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Endocrinology Flashcards

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  1. A 55-year-old postmenopausal woman is found to have a T-score of -2.8 at the lumbar spine. She has no prior fractures. FRAX 10-year hip fracture probability is 4%. What is the most appropriate next step?

    Answer: Reassess with FRAX including bone mineral density and treat if major osteoporotic fracture risk ≥20% or hip ≥3%

    NOF/AACE guidelines recommend pharmacotherapy when 10-year major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%, using FRAX with BMD integrated into the decision.

  2. A patient presents with hypercalcemia, low PTH, elevated PTHrP, and a lung mass. What is the mechanism of hypercalcemia?

    Answer: Humoral hypercalcemia of malignancy via PTHrP

    PTHrP (PTH-related peptide) secreted by squamous cell carcinomas mimics PTH action, causing humoral hypercalcemia of malignancy with suppressed native PTH.

  3. A patient with hyperthyroidism presents to the ED with fever of 104°F, tachycardia of 148 bpm, altered mental status, and vomiting. What is the immediate treatment priority?

    Answer: High-dose PTU, beta-blocker, iodine solution (given after PTU), and glucocorticoids

    Thyroid storm requires PTU to block synthesis and conversion, beta-blockers for rate control, iodine (given 1 hour after PTU) to block release, and corticosteroids to prevent adrenal crisis.

  4. Which of the following is the mechanism of action of empagliflozin in reducing cardiovascular mortality in type 2 diabetes?

    Answer: Inhibits SGLT-2 in the proximal tubule causing glucosuria, natriuresis, and volume reduction

    SGLT-2 inhibitors reduce glucosuria, promote natriuresis and osmotic diuresis, lowering preload and afterload, which underlies their heart failure and CV mortality benefits.

  5. A 45-year-old woman with no prior thyroid disease is found to have TSH of 6.8 mIU/L and normal free T4 on two separate measurements. She is asymptomatic and not pregnant. What is the most appropriate management?

    Answer: Obtain thyroid antibodies; treat if positive or TSH >10

    Subclinical hypothyroidism with TSH <10 in an asymptomatic, non-pregnant patient warrants observation; treatment is considered if TPO antibodies are positive or TSH exceeds 10 mIU/L.

  6. A patient with acromegaly has persistent elevated IGF-1 after transsphenoidal surgery. Which medical therapy directly targets somatostatin receptors to suppress GH?

    Answer: Octreotide LAR

    Somatostatin analogs (octreotide, lanreotide) bind somatostatin receptors to suppress GH secretion and reduce IGF-1 levels in persistent acromegaly.

  7. A 30-year-old woman presents with episodic headaches, palpitations, and diaphoresis. Blood pressure during an episode is 210/120 mmHg. 24-hour urine metanephrines are 3× the upper limit of normal. CT abdomen shows a 3 cm right adrenal mass. What is the correct sequence of management?

    Answer: Start alpha-blockade first, add beta-blocker after adequate alpha-blockade, then surgery

    Alpha-blockade must precede beta-blockade to prevent unopposed vasoconstriction; beta-blockers alone can precipitate hypertensive crisis in pheochromocytoma.