Endocrine Board Review 2014 Flashcards
What lipid disorder classically presents with feeding difficulty beginning in childhood?
Lipoprotein lipase deficiency
What is the signature physical exam finding in familial genetic hypercholestrolemia?
Tendon xanthomas
What is the signature physical exam finding in dysbetalipoproteinemia (type 3 hyperlipoproteinemia)?
Palmar xanthomas
Eliminating what from diet can dramatically reduce high triglycerides?
Alcohol
What two disorders cause both elevated cholesterol and triglycerides?
- Dysbetalipoproteinemia
- Familial combined hyperlipidemia
How do you diagnose dysbetalipoproteinemia?
Applipoprotein E genotyping
APOEE2/APOEE2
APOEE2/APOEE2
Disease?
Dysbetalipoproteinemia
APOEE4/APOEE4
Disease?
Alzheimer’s disease
What do patients with dysbetalipoproteinemia respond well to?
Fibric acids
What affect to fibric acid drugs have on the complications of diabetes?
Decreased retinopathy
Which drug class used to treat hyperlipidemia has been shown to improve diabetes control?
Bile acid-binding resin
e.g. Colesevelam
Does hypothyroidism raise cholesterol or triglycerides?
Raises cholesterol
If patients are experiencing muscle cramps and pain with statins then what approach can you use?
Can give every other day statin or weekly statin
Which lipid drug that is a peroxisome proliferator-activated receptor (PPAR) alpha agonist can cause lowering of HDL?
Fenofibrate
Is ABCA1 inhibited by metformin?
No
What lipid finding is found in Tangier disease?
Low HDL
What gene defect causes Tangier disease?
ABCA1 defects
What does insulin do to HDL levels?
Increase them
What is a common complication of hypobetalipoproteinemia?
Nonalcoholic fatty liver disease
Beta blockers can raise triglyceride levels in collagen-vascular diseases.
True or false?
True
What’s the test with the best predictive value for cardiovascular disease events in middle-aged men (other than a lipid panel)?
Coronary calcium score
What does cholesterol ester transfer protein (CETP) deficiency due to HDL cholesterol levels?
Increases HDL levels
What does hepatic lipase deficiency due to HDL cholesterol levels?
Increases HDL levels
Does interaction with protease inhibitors increase or decrease the risk of myositis with statins?
Increases risk of myositis
How do you differentiate between primary hyperparathyroidism and familial hypocalciuric hypercalcemia (FHH) if the calcium clearance to creatinine clearance is 0.01?
Genetic testing for a calcium-sensing receptor (CASR) mutation
What is the next step after diagnosing normocalcemic primary hyperparathyroidism in a patient with no symptoms?
Repeat calcium and albumin measurements in 6 - 12 months (these people may eventually develop hypercalcemia).
What does teriparatide do to serum calcium levels?
Slightly and transiently elevates calcium levels.
Patients who take teriparatide should have their bloodwork drawn how long after their dose for their serum calcium to return to normal?
16 hours
Can you see hypercalcemia in secondary hyperparathyroidism (e.g. because of vitamin D deficiency)?
No
What test can tell how old a vertebral fracture is?
Nuclear medicine bone scan.
Uptake for 1 to 2 years after a fracture
Is history of cigarette smoking included in the FRAX score calculation?
No (only current smoking)
What is the natural history of Paget’s disease near a weight-bearing joint?
Progressive joint destruction
Are the PTH levels of patients with adynamic bone disease low or high?
Low
What kind of bone disease do patients with chronic kidney disease get?
Adynamic bone disease (renal osteodytrophy)
Is a wrist fracture an indication for treatment for osteoporosis according to the National Osteoporosis Foundation guidelines?
No
What is a contra-indication of using teriparatide owing to the theoretical increased risk of developing osteosarcoma with it?
Patients with history of bone/skeletal irradiation/radiation treatment.
What is the first step in determining the cause of hypophosphatemia?
Distinguishing between gastrointestinal malabsorption/depletion from renal phosphate wasting by measuring tubular reabsorption of phosphate (serum/urine phosphorus levels) while the phosphate level is low.
What disease causes hypophosphatemia along with decreased 1,25 vitamin D levels?
Tumor-induced osteomalacia
What are the indications for treatment of Paget’s disease?
