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

1. A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions.
On examination, he now had post-pubertal secondary sexual characteristics. He had 15-20 mL testes.
Investigations:
serum testosterone27.0 nmol/L (9.0-35.0)
serum sex hormone binding globulin28 nmol/L (10-62)
serum follicle-stimulating hormone2.0 U/L (1.0-7.0)
serum luteinising hormone2.9 U/L (1.0-10.0)
What is the chief product of the Sertoli cell?

A) testosterone
B) oestrogen
C) anti-Muellerian hormone
D) serum sex hormone binding globulin
E) kisspeptin

2. An 18-year-old man was referred with muscle weakness and cramps. His blood pressure was 108/60 mmHg.
Investigations:
serum sodium143 mmol/L (137-144) serum potassium2.4 mmol/L (3.5-4.9) serum bicarbonate32 mmol/L (20-28) serum magnesium0.96 mmol/L (0.75-1.05)
24-h urinary calcium3.6 mmol (2.5-7.5) 24-h urinary magnesium4.2 mmol (2.5-8.0)
plasma renin activity (after 30 min supine)6.4 pmol/mL/h (1.1-2.7) plasma aldosterone (after 30 min supine)680 pmol/L (135-400)
What is the most likely diagnosis?

A) renal tubular acidosis
B) syndrome of apparent mineralocorticoid excess
C) Liddle's syndrome
D) Bartter's syndrome
E) Gitelman's syndrome

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

4. A 62-year-old woman was referred with generalised weakness. She had no previous history of note and was not taking any medication. She reported drinking 60 units of alcohol per week.
On examination, she was found to have central adiposity, pale abdominal striae and
wasting of the limb muscles. Her blood pressure was raised at 160/100 mmHg.
Investigations:
serum sodium138 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cortisol (09.00 h)750 nmol/L (200-700)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol120 nmol/L (<50)
high-dose dexamethasone suppression test (8 mg/day for 48 h):
serum cortisol45 nmol/L (should suppress to
<50% of day 0 value)
24-h urinary free cortisol 360 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)22.0 pmol/L (3.3-15.4)
MR scan of pituitary glandnormal
CT scan of adrenal glands1-cm mass in the left adrenal gland
What is the most likely cause for her presentation?

A) adrenal carcinoma
B) pseudo-Cushing's syndrome
C) adrenal adenoma
D) ectopic adrenocorticotropic hormone syndrome
E) Cushing's disease

5. A 17-year-old girl presented with primary amenorrhoea. She had grown and developed normally. There was no history of galactorrhoea or hirsutism.
On examination, her height was 1.69 m, her weight was 68.3 kg, and her body mass index was 23.9 kg/m2 (18-25). She had stage 5 breast development and stage 5 pubic hair. Her visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)416 nmol/L (200-700) serum oestradiol51 pmol/L (200-400)
serum follicle-stimulating hormone0.8 U/L (2.5-10.0) serum luteinising hormone1.2 U/L (2.5-10.0) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T415.6 pmol/L (10.0-22.0)
What is the most appropriate next investigation?

A) luteinising hormone-releasing hormone test
B) serum insulin-like growth factor 1
C) short tetracosactide (Synacthen@) test
D) serum prolactin
E) karyotyping

Solutions: