Adrenal and Pituitary Axis Disorders — WACS Viva & Clinical Scenarios (Endocrinology, Diabetes, and Metabolism)

Exam-style adrenal and pituitary axis disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 34-year-old female presents with secondary amenorrhoea, persistent galactorrhoea, and progressive bitemporal visual field loss. Serum prolactin is markedly elevated at >5000 mIU/L. Contrast-enhanced pituitary magnetic resonance imaging demonstrates a 22 mm intrasellar lesion with suprasellar extension abutting the optic chiasm. Formulate the comprehensive diagnostic evaluation, medical therapeutic approach, indications for transsphenoidal surgical decompression, and protocol for visual field monitoring.
• SCENARIO 2: A 28-year-old male with past treated pulmonary tuberculosis presents to the emergency department with profound lethargy, postural dizziness, abdominal cramps, vomiting, and confusion. Clinical examination reveals hyperpigmentation of palmar creases and oral mucosa, blood pressure of 75/45 mmHg, serum sodium of 122 mmol/L, serum potassium of 6.2 mmol/L, and blood glucose of 2.8 mmol/L. Detail the emergency resuscitation protocol, baseline diagnostic sampling requirements prior to therapy, long-term dual hormone replacement, and patient sick-day educational rules.
• SCENARIO 3: A 42-year-old female is referred for evaluation of severe hypertension refractory to three antihypertensive agents, proximal myopathy, purple abdominal striae >1 cm wide, and facial plethora. Detail the stepwise diagnostic algorithm required to confirm endogenous hypercortisolism, distinguish ACTH-dependent from ACTH-independent causes, and achieve precise anatomical localization.
• SCENARIO 4: A 46-year-old male presents with sustained stage 2 hypertension and unprovoked hypokalaemia with serum potassium of 2.7 mmol/L. Outline the diagnostic screening procedure for primary aldosteronism including medication washout rules, confirmatory testing, functional subtype localization via adrenal vein sampling, and targeted therapy for unilateral versus bilateral disease.
• SCENARIO 5: A 39-year-old female presents with paroxysmal episodes of severe headache, profuse diaphoresis, palpitations, and pallor with blood pressure reaching 220/120 mmHg during attacks. Detail the biochemical screening modalities, anatomical and functional imaging localization, preoperative combined blockade protocol, and intraoperative haemodynamic crisis management.