4 indications
- Involvement of a weight-bearing bone (e.g. spine or leg)
- Involvement near a joint
- Involvement of the skull
- Serum alkaline phosphatase level greater than 3 times the upper normal limit
What study should be done in patients suspected of having atypical bone fractures secondary to bisphosphonates?
Nuclear medicine bone scan (fractures are usually bilateral so you can see if a similar process is happening on both sides)
What is a ‘looser zone’ on a radiograph characteristic of?
Osteomalacia
____ international units of vitamin D daily increases the serum concentration of 25-OH vitamin D by ____ ng/mL
100 IU
1 ng/mL
How long does it take for 25-OH vitamin D levels to reach steady state with daily dosing of supplements?
2 - 3 months
What is the dosage for a calcium drip when treating hypocalcemia?
IV bolus of 150 mg calcium followed by continuous calcium infusion of 1 mg/kg/hr
How much elemental calcium does 1 ampule of calcium gluconate contain?
93 mg
How much volume does 1 ampule of calcium gluconate contain?
10 mL
How much elemental calcium does 1 ampule of 10% calcium chloride contain?
272 mg
How much volume does 1 ampule of 10% calcium chloride contain?
10 mL
Is an MRI or a CT safer during pregnancy?
MRI
Is an MRI with and without contrast safe during pregnancy?
Yes
What should you do during treatment if there is a discrepancy in prolactin level and adenoma size?
Monitor tumor size by MRI (as well as prolactin levels)
What proportion of patients with acromegaly respond to cabergoline?
One third.
What should you do if an acromegaly patient does not respond to cabergoline?
Start somatostatin analog.
Which drug used to treat acromegaly significantly worsens diabetes?
Pasireotide
Which drug used to treat acromegaly significantly improves diabetes?
Pegvisomant
What medications can be used to control hyperthyroidism secondary to a TSH-secreting tumor?
Somatostatin analogs
E.g. Lanreotide depot
Is cabergoline effective for TSH-secreting tumors?
No
What is the objective of treating hyperprolactinemia (secondary to microadenoma) causing amenorrhea in pre-menopausal women?
Treating the hypoestrogenism (indicated by restoring the menstrual cycle) so that her bone health is not affected.
What percentage of patients with Cushing’s disease and a post-operative morning cortisol level of greater than 10 microgram/dL have been cured?
Less than 10%
What should the morning cortisol level be after surgery for Cushing’s disease to indicate a cure?
Less than 5 microgram/dL
Do patients typically need hydrocortisone supplementation after successful transsphenoidal resection for Cushing’s disease, and for how long?
Hydrocortisone generally needed for several months initially for both maintenance and stress and later for just stress.
Should you do a cosyntropin stimulation test to check for adrenal insufficiency after transsphenoidal surgery for Cushing’s disease?
No.
It is not useful immediately after surgery because the adrenal glands themselves are not suppressed and will respond to exogenous ACTH resulting in a falsely reassuring result.
Why is acromegaly difficult to diagnose in pregnancy?
The placenta produces a biologically active variant of GH that stimulates IGF-1 production.
Is performing a glucose tolerance test and measuring GH response for diagnosing acromegaly useful in pregnancy?
No, because GH variant produced by the placenta does not suppress with hyperglycaemia.
What should you do if you suspect acromegaly in pregnancy?
Defer work-up until after delivery.
What medication can be tried for very aggressive macroprolactinomas that have been unresponsive to cabergoline, surgeries and gamma-knife radiotherapy?
Temozolomide
What should you do in patients with acromegaly that is only partially controlled by the highest dosage of lanreotide (or other somatostatin analogues)?
Add cabergoline.
Can reduce GH and IGF-1 levels by more than 50% in 50% of patients regardless of whether they have hyperprolactinemia
Does Pegvisomant control tumor growth in acromegaly?
No
Germline inactivating mutations in ____ predispose individuals to pituitary tumors, especially somatotropinomas.
AIP (aryl hydrocarbon receptor interacting protein)
What are mutations in AIP (aryl hydrocarbon receptor interacting protein) associated with?
Isolated familial pituitary adenomas
What are mutations in PRKAR1A associated with?
Carney complex
What does Mifepristone do to the potassium levels?
Decreases them (hypokalemia)
What does Mifepristone do to the cortisol levels?
