Endocrinology and Metabolism Flashcards
Test for vitamin D sufficiency
25-Hydroxyvitamin D measurement
This is the standard test used to assess vitamin D levels in the body.
Treatment of primary adrenal insufficiency
Glucocorticoid and mineralocorticoid replacement
This treatment is necessary to replace hormones that the adrenal glands are not producing.
Common hyperparathyroidism-related vitamin deficiency
Vitamin D
Vitamin D deficiency often occurs due to malabsorption and lack of sunlight exposure.
Bone complications of bisphosphonates
Osteonecrosis of jaw, atypical femur fracture
These are serious side effects that can occur with long-term use of bisphosphonates.
Prolactin level suggestive of macroprolactinoma
> 200 ng/mL
Elevated levels of prolactin can indicate the presence of a macroprolactinoma.
Electrolyte disorder causing functional hypoparathyroidism
Magnesium deficiency
Low magnesium levels can impair parathyroid hormone secretion and action.
Most common cause of primary amenorrhea
Gonadal dysgenesis (e.g., Turner syndrome)
Turner syndrome is a genetic condition that affects females and is characterized by the absence of one X chromosome.
T1DM antibody testing in new diagnosis
Glutamic acid decarboxylase (GAD)
GAD antibodies are commonly tested in the diagnosis of Type 1 Diabetes Mellitus.
First test in patients with secondary amenorrhea
Pregnancy test
A pregnancy test is essential to rule out pregnancy as the cause of secondary amenorrhea.
Diagnosis suggested by thionamide use, fever, sore throat
Agranulocytosis
Agranulocytosis is a potentially life-threatening condition characterized by a dangerously low white blood cell count.
Treatment of macroprolactinoma
Dopamine agonist
Dopamine agonists such as cabergoline are the first-line treatment for macroprolactinomas.
Initial treatment of Graves disease
Thionamides (methimazole or propylthiouracil)
These medications reduce thyroid hormone production in hyperthyroidism.
Treatment following adrenalectomy for Cushing syndrome
Glucocorticoid replacement
After adrenalectomy, glucocorticoid replacement is necessary due to loss of cortisol production.
Screening test for mild autonomous cortisol secretion in adrenal incidentaloma
1-mg overnight dexamethasone suppression test
This test helps to evaluate cortisol secretion from adrenal tumors.
Diagnosis suggested by secondary amenorrhea, elevated FSH, low estradiol
Turner syndrome, POI
Primary ovarian insufficiency (POI) can lead to similar hormonal profiles.
Treatment of DM-related macular edema
Intravitreal anti-VEGF
Anti-VEGF injections help reduce fluid leakage and improve vision in diabetic macular edema.
Frequency of TSH measurement in pregnant patient with hypothyroidism
Every 4 weeks for first half of pregnancy and at 30 weeks
Regular monitoring is crucial to adjust thyroid hormone replacement in pregnancy.
Morning cortisol level strongly suggestive of deficiency
<3 µg/dL
Very low morning cortisol levels can indicate adrenal insufficiency.
Uterine cause of secondary amenorrhea
Intrauterine adhesions (Asherman syndrome)
Asherman syndrome can result from surgical procedures like dilation and curettage (D&C).
Timing of infertility evaluation in women <35 years
≥1 year of regular unprotected intercourse
This duration is recommended before further evaluation for infertility.
Diagnosis of osteoporosis in postmenopausal women and men >50 years
T-score ≤−2.5 or fragility fracture (especially hip or vertebral compression fracture)
A T-score of -2.5 or lower indicates osteoporosis.
Treatment needed after denosumab or teriparatide discontinuation
Alternative antiresorptive therapy (e.g., oral bisphosphonate)
This is necessary to maintain bone density after stopping these treatments.
eGFR contraindication to metformin therapy
<30 mL/min/1.73 m2
A low eGFR increases the risk of lactic acidosis with metformin.
First lab test for thyroid nodule
TSH level
TSH levels help determine the need for further evaluation of thyroid nodules.
Most common cause of primary adrenal insufficiency (Addison disease)
Autoimmune adrenalitis
Autoimmune destruction of the adrenal cortex is the leading cause of Addison’s disease.
Treatment of adrenergic symptoms in thyrotoxic patients
β-Blockers
β-Blockers are commonly used to manage symptoms such as tachycardia and tremors in thyrotoxic patients.
Empiric levothyroxine dose change during pregnancy
30% increase
Pregnant women may require an increase in their levothyroxine dosage to maintain adequate thyroid hormone levels.
Prophylaxis for glucocorticoid-related osteoporosis
Bisphosphonate, denosumab
These medications are used to prevent bone loss in patients receiving glucocorticoids.
Treatment of arginine vasopressin deficiency (central diabetes insipidus)
Desmopressin
Desmopressin is a synthetic analog of vasopressin used to treat diabetes insipidus.
Treatment of ACTH-secreting pituitary adenoma
Surgical resection
Surgery is often the first-line treatment for ACTH-secreting tumors causing Cushing’s disease.
DM diagnostic tests
HgbA1c, FBG, OGTT; random glucose if hyperglycemic symptoms
These tests are utilized to diagnose diabetes mellitus.
ACP-recommended goal HgbA1c in most patients with T2DM
7% to 8%
This range is recommended to balance the benefits of glycemic control with the risks of treatment.
Frequency of HgbA1c assessment in T2DM not at glycemic goal
3 months
Increased monitoring is necessary for patients who are not achieving their glycemic targets.
Diagnosis suggested by primary amenorrhea, short stature
Turner syndrome
Turner syndrome is a chromosomal disorder affecting females, often characterized by these symptoms.
HgbA1c level below which to consider deintensifying pharmacologic therapy
6.5%
A lower level may indicate that the patient is at risk for hypoglycemia with continued therapy.
Age-related indication for osteoporosis screening in average-risk postmenopausal women
Age ≥65 years
Screening is recommended for women starting at this age to assess fracture risk.
Most common cause of hirsutism/androgen excess in women
PCOS
Polycystic ovary syndrome is the leading cause of hirsutism due to elevated androgen levels.
Initial test for suspected acromegaly
IGF-1 level
Insulin-like growth factor 1 levels are typically elevated in acromegaly.
Recommended initial antihypertensive medications in T2DM
ACE inhibitors or ARBs; dihydropyridine CCBs; thiazide diuretics
These medications are preferred to manage hypertension in diabetic patients.
Diabetic proliferative retinopathy treatment
Photocoagulation or intravitreal anti-VEGF
These treatments aim to prevent vision loss from diabetic retinopathy.
Diagnosis suggested by hyperthyroidism, elevated TSH, and elevated free T4
TSH-secreting pituitary tumor
This condition results in excessive thyroid hormone production despite high TSH levels.
Most common type of familial hypercalcemia
Familial hypocalciuric hypercalcemia
This genetic condition leads to elevated calcium levels due to impaired renal calcium excretion.
Initial imaging test for ACTH-independent Cushing syndrome
Adrenal CT or MRI
Imaging is critical to identify adrenal tumors causing Cushing syndrome.
Diagnosis suggested by tall stature, small testes, primary hypogonadism
Klinefelter syndrome (47,XXY)
This genetic disorder affects male physical and cognitive development.
Treatment of Paget disease of bone
Single dose of zoledronic acid
Zoledronic acid is effective in reducing bone turnover in Paget’s disease.
Treatment of thyroid hormone deficiency
Levothyroxine
Levothyroxine is the standard treatment for hypothyroidism.
Most reliable case-detection test for primary aldosteronism
PAC/PRA
The plasma aldosterone concentration to plasma renin activity ratio is crucial for diagnosing this condition.
Potential benefits of testosterone therapy in men with hypogonadism
Increased libido, lean muscle mass, fat-free mass, bone density, and secondary sexual characteristics
These benefits highlight the importance of testosterone in male health.
Drug class associated with euglycemic ketoacidosis
SGLT2 inhibitors
This class of medications can lead to ketoacidosis even in the presence of normal blood glucose levels.
Diagnosis suggested by rapid-onset virilization, menstrual irregularities
Androgen-secreting adrenal tumor
These tumors can produce excess androgens, leading to virilization in women.
Diagnosis suggested by hyperthyroidism, diffusely enlarged thyroid
Graves disease
Frequency of DM-related dilated eye exams during pregnancy
Every trimester
Invasive test to confirm source of hyperaldosteronism
Adrenal vein sampling
Impact of chronic opioid therapy on gonadal function
Hypogonadotropic hypogonadism
Diagnosis suggested by low cortisol, elevated ACTH
Primary adrenal insufficiency
BMI threshold for bariatric surgery in patients with comorbidities
≥30
Most common cause of subclinical hyperthyroidism
Toxic multinodular goiter
Nonpituitary endocrine cause of hyperprolactinemia
Hypothyroidism
Lab test diagnostic criteria for male hypogonadism
Two low 8 am serum total testosterone measurements
Hormone replacement for all patients with panhypopituitarism
T4 and cortisol
Treatment of adrenal mass >4 cm
Resection
Order of drugs for treating adrenal crisis and hypothyroidism
Hydrocortisone, then thyroid hormone replacement
Pharmacologic PCOS treatment when fertility desired
Clomiphene citrate or letrozole
Bone indication for hyperparathyroidism-related parathyroidectomy
T-score ≤−2.5 or vertebral fracture
Route of insulin administration recommended for critically ill hospitalized patients
Intravenous
Thyroid cancer associated with MEN types 2A and 2B
Medullary
Thyroid storm treatment
β-Blockers, PTU, glucocorticoids, and potassium iodide
Painful thyroiditis associated with elevated ESR/CRP, typically following viral URI
Subacute thyroiditis
Contraindications to initial full-dose thyroid hormone replacement
Age ≥65 years, cardiac disease
Condition that is a common cause of acquired hypocalcemia
CKD
Inpatient glucose threshold for insulin initiation
180 mg/dL
Most common manifestation of primary aldosteronism
Hypertension
Treatment of hypoglycemia unawareness
Relax glycemic targets, modify hypoglycemia-inducing therapies
Most common optic chiasm compression–related visual field defect
Bitemporal hemianopsia
Indication for weight loss pharmacotherapy after unsuccessful lifestyle modification trial
BMI ≥30 or BMI ≥27 with ≥1 obesity-associated comorbid condition
First drug administered in treatment of myxedema coma
Hydrocortisone
Hormonal treatment of POI
Estrogen-progestin therapy until age 51 years
Most common cause of osteomalacia
Severe and prolonged vitamin D deficiency
Test for thyroid nodule with normal TSH
Ultrasonography
Initial testing for hypercalcemia
Serum calcium and PTH levels
Most common cause of non–PTH-mediated hypercalcemia
Malignancy
TSH level indication for subclinical hypothyroidism treatment
> 10 µU/mL
Endocrine adverse effect of checkpoint inhibitor drugs
Hypophysitis
Treatment of men with biochemically proven hypogonadism
Testosterone therapy
BMI threshold for bariatric surgery in patients with no comorbidities
≥35
Hormonal or surgical therapy to adapt patient’s body to experienced gender
Gender-affirming treatment
Treatment of Graves ophthalmopathy
Glucocorticoids, surgery, rituximab, tocilizumab, teprotumumab
Teriparatide treatment duration
2 years
UACR cutoff for consideration of ACE inhibitor/ARB in T2DM with hypertension
UACR ≥30 mg/g
Test for thyroid nodule with suppressed TSH
Thyroid scintigraphy
Most common cause of hypoparathyroidism
Neck surgery–associated injury
Genetic testing for medullary thyroid cancer
RET oncogene
Initial treatment of severe hypercalcemia
Aggressive hydration with 0.9% saline
Most common cause of familial hyperparathyroidism
MEN1
Osteoporosis testing interval in low-risk patient with T-score of −1 to −2
3 to 5 years
Diseases associated with acanthosis nigricans
Insulin resistance/T2DM, malignancy
Initial pharmacologic treatment of PCOS
Combined oral contraceptive (unless fertility desired)
Feminizing gender-affirming hormone therapy
Estradiol and androgen blocker (both used off label)
Morning cortisol level that rules out deficiency
> 15 µg/dL
Diagnosis suggested by acne, gynecomastia, small testes, low gonadotropins, erythrocytosis
Anabolic steroid use
Most common cause of primary hypothyroidism in U.S.
Hashimoto thyroiditis (chronic lymphocytic thyroiditis)
Hashimoto thyroiditis is an autoimmune disorder that leads to destruction of the thyroid gland.
