Endocrine

Question 1

How are patients with severe Grave’s disease managed?

Answer 1

Initially stabilize with a beta-blocker and an antithyroid drug (e.g. methimazole, PTU) and once stable, treat with radioactive iodine therapy (or thyroidectomy if suspicious for malignancy or large goiter)

Question 2

How does hyperthyroidism affect bone health?

Answer 2

Increases osteoclast activity leading to decreased bone density

Question 3

How can hyperparathyroidism affect cardiovascular health?

Answer 3

Can cause hypertension, arrhythmias, ventricular hypertrophy, and vascular and valvular calcification

Question 4

What additional metabolic abnormalities can hypothyroidism cause?

Answer 4

Hyperlipidemia, hyponatremia, and asymptomatic elevations of creatinine kinase and serum transaminases. Hyperlipidemia is due to down regulation of LDL receptors

Question 5

What is the thyroid function test pattern in euthyroid sick syndrome?

Answer 5

Low T3, normal T4 and TSH. Occurs in acutely ill patients

Question 6

In a patient with elevated PTH and hypocalcemia, what tests should be obtained?

Answer 6

Serum vitamin D and creatinine (both low vitamin D and kidney disease can lead to hypocalcemia)

Question 7

How does diabetes present in a glucagonoma?

Answer 7

Mild hyperglycemia that is easily controlled with oral agents and diet. Usually does not require insulin

Question 8

What is the gold standard for diagnosing T2DM in pts with PCOS?

Answer 8

An oral glucose tolerance test (better than fasting or A1c in pts with PCOS)

Question 9

What are features of subacute thyroiditis (de Quervain thyroiditis)?

Answer 9

Often postviral. Pts get prominent fever and hyperthyroid symptoms with a painful/tender goiter. Pts have elevated ESR and CRP and low radioiodine uptake. Hyperthyroid phase spontaneously resolves after a few weeks and may be followed by a hypothyroid phase lasting a few months.

Question 10

What is the treatment for subacute thyroiditis?

Answer 10

Sx treated with beta blockers and NSAIDs for pain relief.

Question 11

What are the initial steps in evaluation of suspected Cushing syndrome?

Answer 11

Late-night salivary cortisol assay, 24-hour urine free cortisol measurement, and/or overnight low-dose dexamethasone suppression test. Two of these first-line tests should be abnormal to establish the diagnosis. If hypercortisolism is confirmed, ACTH levels are measured

Question 12

How is primary adrenal insufficiency initially evaluated?

Answer 12

With early-morning cortisol levels

Question 13

What is the likely cause of adrenal insufficiency in a patient with eosinophilia and hyperplasia of lymphoid tissue (e.g. tonsils)?

Answer 13

Primary adrenal insufficiency (most cases are autoimmune)

Question 14

What imaging is used to look for a parathyroid adenoma?

Answer 14

Sestamibi scan (nuclear scan)

Question 15

What plasma aldosterone/plasma renin ratio suggests primary aldosteronism?

Answer 15

> 20

Question 16

What is the dawn phenomenon?

Answer 16

A hyperglycemic surge in the early morning hours due diurnal increases in counter regulator hormones (e.g. growth hormone, cortisol). Causes elevated fasting glucose in the morning in some patients with diabetes

Question 17

What test should be done first in a patient with suspected acromegaly?

Answer 17

IGF-I level. If elevated, do an oral glucose suppression test (GH levels should decrease normally with administration of glucose, but will not decrease or may even paradoxically increase in acromegaly)