Increases them
What does Mifepristone do to the ACTH levels?
Increases them
When should visual field testing be performed in a patient with an incidental non-secretory pituitary macroadenoma?
When the MRI shows significant supra-sellar extension with abutment of the optic chiasm.
Is there any data to show adverse effects of performing MRI scans or giving gadolinium during pregnancy?
No
What happens to the cortisol levels during pregnancy and why?
They increase for two reasons:
- Cortisol increases up to three times during pregnancy.
- Cortisol-binding globulin levels increase.
What is the likely diagnosis in a previously well female who presents with a pituitary mass near term of her pregnancy?
Lymphocytic hypophysitis
If a patient with panhypopituitarism is on oral estrogen - does stopping it increase or decrease the dose of hydrocortisone needed?
It has no effect.
If a patient with panhypopituitarism is on oral estrogen - does stopping it increase or decrease the dose of growth hormone needed?
It decreases the growth hormone needed.
If a patient with panhypopituitarism is on oral estrogen - does stopping it increase or decrease the dose of levothyroxine needed?
It increases the levothyroxine needed.
How do oral estrogens affect IGF-1 levels?
They act on the liver to decrease the responsiveness of the liver to growth hormone with respect to IGF-1 production.
Do estrogens stimulate or inhibit hepatic thyrotoxine-binding globulin?
Stimulate it.
How do you determine if a child on growth hormone therapy for growth hormone deficiency should be continued on growth hormone supplementation as an adult?
Re-test with a growth hormone stimulation test.
For how long does growth hormone need to be stopped before doing a growth hormone stimulation test?
1 month
What is the first step in determining whether a man is infertile?
Semen analysis
What medications can be used to treat modest hyponatremia in the setting of congestive heart failure?
Vasopressin receptor antagonists such as conivaptan and tolvaptan.
Is Demeclocyline used for acute or chronic hyponatremia?
Chronic, symptomatic hyponatremia
Mutations in which two genes cause combined pituitary hormone deficiencies?
- PROP1
- POU1F1 (PIT1)
Is diabetes insipidus more common in patients with pituitary adenomas or those with craniopharyngiomas?
Craniopharyngiomas
What is the typical MRI finding seen with Langerhans cell histiocytosis?
Stalk thickening on MRI
What is the gene most commonly associated with typical human obesity?
FTO gene
Does obesity related to MC4R, LEP and LEPR mutations develop in childhood or adulthood?
Childhood
What happens to resting energy expenditure when you successfully lose weight?
Energy expenditure decreases (body adapts to try to re-gain the lost weight)
For weight-stable, non-growing adults, energy expenditure in linearly related to lean body mass.
True or false?
True
What happens to energy expenditure during physical activity when you successfully lose weight?
Energy expenditure decreases
For a person who has successfully lost weight, the resting energy expenditure and the energy expended in physical activity both decline more than would be expected by the decline in lean body mass.
True or false?
True
Which parts of the hypothalamus regulate hunger and satiety?
Ventral tegmentum and nucleus accumbens.
Which part of the hypothalamus regulates physical activity and relays information about food intake to other parts of the brain?
Lateral hypothalamic area
Which part of the hypothalamus relays information from the gastrointestinal tract to the brain and organizes some of the mechanics of food intake and digestion?
Nucleus of the solitary tract and the dorsal vagal nucleus
What is the weight loss (percentage of baseline weight) provided by laparoscopic banding?
18 - 22%
What is the weight loss (percentage of baseline weight) provided by sleeve gastrectomy?
22 - 25%
What is the weight loss (percentage of baseline weight) provided by Roux-en-Y gastric bypass?
25 - 28%
What is the weight loss (percentage of baseline weight) provided by biliopancreatic diversion?
32 - 35%
What happens to total daily energy expenditure with shortened sleep time?
Increases
What happens to ghrelin levels with shortened sleep time?
Increase
What happens to cortisol levels with shortened sleep time?
Increase
What happens to insulin resistance with shortened sleep time?
Increases
Which diet provides the most cardiovascular benefits?
Mediterranean diet
What gene is mutated in the most common monogenic form of early-onset obesity?
MC4R (melanocortin 4 receptor)
What syndrome is associated with childhood weight-gain, hypotonia, poor feeding after birth, learning disabilities, growth retardation, behavioral problems, hypothalamic hypogonadism, and cryptorchidism?
