Endocrine, Diabetes & Metabolism

Question 1

What is the most comon cause of congenital adrenal hyperplasia?

Answer 1

21-hydroxylase deficiency

Question 2

Diagnosis:

1. Female with hyperandrogenism (acne, hirsutism)
2. Lab studies show elevated 17-hydroxyprogesterone

Answer 2

Congenital adrenal hyperplasia

Question 3

At what age do females with partial 21-hydroxylase deficiency typically present?

Answer 3

These girls normally present in adolescence or adulthood with symptoms of hyperandrogenism (acne hirsutism).

Question 4

Treatment:

Gestational diabetes

Answer 4

1. dietary modification
2. exercise
3. insulin
4. oral antidiabetics

Question 5

Which oral antidiabetic drugs are contraindicated in pregnant women?

Answer 5

Pioglitazone (a thiazolidinedione)

Question 6

What complications are associated with maternal hyperglycemia?

Answer 6

1. Congenital malformations
2. Macrosomia
3. Neonatal hypoglycemia
4. Polycythemia (causing hyperviscosity)

Question 7

Definition:

Secondary amenorrhea

Answer 7

The absence of menses for >/= 3 cycles OR >/=6 months in a women who previously menstruated

Question 8

Work up:

Secondary Amenorrhea

Answer 8

1. Beta hCG
2. serum prolactin
3. TSH
4. FSH

Question 9

When should a oral glucose tolerance test be used to screen pregnant women for gestational diabetes?

Answer 9

Oral glucose tolerance test should be given to all pregnant women between 24-28 weeks.

Question 10

How does pregnancy affect the following lab values:

TSH
T3
T4

Answer 10

TSH= decreased
T3 & T4= increased

Pregnant women also have an increased thyroid binding globulin, but the T3 & T4 productions is slightly higher.

Question 11

Why might obese women experience milder menopausal symptoms?

Answer 11

The major source of estrogen in menopausal women comes from the peripheral conversion of adrenal androgens into estrogen by the enzyme aromatase. Aromatase is present in the adipose tissue. As a result, obese women have a higher estrogen level.

Question 12

Clinical Manifestation:

1. irritability
2. tachycardia
3. poor weight gain

in an infant born to a women with Grave’s disease

Answer 12

thyrotoxicosis

Question 13

Treatment:

Thyrotoxicosis

Answer 13

Methimazole PLUS B-blocker given to symptomatic patients until the resolution of symptoms. This can take a few weeks to months.

Question 14

Pathogenesis:

Thyrotoxicosis in an infant born to a women with Grave’s Disease

Answer 14

Maternal TSH receptor antibodies pass across the placenta

Question 15

How does the maternal dosage of levothyroxine change with pregnancy?

Answer 15

Levothyroxine dose is increased during pregnancy in patients with hypothyroidism.

Question 16

Diagnosis:

Bilateral milky, yellow brown, gray or green galactorrhea

Answer 16

Physiologic galactorrhea

Question 17

What is the most common cause of physiologic galactorrhea?

Answer 17

Hyperprolactinemia

Question 18

What is the work-up for galactorrhea?

Answer 18

1. serum prolactin
2. TSH
3. brain MRI (possibly)

Question 19

When should you evaluate a patient with galactorrhea for malignant causes?

Answer 19

When the patient has:

1. unilateral
2. bloody (gross or occult) nipple discharge
3. palpable abnormalities
4. skin changes