Waist circumference associated with increased risk for DM, ASCVD, and mortality
> 40 inches in men, >35 inches in women
Increased waist circumference is a significant indicator of metabolic syndrome.
Indication for insulinoma localization imaging in hypoglycemia
After confirmation of endogenous hyperinsulinism
Imaging is essential to locate insulinomas which cause hypoglycemia.
Treatment of nonthyroidal illness syndrome
Observation
Nonthyroidal illness syndrome often resolves with treatment of the underlying condition.
Initial duration of oral bisphosphonate therapy for low-risk osteoporosis
5 years
This duration may vary based on individual risk assessments.
Diagnosis suggested by small/absent pituitary gland on MRI
Empty sella syndrome
This condition is characterized by the herniation of the arachnoid membrane into the sella turcica.
Diagnosis suggested by low testosterone, normal LH and FSH in men
Secondary (pituitary) hypogonadism
This indicates a malfunction of the pituitary gland affecting testosterone production.
Initial tests in nonpregnant women with secondary amenorrhea
FSH, estradiol, TSH, free thyroxine, and prolactin levels
These tests help determine the underlying cause of amenorrhea.
Strongest environmental risk factor for thyroid cancer
Radiation
Exposure to radiation, especially during childhood, significantly increases thyroid cancer risk.
T2DM medications beneficial in heart failure
SGLT2 inhibitors
SGLT2 inhibitors have shown cardiovascular benefits in patients with type 2 diabetes.
Tests for pituitary hypersecretion in all pituitary incidentalomas
Prolactin and IGF-1 levels
These tests assess for possible hormone overproduction from incidentalomas.
Drug class used before adrenalectomy for pheochromocytoma
α-Receptor blocker
α-Receptor blockers are used to control hypertension related to catecholamine release.
Contraindications to 131I therapy
Pregnancy, significant Graves ophthalmopathy
These conditions increase the risk of complications from radioactive iodine treatment.
Drugs for diabetic peripheral neuropathy
Gabapentinoids, SNRIs, tricyclic antidepressants, sodium channel blockers
These medications help manage neuropathic pain in diabetic patients.
Universal vitamin deficiency after bariatric surgery
Vitamin D
Bariatric surgery can significantly affect nutrient absorption, leading to deficiencies.
Monitoring in secondary hypothyroidism
Free T4 measurement
Free T4 levels are crucial for assessing thyroid function in secondary hypothyroidism.
Electrolyte abnormality following thyroid surgery
Hypocalcemia (from parathyroid injury)
Parathyroid injury during thyroid surgery can lead to decreased calcium levels.
First step in evaluation of female infertility
Assessment of ovulatory function
Evaluating ovulation is critical in determining the cause of infertility.
Main two options for blood glucose monitoring (BGM)
Fingerstick BGM and continuous glucose monitoring (CGM)
Both methods are essential for managing diabetes effectively.
Cause of hypocalcemia after first dose of bisphosphonate
Vitamin D deficiency
Vitamin D is crucial for calcium metabolism, and deficiency can lead to hypocalcemia.
In T1DM, percentage of total daily insulin dose typically consisting of basal insulin
Approximately 50%
This ratio can vary based on individual insulin sensitivity and requirements.
Antibody test for autoimmune adrenalitis
21-Hydroxylase antibodies
The presence of these antibodies indicates autoimmune adrenalitis, leading to adrenal insufficiency.
Initial localization study of choice for primary aldosteronism
Dedicated adrenal CT
This imaging is crucial for identifying adrenal adenomas causing excess aldosterone production.
Thyroid effects of amiodarone
Hypothyroidism, hyperthyroidism, thyroiditis
Amiodarone can impact thyroid function due to its iodine content.
Test following male hypogonadism diagnosis
LH and FSH levels
These hormone levels help determine the cause of hypogonadism.
What are the treatment options for toxic adenoma?
Radioactive iodine, surgery, or thionamides
Toxic adenoma is a type of hyperfunctioning thyroid nodule that can lead to hyperthyroidism.
Which vitamin interferes with thyroid function assays?
Biotin
Biotin can cause falsely elevated thyroid hormone levels in laboratory tests.
