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

1. An 18-year-old man, whose ambition was to become a member of the elite armed forces, presented with gynaecomastia. His weekly alcohol consumption was 35 units.
On examination, he had normal secondary sexual characteristics, a well-developed, muscular physique and modest, slightly tender bilateral gynaecomastia. Testes were 10 mL with soft texture.
Investigations:
haemoglobin160 g/L (130-180)
MCV96 fL (80-96)
serum dehydroepiandrosterone sulphate4 umol/L (2-10)
serum oestradiol180 pmol/L (<180)
serum testosterone (09.00 h)6.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone1.0 U/L (1.0-7.0)
plasma luteinising hormone0.7 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) oestrogen-secreting testicular tumour
B) androgen abuse
C) persistence of pubertal gynaecomastia
D) primary hypogonadotrophic hypogonadism
E) alcohol excess

2. A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.
Investigations:
serum urea6.2 mmol/L (2.5-7.0)
serum creatinine89 umol/L (60-110)
serum albumin40 g/L (37-49)
serum total bilirubin17 umol/L (1-22) serum alanine aminotransferase48 U/L (5-35) serum aspartate aminotransferase37 U/L (1-31) haemoglobin A1c55 mmol/mol (20-42)
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone0.7 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin458 mU/L (<360) serum thyroid-stimulating hormone3.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely explanation of his symptoms?

A) hyperprolactinaemia
B) cirrhosis of liver
C) pituitary adenoma
D) haemochromatosis
E) age-related hypogonadism

3. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image

What is the most likely diagnosis?

A) Paget's disease
B) multiple myeloma
C) prostate cancer
D) fibrous dysplasia
E) osteomalacia

4. A 61-year-old woman was referred to the blood pressure clinic because of refractory hypertension. One year previously, her blood pressure, urea and electrolytes had been normal. Her current therapy included verapamil modified-release 240 mg daily and doxazosin 16 mg daily.
On examination, she was 1.63 m tall and weighed 90 kg with an elevated waist to hip ratio. Her blood pressure was 182/94 mmHg supine.
Investigations:
serum sodium137 mmol/L (137-144)
serum potassium2.8 mmol/L (3.5-4.9)
serum creatinine79 umol/L (60-110)
plasma renin activity (after 30 min supine)<1.1 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)<135 pmol/L (135-400)
What is the most appropriate investigation?

A) 24-h urine to assess free cortisol:cortisone ratio
B) overnight dexamethasone suppression test
C) repeat renin and aldosterone concentrations after stopping verapamil for 2 weeks
D) 24-h urinary electrolytes
E) analysis of the SCNN1B and SCNN1G genes

5. A 40-year-old man presented with a 4-month history of increasing central obesity. His medical history included HIV infection and allergic rhinitis. He was taking highly active antiretroviral therapy and nasal fluticasone.
On examination, he had marked central adiposity. His blood pressure was 160/95 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cholesterol5.5 mmol/L (<5.2)
fasting serum triglycerides8.20 mmol/L (0.45-1.69)
serum cortisol (09.00 h)<50 nmol/L (200-700)
serum thyroid-stimulating hormone4.6 mU/L (0.4-5.0)
serum free T49.3 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) Addison's disease
B) hypothyroidism
C) HIV-associated lipodystrophy
D) glucocorticoid resistance
E) Cushing's syndrome

Solutions: