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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

1. A 47-year-old man presented with a 2-month history of polyuria and polydipsia. He awoke six times most nights to pass copious volumes of urine despite not drinking any fluid for 4 hours before going to bed.
Investigations:
MR scan of pituitary fossasee image
A water deprivation test confirmed the diagnosis of cranial diabetes insipidus.

What is the most likely underlying diagnosis?

A) microadenoma
B) chordoma
C) craniopharyngioma
D) meningioma
E) Langerhans' histiocytosis

2. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) treat with growth hormone
B) advise him that he will continue to grow for 12 months
C) advise him that growth is complete
D) investigate for growth hormone deficiency
E) refer for leg lengthening surgery

3. A 50-year-old woman with acromegaly presented with persistent sweating and headaches
despite having undergone trans-sphenoidal surgery and pituitary radiotherapy 2 years
previously. She had been intolerant of treatment with octreotide.
Investigations:
serum growth hormone11.1 ?g/L (<0.4)
serum insulin-like growth factor 186.2 nmol/L (5.6-23.3)
Following imaging, it was judged that there was no role for repeat surgery. She was treated
with pegvisomant 10 mg. Six months into treatment, her symptoms had improved.
Investigations (6 months later):
serum growth hormone20.3 ?g/L (<0.4)
serum insulin-like growth factor 115.2 nmol/L (5.6-23.3)
What is the most appropriate next step in management?

A) increase dosage of pegvisomant
B) stop pegvisomant
C) add cabergoline
D) arrange another full course of pituitary radiotherapy
E) continue present dosage of pegvisomant

4. A 48-year-old woman presented with a 2-year history of weight gain, easy bruising and
mood disturbance.
Investigations:
fasting plasma glucose6.9 mmol/L (3.0-6.0)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol200 nmol/L (<50)
24-h urinary free cortisol (?3)670, 400 and 300 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)25.0 pmol/L (3.3-15.4)
MR scan of pituitarynormal
What test is most likely to give a definitive diagnosis?

A) octreotide scan
B) petrosal sinus sampling
C) CT scan of chest
D) high-dose dexamethasone suppression text (8 mg/day for 48 h)
E) corticotropin-releasing hormone test

5. A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).

Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?

A) macular oedema
B) preproliferative diabetic retinopathy
C) retinitis pigmentosa
D) drusen
E) benign choroidal naevus

Solutions: