Adrenal N Pancreas

Question 1

Metabolic syndrome- 3 criteria must b met out of the ff 5

Answer 1

• Abdominal obesity ( M>40, F>35 inches);
• impaired fasting glycemia
• BP>130/80
• TGA>150
• HDL(<40M, <50F)

Question 2

What plays the central role in metabolic syndrome?

Answer 2

Insulin resistance

Question 3

Secretory, high volume, watery, low osmotic gap diarrhea; hypercalcemia; hyperglycemia; hypokalemia; achlorohydria; pancreatic mass mostly in the tail
Dx?

Answer 3

VIPoma

Question 4

Cushing syndrome is an important cause of secondary htn; hyperglycemia, hypokalemia
How?

Answer 4

ACTH dependent hormones like deoxycorticosterone, corticosterone n cortisol lead to vasoconstriction, insulin resistance n mineralocorticoid activity

Question 5

Dapagliflozin, canagliflozin, group, MOA, side effects

Answer 5

SGLT2 inhibitors
Inhibit reabsorption of glucose in the PCT. Increased risk of UTI, fungal vaginitis
- has cardiovascular benefits, weight n BP reduction

Question 6

Ectopic ACTH causes more severe htn n hypokalemia. Why?

Answer 6

Cortisol has high affinity for mineralocorticoid receptors but is normally converted to inactive cortisone by the enzyme 11-beta hydroxyl dehydrogenase in the renal tubular cells. High cortisol from ectopic ACTH can saturate the enzyme…

Question 7

The most accurate measure of severity in DKA?

Answer 7

Serum bicarbonate level or anion gap

Question 8

MOA of metformin, weight

Answer 8

Blocks gluconeogenesis, no wt gain

Question 9

Incretins are?

Answer 9

GIP n GLP r secreted when food esp CHOs enter the duodenum and they increase insulin release, decrease glucagon release

Question 10

S/E - wt gain, edema, CHF, bone #

Bladder Ca …. r for which hypoglycemic drugs?

Answer 10

Thiazolindinediones/glitazones

Question 11

Nateglinide, repaglinide

Group, MOA

Answer 11

Meglitinides

- similar to sulfonylureas but no sulfa and r short acting

Question 12

Gastroparesis

• sxs
• Rx

Answer 12

Bloating, constipation, early satiety, vomiting

-Rx - metoclopramide or erythromycin

Question 13

Pramilinitide

Answer 13

Amylin analog

Amylin is normally secreted with insulin n decreases gastric emptying, glucagon level n appetite

Question 14

MEN1, 2A, 2B

Answer 14

MEN1- pituitary, PTH, pancreases
MEN2A- PTH, medullary thyroid, pheochromocytoma
MEN2B- mucosal neuroma, medullary, pheochromo

Question 15

The best initial therapy in pheochromo

Answer 15

Phenoxybenzamine

Question 16

Hyperglycemia, non-specific sxs like diarrhea, anemia, wt loss and necrotic migratory erythema

Answer 16

Glucagonoma

Question 17

Episodic headache, htn, palpitation, tremor, sweating

Answer 17

Pheochromocytoma

Question 18

Addison disease is most commonly (>80%) caused by

Answer 18

Autoimmune destruction of the gland. Pts May have involvement of other glands such as thyroid, Parath, ovaries and other autoimmune phenomenon like vitiligo.

Question 19

Exenatide, liraglutide…

group, MOA, weight

Answer 19

Incretin mimetic
Direct replacement of incretins
Decrease wt

Question 20

Sitagliptin, saxagliptin

Group, MOA, wt

Answer 20

DPP-lV inhibitors
Inhibit metabolism of incretins by DPP-lV
Are wt neutral

Question 21

Cosyntropin stimulation test is?

Initial evaluation of hypocortisolism is?

Answer 21

The most specific test for adrenal function
Cosyntropin is a synthetic ACTH. Normally, there should b a rise in cortisol after cosyntropin administration
- initially- 8AM serum cortisol and ACTH
cosyntropin test is concurrently performed since ACTH assay takes several days.

Question 22

Primary hyperaldosteronism best initial test

Answer 22

Ratio of plasma aldosterone to renin is diagnostic

Question 23

Based on HbA1c goal of therapy?cut off for Dx, normal

Answer 23

Goal<7%
Dx - >6.5
Normal<5.7

Question 24

Once u confirm an elevated ACTH level in a suspected Cushing syndrome, u can scan the brain. What’s the next step iF the MRI doesn’t show a clear pituitary lesion?

Answer 24

Do inferior petrosal venous sinus sampling for ACTH ( the venous drainage of the pituitary)
If negative, look for ectopic ACTH production by scanning the chest

Question 25

MEN-2 screening in a pt with a family hx?

Answer 25

Genetic testing ( RET protooncogen)

Question 26

Hypoglycemia, dm patient taking Anti-DIABETIC drugs , elevated c-peptide pro insulin, n insulin

Answer 26

Sulfonylurea abuse

Check urine for sulfonilurea metabolites

Question 27

Hypoglycemia with high insulin, low c-peptide, low proinsulin

Answer 27

Surreptitious use of insulin/suicide

Question 28

The best initial n specific test to Dx hypercortisolism

Answer 28

24 hr urine cortisol >90micogram/24

Others- 1mg overnight dexamethasone suppression; late night salivary cortisol level

Question 29

Acarbose, miglitol

- MOA, group

Answer 29

Alpha glucosidase inhibitors.

They block glucose absorption in the bowel.