Image-Based Questions in Endocrinology (MRCP Part 1)

TL;DR Image-based questions in endocrinology (MRCP Part 1) test your ability to interpret scans, photographs and radiographs in hormonal disorders. Expect thyroid scans, pituitary MRIs, adrenal CTs, dermatologic changes, and skeletal imaging. Master the core visual patterns, pitfalls, and linking images to lab/clinical context to boost your accuracy.

Why this matters in MRCP Part 1

The MRCP(UK) Part 1 examination is intended to assess not only factual medical knowledge but also clinical science and diagnostic reasoning. thefederation.uk+1 In recent exams, image-based questions increasingly appear to assess how well candidates integrate visual data into endocrine diagnoses, rather than simply recall facts. A candidate who sees a scan but fails to connect it to biochemistry or symptoms may lose easy marks.

Endocrinology is a domain particularly amenable to visual clues—pituitary sella, thyroid scintigraphy, adrenal nodules, bone radiographs, skin signs — and MRCP practice must incorporate image question drills. A structured approach helps transform an intimidating visual into a high-yield question.

Scope: what kinds of images you’ll see & high-yield focuses

Below are the five most tested endocrine subtopics in image-based questions, with 8–12 high-yield visual themes grouped across them.

Five high-yield endocrine subtopics for imaging

1. Pituitary / sellar lesions

2. Thyroid / parathyroid imaging

3. Adrenal gland imaging

4. Bone / skeletal manifestations of endocrine disease

5. Dermatologic, ocular, soft-tissue signs of endocrine syndromes

Across these, here are visual themes you should internalise:

1. Pituitary MRI / CT — see sellar expansions, suprasellar extension, pituitary stalk thickening, “empty sella.”

2. Thyroid scans / radioisotope imaging — cold vs hot nodules, diffusely increased uptake (Graves’), focal tracer defects.

3. Parathyroid localisation imaging — sestamibi scans, 4D CT, ultrasound correlation.

4. Adrenal CT / MR — unilateral vs bilateral adrenal masses, size, attenuation patterns, washout characteristics.

5. Bone X-rays — subperiosteal bone resorption (phalanges), “salt and pepper” skull, brown tumours.

6. Skin / soft tissue photos — pretibial myxoedema, acanthosis nigricans, necrolytic migratory erythema (glucagonoma).

7. Ocular / orbital imaging / photographs — proptosis, extraocular muscle enlargement (thyroid eye disease).

8. Nuclear / functional imaging — PET, MIBG, DOTA scans in neuroendocrine tumours.

9. Pituitary stalk / central DI imaging — thickened stalk, loss of posterior bright spot on MRI.

10. Neck ultrasound with vascular patterns in thyroid nodules.

To summarise:

Image Theme	Key Visual Feature	Likely Diagnosis / Focus	What to correlate
Pituitary mass	Suprasellar extension, optic chiasm effect	Pituitary adenoma, craniopharyngioma	Hormonal labs (GH, ACTH, prolactin)
Thyroid scan	Cold focus or diffuse uptake	Carcinoma / Graves’	TSH, uptake pattern
Parathyroid localization	Focal tracer retention	Parathyroid adenoma	Serum calcium, PTH
Adrenal CT	Low attenuation mass, washout	Adenoma vs carcinoma	Hormonal cortisol / aldosterone / catecholamines
Bone X-ray	Subperiosteal resorption	Hyperparathyroidism	Calcium, PTH, renal function
Skin lesion	Pretibial thickening, hyperpigmentation	Graves’ dermopathy, acanthosis	Thyroid, insulin resistance
Eye / orbit image	Proptosis, muscle thickening	Thyroid eye disease	TSH, TSI antibodies
Nuclear scan	Focal uptake in adrenal / NET site	Pheochromocytoma / NET	Catecholamine / serotonin panels

You should ensure you have seen at least one example of each of the above before attempting exams.

Practical example / MCQ with explanation

Case / MCQ

A 45-year-old woman has hypertension, hypokalaemia, and mild hyperglycaemia. Her adrenal CT shows a 2.5 cm unilateral adrenal mass with >20 Hounsfield units on non-contrast imaging and >50% contrast washout at delayed imaging. A photograph of the lesion is not provided, but the CT image is presented with arrows to the adrenal gland.