Prader-Willi syndrome
What syndrome is associated with childhood weight-gain leading to truncal obesity, polydactyly, rod-cone dystrophy, cognitive impairment, male hypogonadotrophic hypogonadism, female genitourinary malformations, and renal abnormalities?
Bardet-Biedl syndrome
What syndrome is associated with childhood weight-gain leading to truncal obesity, insulin resistance, childhood development of type 2 diabetes, vision and sensory neural hearing problems (and PCOS and hyperandrogenism in female patients)?
Alstrom syndrome
Which syndrome has presence of polydactyly…
Bardet-Biedl syndrome or Alstrom syndrome?
Bardet-Biedl syndrome
International Diabetes Federation
Increased risk of metabolic disease with waist circumference of greater than _____ in men from South Asia.
35.5 inches or 90 cm
International Diabetes Federation
Increased risk of metabolic disease with waist circumference of greater than _____ in women from South Asia.
31.5 inches or 80 cm
Which bariatric surgery procedure does not cause malabsorption, and subsequently does not result in vitamin and minerals deficiencies?
Laparoscopic banding procedure
Would a melanocortin 4 receptor agonist cause weight gain or weight loss?
Weight loss
Is there a Risk Evaluation and Mitigation Strategy (REMS) in place by the FDA for cardiac valve problems with Lorcaserin use?
No
Is there a Risk Evaluation and Mitigation Strategy (REMS) in place by the FDA for potential birth defects with phentermine/topiramate use?
Yes
Topiramate exposure in the first trimester is associated with cleft palate and cleft lip
Is there a Risk Evaluation and Mitigation Strategy (REMS) in place by the FDA for potential birth defects with phentermine use?
No
It’s an old medication and not subject to REMS
Is there a Risk Evaluation and Mitigation Strategy (REMS) in place by the FDA for fat soluble vitamin deficiencies with orlistat use?
No
What percentage weight loss is achieved with phentermine/topiramate?
8 - 10%
What percentage weight loss is achieved with phentermine?
3 - 5%
What percentage weight loss is achieved with orlistat?
3 - 5%
What percentage weight loss is achieved with lorcaserin?
4 - 5%
What percentage weight loss is achieved with liraglutide (3 mg/day)?
4 - 6%
How much weight loss can be achieved through increased physical activity?
2 - 3% of baseline weight typically.
There is variability: some people lose 5 - 8% and others gain weight.
Does fitness have more of an affect on cardiovascular mortality or obesity?
Fitness
If someone is obese what is there risk of death (% lower or higher) for a cardiac intervention compared to if their BMI was normal?
30 - 50% lower
the obesity paradox
Obese individuals under-report their energy intake.
True or false?
True
What is the treatment for non-active Graves ophthalmopathy presenting as proptosis and dysconjugate gaze?
Orbital decompression followed by strabismus surgery
What is the next step in a patient who has thyrotoxic multinodular goiter who has become hypothyroid on methimazole?
Reduce the methimazole dosage.
(Don’t stop it even if they are hypothyroid because they don’t go into remission and will become hyperthyroid again if the methimazole is stopped)
What should hypothyroid women do to their levothyroxine dose when they get pregnant?
Increase levothyroxine dose by 30%
Why does levothyroxine requirement go up in nephrotic syndrome?
Loss of thyroid-binding globulins/proteins (with thyroid hormone still bound) in the urine.
What happens to levothyroxine requirements in nephrotic syndrome when the proteinuria resolves?
Requirements return back to baseline.
Can celiac disease increase levothyroxine requirements in patients with hypothyroidism?
Yes
What is the most prominent and pronounced early change in thyroid function tests in euthyroid sick syndrome?
Decrease T3 levels (total and free) and increase in reverse T3 levels.
What does a very low T4 level in euthyroid sick syndrome indicate?
Poor prognosis
What is the free T4 level usually in euthyroid sick syndrome?
Normal or low-normal range
What usually happen to the TSH level in the recovery phase of euthyroid sick syndrome?
Elevated (but usually less than 20 mIU/L)
What is the most common inherited form of hyperthyroxinemia?
Familial dysalbuminemic hyperthyroxinemia
What happens to the free T4 in familial dysalbuminemic hyperthyroxinemia?
