGHD by evaluating the GH response to glucose reduction.

Question 4

What GH peak value during an insulin-induced hypoglycemia test is diagnostic of AGHD?
A) GH <10 μg/L
B) GH <7 μg/L
C) GH <5 μg/L
D) GH <3 μg/L

Answer 4

Correct Answer: D) GH <3 μg/L
Rationale: AGHD is diagnosed when the peak GH response to hypoglycemia is <3 μg/L.

Question 5

What is the most appropriate treatment for a patient with pituitary apoplexy who has significant visual loss?
A) Observation and high-dose glucocorticoids
B) Anticoagulation therapy
C) Urgent surgical decompression
D) Radiation therapy

Answer 5

Correct Answer: C) Urgent surgical decompression
Rationale: Significant or progressive visual loss, cranial nerve palsy, or loss of consciousness are indications for urgent surgical decompression to restore function and prevent further complications.

Question 6

Which imaging modality is most useful for diagnosing pituitary apoplexy?
A) Skull X-ray
B) CT or MRI
C) PET scan
D) Doppler ultrasound

Answer 6

Correct Answer: B) CT or MRI
Rationale: CT or MRI of the pituitary can reveal intratumoral or sellar hemorrhage, pituitary stalk deviation, and compression of surrounding tissues, making these imaging modalities essential for diagnosis.

Question 7

What is a common long-term complication following pituitary apoplexy?
A) Empty sella syndrome
B) Hyperprolactinemia
C) Hypopituitarism
D) Diabetes insipidus

Answer 7

Correct Answer: C) Hypopituitarism
Rationale: Hypopituitarism is a common long-term complication of pituitary apoplexy due to damage to the pituitary gland.

Question 8

Patients with empty sella syndrome most often have:
A) Severe hypopituitarism.
B) Normal pituitary function.
C) Prolactinoma.
D) Visual field defects.

Answer 8

Correct Answer: B) Normal pituitary function.
Rationale: Most patients with empty sella syndrome have normal pituitary function because the rim of pituitary tissue remains functional.

Question 9

Which condition is sometimes associated with the development of a partially or totally empty sella?
A) Intracranial hypertension
B) Hypothalamic tumors
C) ACTH hypersecretion
D) Chronic anemia

Answer 9

Correct Answer: A) Intracranial hypertension
Rationale: Empty sella syndrome can be associated with intracranial hypertension, causing the sella to fill with cerebrospinal fluid.