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Endocrinology Flashcards

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  1. A 40-year-old woman presents with hypertension, hypokalemia, and suppressed plasma renin activity. Aldosterone-to-renin ratio is markedly elevated. What is the next best diagnostic step?

    Answer: Confirm with oral sodium loading or fludrocortisone suppression test

    An elevated aldosterone-to-renin ratio is a screening test; confirmatory testing (salt loading or fludrocortisone suppression) is required before adrenal imaging or vein sampling.

  2. A 25-year-old man is found to have bilateral adrenal masses and hypertension. Urine metanephrines are markedly elevated. Before surgical planning, which additional workup is mandatory?

    Answer: Serum calcitonin and RET proto-oncogene mutation testing

    Bilateral pheochromocytoma raises concern for MEN2 or VHL; serum calcitonin screens for medullary thyroid cancer and RET mutation testing identifies MEN2.

  3. Which of the following features most strongly differentiates papillary thyroid carcinoma from follicular thyroid carcinoma on fine needle aspiration?

    Answer: Nuclear grooves, pseudoinclusions, and Orphan Annie eye nuclei

    Papillary thyroid carcinoma is diagnosed by characteristic nuclear features: grooves, pseudo-inclusions, and pale (Orphan Annie eye) nuclei on cytology.

  4. A 35-year-old woman with type 1 diabetes develops nausea, hypotension, hyponatremia, and hyperkalemia. Morning cortisol is 3 mcg/dL. What diagnosis must be ruled out immediately?

    Answer: Primary adrenal insufficiency (Addison disease)

    The combination of hyponatremia, hyperkalemia, hypotension, and low cortisol in a T1DM patient is classic for autoimmune primary adrenal insufficiency.

  5. A patient on amiodarone develops fatigue, weight gain, and bradycardia. TSH is 42 mIU/L and free T4 is 0.4 ng/dL. What is the most appropriate management?

    Answer: Start levothyroxine replacement

    Amiodarone-induced hypothyroidism requires levothyroxine replacement; amiodarone discontinuation is often not feasible due to underlying cardiac disease.

  6. A 50-year-old man with type 2 diabetes has an HbA1c of 9.2% despite maximum metformin. He has established atherosclerotic cardiovascular disease. Which agent should be added next according to current guidelines?

    Answer: GLP-1 receptor agonist with proven CV benefit

    ADA guidelines prioritize GLP-1 receptor agonists with proven cardiovascular benefit (liraglutide, semaglutide) or SGLT-2 inhibitors in patients with established ASCVD.

  7. An insulinoma is suspected in a patient with fasting hypoglycemia. Which laboratory finding pattern is diagnostic?

    Answer: High insulin, high C-peptide, high proinsulin, negative sulfonylurea screen

    Insulinoma produces endogenous insulin with elevated C-peptide and proinsulin; exogenous insulin use causes low C-peptide, and sulfonylurea abuse is excluded by drug screen.