It is spuriously elevated because of altered protein binding. Free T4 values are normal when checked by equilibrium dialysis.
Why is the total T4 elevated in familial dysalbuminemic hyperthyroxinemia?
The genes encoding albumin greatly enhance the affinity of albumin for T4 (but not for T3), resulting in an elevated total T4 level, and elevated free T4 index.
What happens to the total T3 level in thyroid hormone resistance syndrome?
Increases
What happens to the total T3 level in familial thyroxine-binding globulin excess?
It is increased.
What is the next step when molecular testing for a thyroid nodule reveals PAX8/PPARG rearrangement?
Thyroidectomy
What is a common benign cause of C-cell hyperplasia?
Hashimoto’s thyroiditis
What embryopathies is exposure to methimazole in the first trimester associated with?
(4 points)
- Aplasia cutis
- Choanal atresia
- Esophageal atresia
- Omphalocele
Which enzyme inactivates T4 to reverse T3 and to T2?
Type 3 deiodinase (DIO3)
Which two enzymes activate T4 to T3?
Type 1 and type 2 deiodinases (DIO1 and DIO2)
Patients with a tumor secreting _____ will require really large amounts of exogenous T3 and T4 (to keep up with enhanced deactivation).
[Consumptive hypothyroidism]
Type 3 deiodinase (DIO3)
What is the treatment of fetal hypothyroidism?
Intra-amniotic levethyroxine (typical doses are 150 - 300 mcg injected on 2 - 4 occasions.
What is the most common effect that sunitinib has on thyroid function?
It causes primary hypothyroidism.
After making the initially diagnosis of medullary thyroid cancer what else must you do before sending the patient to surgery?
Screen for pheochromocytoma.
What is the treatment for pain secondary to bone metastasis in differentiated thyroid cancer?
Bisphosphonates (usually IV) although denosumab may be used as well.
How much total iodine does a 200 mg pill of amiodarone contain?
74 mg
How much free iodine does a 200 mg pill of amiodarone contain?
7.4 mg
What mutations do hot nodules usually have?
Somatic activating mutation in the gene encoding the TSH receptor or Gs alpha subunit.
What do patients who get repeated infectious thyroiditis typically have?
Pyriform sinus fistula
What is the most advanced AJCC stage category for patients younger than 45 years old with thyroid cancer?
Stage II
Does an alpha-subunit to TSH molar ratio of less than 1 favor a TSH-producing pituitary tumor or thyroid hormone resistance?
Thyroid hormone resistance.
What should you think of when you see uptake at the base of the tongue on a thyroid scan?
Lingual thyroid
What is the recommended daily iodine intake during pregnancy?
220 mcg
What is the recommended daily iodine intake during lactation?
280 mcg
How much iodine should prenatal vitamins contain?
150 mcg
What is the most common sequela of high-dose radioactive iodine therapy?
Xerostomia - resulting in excessive dental caries
It is recommended that men desiring future fertility and receiving radioactive iodine doses greater than _____ use sperm cryopreservation.
400 mCi
What is the treatment of persistent, non-resectable thyroid cancer involving the trachea and recurrent laryngeal nerve that is not radioiodine avid?
External beam radiation therapy
What can you use to prepare a patient in thyroid storm for thyroidectomy if you cannot start anti-thyroid drugs (because of development of agranulocytosis)?
Plasmapharesis
When evaluating hypoglycemic should the fast be supervised or unsupervised?
Supervised
Low carbohydrate, high fat, ketogenic diets cause greater weight loss and loss of body fat than calorie-restricted, low fat diets for periods of 3 - 6 months.
True or false?
True
What is type 3 diabetes?
Pancreatic diabetes
What two hormones are patients with type 3 diabetes deficient in?
Insulin and glucagon
What is the serum creatinine FDA cut off in men for metformin use?
Equal to or more than 1.5 mg/dL
What is the serum creatinine FDA cut off in women for metformin use?
Equal to or more than 1.4 mg/dL
What does iron deficiency do you HbA1c?
Falsely elevates it.
What is a HbA1c substitute that is independent of red blood cell turnover?
Fructosamine measurement
Has treatment of low-normal or borderline-low testosterone been demonstrated to improve sexual function in diabetes?
