Endocrine

Question 1

FSH, LH, estrogen, and progesterone in amenorrhea due to anovulation

Answer 1

FSH and LH: Normal
Estrogen: High or normal
Progesterone: Low

Question 2

McCune-Albright syndrome classic triad

Answer 2

Gonadotropin-independent precocious puberty, cafe-au-lait spots, polyostotic fibrous dysplasia (fracture risk)
(Can also have autonomous hyperfunction of other endocrine organs)

Question 3

Tests for adrenal insufficiency

Answer 3

8 am cortisol and ACTH level
Cosyntropin test (ACTH stimulation test) is often done concurrently.

Question 4

Tests for Cushing syndrome

Answer 4

Any of late-night salivary cortisol, 24-hour urinary cortisol, or low-dose dexamethasone suppression test.
If positive, next test is ACTH level.

Question 5

Diabetic oculomotor palsy

Answer 5

Motor palsy but no blown pupil (parasympathetics spared)

Question 6

CI to metformin

Answer 6

Renal failure (risk of lactic acidosis)

Question 7

AEs of thiazolidinediones like pioglitazone

Answer 7

Weight gain and heart failure (also fractures and bladder cancer).
(Unlike metformin, can be used in renal failure)

Question 8

Oral hypoglycemics that lead to weight gain? Weight loss?

Answer 8

Weight gain: sulfonylureas (e.g. glipizide, glimeperide), thaizolidinediones (e.g. pioglitazone)

Weight loss: GLP-1 agonists (e.g. exenatide)

(Metrofrin and DPP-IV inhibitors (e.g. sitagliptin) are weight neutral

Question 9

Key secondary metabolic abnormality in hypothyroidism

Answer 9

Hyperlipidemia (decreased LDL receptor activity)

Can also see hyponatremia and CK and AST/ALT elevation

Question 10

Is hypothyroid myopathy painful or not? CK and ESR?

Answer 10

Painful, elevated CK, normal ESR.

Question 11

Effect of estrogen on the thyroid hormone axis

Answer 11

Increase TBG levels (so women on synthroid who are put on OCPs, estrogen replacement, or SERMs may need a dose increase).

Question 12

What can trigger thyroid storm?

Answer 12

Iodine contrast for imaging (or surgery, illness, or childbirth)