PANCE, Medical exams, 6%

Endocrine System

Endocrine questions concentrate on diabetes, thyroid, adrenal, pituitary, and parathyroid disease. Laboratory-pattern interpretation carries most of the weight, so axis-based reasoning pays off quickly.

Position: 9 of 15 content areas
Published weighting: 6% in the official framework
Topics covered: 6 topics in this guide

What is covered

Topics inside this content area.

These topics describe the scope students most often review for this part of PANCE. Treat them as a study checklist rather than an exhaustive list of what a single exam form can sample.

Diabetes mellitus: Diagnostic thresholds, therapy escalation, hypoglycemia response, and acute crises.
Thyroid disorders: Hyper- and hypothyroidism patterns, nodules and cancer workup, and thyroiditis timelines.
Adrenal disorders: Cushing syndrome, adrenal insufficiency, and hyperaldosteronism testing sequences.
Pituitary disorders: Prolactinoma, acromegaly, and the panhypopituitarism pattern.
Parathyroid and calcium disorders: Hyper- and hypocalcemia causes with their PTH-based differentials.
Endocrine neoplasms: MEN syndromes and the malignancies each axis can produce.

Study tips

How to practice Endocrine.

Section-specific guidance that follows from how this material is usually tested.

Interpret every thyroid or adrenal case from the lab pattern first, then confirm with the story.
Drill diabetic emergency management steps in order; sequencing is what gets tested.
Draw each hormonal axis once from memory weekly; feedback loops answer many stems by themselves.

Where this fits

Endocrine System is 9 of 15 content areas in the PANCE guide, and it carries a published weighting of 6% in the official framework. Use the full guide to balance it against everything else you have to review.

Back to the PANCE guide Official exam information

Sample Endocrine questions

Practice questions, not yet expert-reviewed

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

Question 1Foundational
Which hemoglobin A1c value or higher establishes a diagnosis of diabetes mellitus when confirmed on repeat testing?
1. A5.7%
2. B6.0%
3. C6.5%
4. D7.0%
Show answer
Answer: C. 6.5%
A hemoglobin A1c of 6.5% or greater meets the diagnostic threshold for diabetes, and the result is confirmed with a second abnormal test unless the person has unequivocal hyperglycemic symptoms. The value 5.7% is the tempting distractor because it marks the lower bound of prediabetes, and 7.0% is a common glycemic treatment target rather than a diagnostic cutoff.
Key insight: 5.7% starts prediabetes, 6.5% diagnoses diabetes, and 7.0% is a typical treatment goal.
Question 2Foundational
Which combination of thyroid function tests is expected in primary hypothyroidism?
1. AElevated TSH with low free T4
2. BLow TSH with high free T4
3. CLow TSH with low free T4
4. DElevated TSH with high free T4
Show answer
Answer: A. Elevated TSH with low free T4
When the thyroid gland itself fails, falling thyroxine releases the pituitary from negative feedback and thyroid-stimulating hormone rises while free T4 falls. Low TSH with low free T4 is the tempting distractor, but that pattern indicates central hypothyroidism from pituitary or hypothalamic disease rather than primary gland failure.
Key insight: Read the axis in pairs: a high TSH with a low free T4 localizes the problem to the gland itself.
Question 3Intermediate
What is the most common cause of hyperthyroidism in the United States?
1. AToxic multinodular goiter
2. BGraves disease
3. CSubacute granulomatous thyroiditis
4. DToxic adenoma
Show answer
Answer: B. Graves disease
Graves disease, an autoimmune disorder driven by stimulating antibodies against the thyrotropin receptor, accounts for the large majority of hyperthyroidism and adds orbitopathy and pretibial myxedema. Toxic multinodular goiter is the tempting distractor and is more common in older adults and in iodine-deficient regions, but it does not cause eye disease.
Key insight: Diffuse uptake with eye findings means Graves; patchy uptake in an older adult suggests a toxic nodular goiter.
Question 4Intermediate
Which endocrine disorder presents with fatigue, hypotension, skin and mucosal hyperpigmentation, hyponatremia, and hyperkalemia?
1. ASecondary adrenal insufficiency
2. BPrimary adrenal insufficiency
3. CCushing syndrome
4. DPrimary hyperaldosteronism
Show answer
Answer: B. Primary adrenal insufficiency
Destruction of the adrenal cortex removes both cortisol and aldosterone, producing hyponatremia with hyperkalemia, while the accompanying rise in ACTH and its precursor peptide drives hyperpigmentation. Secondary adrenal insufficiency is the tempting distractor, but low ACTH means no hyperpigmentation and preserved aldosterone means potassium usually stays normal.
Key insight: Hyperpigmentation plus hyperkalemia localizes adrenal insufficiency to the gland rather than the pituitary.
Question 5Advanced
Which laboratory test is the recommended initial screening study when primary hyperaldosteronism is suspected as a cause of resistant hypertension with hypokalemia?
1. APlasma aldosterone to renin ratio
2. BTwenty-four hour urine free cortisol
3. CLow-dose dexamethasone suppression test
4. DPlasma free metanephrines
Show answer
Answer: A. Plasma aldosterone to renin ratio
Autonomous aldosterone secretion raises aldosterone while suppressing renin, so the ratio of the two is the screening test that separates primary hyperaldosteronism from secondary causes. Plasma free metanephrines are the tempting distractor because they screen another surgically curable secondary hypertension, but they detect pheochromocytoma and do not explain hypokalemia.
Key insight: High aldosterone with suppressed renin is the signature of an autonomous adrenal source.

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Endocrine System