No
Do diabetics respond to phosphodiesterase 5 inhibitors as well as non-diabetics?
No
Are phosphodiesterase 5 inhibitors reasonable first line treatment for erectile dysfunction in diabetics?
Yes
The effectiveness of ARBs and ACEIs in reducing proteinuria is blunted by high sodium intake.
True or false?
True
How can effectiveness of ARBs and ACEIs in reducing proteinuria be improved?
(2 ways)
- Reducing dietary sodium intake.
- Diuretics
Gradual onset of blurred vision occurring over months in a patient with known diabetic retinopathy.
Diagnosis?
Macular edema
Very gradual onset of blurred vision occurring over years in a patient with known diabetic retinopathy.
Diagnosis?
Cataracts
What is the best initial test for osteomyelitis?
MRI
How much do DPP-4 inhibitors reduce HbA1c?
0.6 - 0.9%
In a 75 gram glucose tolerance test what should the glucose value be at 2 hours if you are pre-diabetic?
140 mg/dl to less than 200 mg/dl
How should you evaluate patients who had gestational diabetes after they have delivered?
(What test and when?)
75 gram 2 hour glucose tolerance tests 6 - 12 weeks after delivery
Is screening asymptomatic diabetic patients for cardiovascular disease recommended?
No
What medication is recommended for steroid induced hyperglycemia?
Insulin
When treated with SGLT-2 inhibitors, how long does the weight loss persist?
6 - 12 months
How much do DPP-4 inhibitors reduce HbA1c if the GFR is below 60 mg/dl?
0.4%
Do testosterone levels correspond with degree of hirsutism in women?
No
What is the first line pharmacologic therapy for hirsutism/
Oral contraceptive pills
with a less androgenic progestin such as norethindrone or drospirenone and not norgestrel or levonorgestrel
Is spironolactone recommended alone in pre-menopausal women for the treatment of hirsutism?
No - it can cause irregular periods and theoretical risk of causing ambiguous genitalia in a male fetus if taken during early pregnancy.
What complications during pregnancy are patients with Turner’s syndrome at increased risk for?
(3 points)
- Pre-eclampsia
- Stroke
- Ruptured aorta
What is the confirmation test for nonclassical congenital adrenal hyperplasia?
Measurement of stimulated 17-hydroxyprogesterone 30 minutes after cosyntropin administration.
The diagnosis of 21 alpha-hydroxylase deficiency is confirmed by documenting stimulated levels of 17-hydroxyprogesterone greater than _______ ng/dL 30 - 60 minutes after ACTH stimulation,
1000 - 1500
What are the two most common causes of progression of post-menopausal hirsutism to frank virilization?
- Obesity
- Hyperthecosis ovarii
Is early or late menarche associated with increased risk for breast cancer in response to post-menopausal hormone replacement therapy?
Early menarche
Is early or late menopause associated with increased risk for breast cancer in response to post-menopausal hormone replacement therapy?
Late menopausea
Is nulliparity or multiparity associated with increased risk for breast cancer in response to post-menopausal hormone replacement therapy?
Nulliparity
What is the most common adverse effect of low-dose hormone therapy in post-menopausal women?
Gallstones
Mutations in which two genes can cause anosmic hypogonadotrophic hypogonadism with absent sexual maturation?
- FGFR1 (fibroblast growth factor receptor 1)
- FGF8 (fibroblast growth factor 8)
The risk of ____ increases with estrogen-only hormone therapy at menopause.
Stroke
How do you screen for fragile X premutations in women with premature ovarian insufficiency?
FMR1 genetic testing
shows CGG repeats
What is the recommended regimen for masculinization in female-to-male transsexual patients?
GnRH analogue every 3 months and testosterone gel (e.g. 5 mg daily)
Why is GnRH analogue therapy recommended in female-to-male transsexuals?
To induce medical castration
Is norethidrone comparatively more or less androgenic than other progestins?
Less androgenic
Is the AMH level high or low in PCOS?
High
Is the FSH level high or low in PCOS?
Low
Is the AMH level high or low in impending premature ovarian insufficiency?
Low
Is the FSH level high or low in impending premature ovarian insufficiency?
High
What is the minimum amount of time it takes normal, eugonadal men escape the suppressive effects of intramuscular testosterone enanthate or cypionate?
