Endo

Question 1

classic radiographic skeletal changes for osteitis fibrosa cystica

Answer 1

subperiosteal resorption of bone, most prominent at the phalanges of the hands

Question 2

Why does osteitis fibrosa cystica occur?

Answer 2

high PTH (hyperparathyroidism) = high bone turnover/bone resorption. Patients may have fracture

Question 3

what is deficient in osteomalacia?

Answer 3

Vitamin D…deficiency in kids is rickets, adults is osteomalacia. Results in low Phos and low Ca, with resultant secondary hyperPTH

Question 4

what screening tests should be performed when an adrenal mass is discovered?

Answer 4

1. 24-hour urine metanephrine: screen all for a pheochromocytoma (can use free plasma metanephrine when high suspicion, there is a higher FP rate)
2. 1-mg overnight dexamethasone suppression test: screen for Cushing syndrome (not 24 hour urine cortisol)
3. if hypertension present, plasma aldosterone-plasma renin (ARR) ratio: screen for primary aldosteronism (may have hypokalemia)

Question 5

when do you measure DHEAS?

Answer 5

suspecting hyperandrogenism. women with hirsutism, menstrual irregularities, virilization

Question 6

what is initial medical management for myxedema coma?

Answer 6

Check serum cortisol asap to chec for adrenal insufficiency, PRIOR to IV thyroid replacement (because otherwise this can precipitate adrenal crisis)

Question 7

Initial workup in secondary amenorrhea?

Answer 7

pregnancy test, FSH, TSH, Prolactin

Question 8

how does hypothyroidism contribute to cardiovascular disease?

Answer 8

reduces cholesterol metabolism = hypercholesterolemia

Question 9

T/F: SGLT2 inhibitors (empagliflozin) carry risk of hypoglycemia like insulin

Answer 9

True. So do GLP-1 agonists (liraglutide), sulfonylureas (Glipizide/glyburide/glimepiride), DPP4 inhibitors,

Question 10

treatment of prolactinomas

Answer 10

dopamine AGONISTS (bromocriptine, cabergoline)

Question 11

radiation exposure leading to thyroid cancer

Answer 11

PAPILLARY

Question 12

thyroid cancers by occurrence

Answer 12

Papillary (esp radiation); Follicular; Medullary (least common, measure RET and think MEN)

Question 13

T/F: Morning or random serum cortisol is the initial screening test for Cushing’s

Answer 13

False. It is unreliable due to overlap of serum cortisol levels among normal patients and Cushing

Question 14

Initial diagnostic tests for Cushing syndrome

Answer 14

Options:

1. 24-hour urine free cortisol (3x > normal)
2. Midnight salivary cortisol
3. 1-mg overnight dexamethasone suppression test

(don’t use am cortisol) got to have biochemical dx before imaging b/c frequent incidentalomas

Question 15

next step after dx of cushings

Answer 15

ACTH (detectable/elevated) dependent:

• pituitary tumor
• ectopic i.e. bronchial carcinoid tumor
• severe psychiatric illness

ACTH (low) independent

• exogenous glucocorticoid
• cortisol-secreting adrenal tumor

Question 16

what is the fearful adverse effect of Methimazole (used for hyperthyroidism)

Answer 16

Agranulocytosis –> presents as sore throat, fever. stop drug and check cbc.

Question 17

how low does kidney function need to be to stop metformin?

Answer 17

Safe in GFR >45

Contraindicated GFR <30

Question 18

HbA1c goal

Answer 18

for most diabetics 7-8%. For those early in dz course with few comorbidities, 6.5-7.5%

Question 19

T/F: Empagliflozin (SGLT2 inhibitor can improve glycemic control and will also reduce blood pressure and weight

Answer 19

True.

Question 20

When is dual therapy with metformin + agent initiated?

Answer 20

If patient does not achieve HbA1c target after 3 months of Metformin + Lifestyle mod

Question 21

how is measurement of cortisol level affected by estrogen?

Answer 21

Increased estrogen (i.e. oral estrogen) = increase cortisol-binding proteins = increase serum total cortisol but not free cortisol

Question 22

how are thyroid (i.e levothyroxine, endogenous) hormone levels affected by sex hormones (i.e. exogenous)

Answer 22

Estrogen, Raloxifene: increase thyroxine-binding globulin = need to increase dose

Androgens (Testosterone) /Anabolic Steroids: reduce thyroxine-binding globulin = increased metabolically active free thyroxine. Need to reduce dose

Question 23

how should levothyroxine be taken?

Answer 23

One hour before food or coffee, on empty/fasting stomach. Needs acidic pH. Reduced absorption with chronic PPI use. Wait 4 hours for calcium carbonate or ferrous sulfate.

Question 24

Gestational thyrotoxicosis

Answer 24

bHCG stimulates TSH receptor, so in first trimester hyperthyroidism with suppressed TSH, elevated T4

Question 25

T/F: Grave’s and Hashimoto = hyperthyroidism

Answer 25

False. GRaves = hypeRthyroidism (most common cause. anti-thyrotropin receptor, TSI)

HashimOtO: HypOthyroidism (autoimmune destruction of thyroid gland, elevated TPO)