Which of the following is the most likely interpretation?

A. Adrenal cortical carcinomaB. PheochromocytomaC. Aldosterone-producing adrenal adenomaD. Metastasis to adrenalE. Non-functioning adrenal incidentaloma

Answer: C. Aldosterone-producing adrenal adenoma

Explanation:

• The combination of hypertension + hypokalaemia suggests primary hyperaldosteronism (Conn’s syndrome).

• CT features: unilateral adrenal lesion, moderate attenuation pre-contrast, and significant washout suggest benign adenoma behaviour (washout > 50%).

• Carcinoma usually shows irregular margins, heterogeneous enhancement and slower washout.

• Pheochromocytoma would more likely have biochemical evidence (elevated catecholamines), and may show different imaging behaviour or uptake on MIBG.

• Metastasis often shows irregular shape, history of primary malignancy, and imaging features inconsistent with adenoma.

In a real exam setting, you would also correlate with aldosterone/renin ratio, and possibly adrenal venous sampling depending on bilateral/unilateral suspicion.

Practical study-tip checklist

• Daily visual exposure: Add 5–10 minutes per day to browse endocrine imaging galleries (e.g. radiology atlases).

• Link images to labs: Always practise “if you see this image, what lab abnormality will accompany it?”

• Timed image blocks: In each mock exam block, reserve 3–5 image-based questions to force speed.

• Error review with diagramming: Redraw or annotate images when you make mistakes, highlighting the misinterpreted region.

• Integration in QBank: Choose QBank platforms that include scans/photos (not just textual stems).

• Spaced repetition of patterns: Use flashcards with image + diagnosis + key distinguishing features.

• Simulate real exam layout: In timed practice, present the image first, then the question; train yourself to scan and interpret quickly.

  
  

Five common pitfalls to avoid

• Mistaking benign lesions (adenoma) for malignancy due to overinterpretation of small irregularities.

• Ignoring clinical/biochemical context — the image alone is rarely diagnostic.

• Overreliance on “textbook images” — real images often show artifacts or variation.

• Confusing isotope uptake patterns (e.g. mislabelling hot vs cold nodules).

• Neglecting contrast washout or multiphase imaging features in adrenal/renal lesions.

  
  

FAQs

How often do endocrine images appear in MRCP Part 1?

Image-based questions constitute a modest but meaningful proportion (perhaps 10–15%) of MCQs, especially in clinical science or endocrine themes.

Must I memorise every scan or photo?

No — focus on pattern recognition and reasoning. Understand common visual signatures and correlate with labs and symptoms rather than rote memory.

Which endocrine disorders show up most in image questions?

Pituitary adenoma, primary hyperparathyroidism, Graves’ disease, Cushing’s syndrome/adrenal adenoma, and pheochromocytoma recur frequently.

Do image-based questions have different marking?

No. They follow the same “best of five” single answer format as textual MCQs — images just add a visual component.

What sources of endocrine imaging are reliable for practice?

Standard radiology and endocrinology atlases, journals (e.g. AJR, Radiographics), and institutional teaching files. The review “Imaging in endocrinology” (Shaw et al.) summarises modalities. ScienceDirect

Ready to start?

Interpreting endocrine images is an essential skill for MRCP Part 1 candidates. With structured visual training, integration with lab/clinical data, and timed practice, you can convert image-based questions from obstacles into opportunities.

To sharpen your visual diagnostic skills, integrate image-based endocrine questions into your regular revision. Explore radiology/endocrinology image banks, combine them in your mocks, and review errors with annotated sketches. Use reliable sources and correlate with biochemistry.

Sources

• MRCP(UK) examination overview — Royal College of Physicians (UK) rcp.ac.uk

• Anatomical and functional imaging in endocrine hypertension review PMC

• Multimodality Imaging in Multiple Endocrine Neoplasia AJR American Journal of Roentgenology

• Parathyroid imaging methods and review Frontiers