1 month
How long does it typically take for the gonadal axis to recover after traumatic brain injury?
4 - 12 months
Patient has:
- Lentigines
- Blue nevi
- Cardiac myxoma
Diagnosis?
Carney Complex
What endocrinopathies are associated with Carney’s complex?
- Acromegaly with or without prolactin co-secretion
- Thyroid cancer or cystic nodules
- Sertoli-cell tumors with increased estradiol production.
Which imaging modality is best to diagnose Sertoli-cell tumors?
Ultrasonography
What is the most common significant adverse effect of estrogen therapy in male-to-female transsexual patients?
Deep venous thrombosis
Patient has:
- Gynecomastia
- Azoospermia
- Very small testes
- Elevated gonadotropins
Diagnosis?
Klinefelter syndrome (47 XXY)
What is the most common adverse effect of testosterone therapy in men younger than 50 years?
Acne
What is the most common adverse effect of testosterone therapy in men older than 50 years?
Erythrocytosis
By what percentage does testosterone therapy increase bone mineral density in hypogonadal men?
2 - 10%
Patient has:
- Hypospadias (or ambiguous genitalia)
- Low-normal gonadotrophins
- High-normal testosterone
- Abonormal spermatogenesis
Diagnosis?
5-alpha reductase deficiency
Does endogenous estrogen from aromatization of testosterone increase or decrease bone density?
Increase
Does endogenous estrogen aromatization of testosterone increase or decrease muscle mass?
No effect on muscle mass
Does endogenous estrogen aromatization of testosterone increase or decrease total body fat?
Decrease
Does endogenous estrogen aromatization of testosterone increase or decrease sexual desire?
Increase
What is the most important variable that effects neonatal macrosomia?
Postprandial glucose level
With proper medical and ophthalmologic care, more than _____ % of severe vision loss resulting from proliferative diabetic retinopathy can be prevented.
90 %
What are two of the most important physical factors influencing the accuracy of blood glucose strips?
- Altitude
- Temperature
What is the risk of development of type 1 diabetes in the offspring of an affected parent?
4 - 8%
What is the risk of development of type 1 diabetes someone with no family history of type 1 diabetes?
0.4%
What is the prevalence of erectile dysfunction in diabetics?
25 - 75%
Are ACE inhibitors associated with erectile dysfunction?
No
What is the lifetime risk of developing a foot ulcer in diabetes mellitus?
25%
What is the strongest predictor of development of foot ulcers in diabetes mellitus?
History of a foot ulcer
What kind of exercise can cause blood glucose to rise…
Aerobic or anaerobic?
Anaerobic exercise
Does autoimmune adrenal insufficiency typically cause bilateral adrenal enlargement?
No
What is the most common fungal disease to cause adrenal insufficiency?
Histoplasmosis
What is the most sensitive diagnostic test to assess for the presence or absence of ACTH-dependent hypercortisolism?
Late night salivary cortisol measurement
Is the 2-day low dose dexamethasone suppression test a sensitive indicator of early recurrent Cushing disease?
No
Very large myelolipomas have been reported in patients with ________.
Congenital adrenal hyperplasia
What does licorice do to potassium levels?
Elevates them
What does licorice do to aldosterone levels?
Suppresses them
What does licorice do to renin activity levels?
Suppresses them
What does licorice do to late night salivary cortisol levels?
Increases them
What does licorice do to blood pressure?
Increases it
Microalbuminuria represents a stage of diabetic nephropathy at which treatment is often successful in preventing progression to macroalbuminuria.
True or false?
True
Pramlintide is an analogue of _____
Amylin
Pramlintide causes a moderate degree of weight loss.
True or false?
True
Most cases of familial paraganglioma are caused by mutations in _______.
SDH genes (SDHB, SDHC, SDHD)
What is the likely diagnosis when a patient with adrenal-dependant Cushing syndrome has high DHEA-S levels?
Adrenocortical carcinoma
Does dexamethasone cross the placenta?
Yes
How do you diagnose adrenoleukodystrophy?
Measure very long-chain fatty acids
What is another name for familial hyperaldosteronism type 1?
Glucocorticoid-remediable hypertension
Patient has:
- Marfanoid body habitus
- Mucosal neuromas
- Family history of bilateral pheochromocytoma
Diagnosis?
MEN 2B
