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Endocrinology and Metabolism Flashcards

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  1. A 48-year-old woman with type 2 diabetes on metformin and linagliptin develops worsening renal function (eGFR now 22 mL/min). Which medication adjustment is most appropriate?

    Answer: Discontinue metformin; continue linagliptin

    Metformin is contraindicated when eGFR <30 mL/min; linagliptin, unlike other DPP-4 inhibitors, is primarily excreted via bile and requires no renal dose adjustment even in severe CKD.

  2. A 35-year-old man has hypertension, hypokalemia, and metabolic alkalosis. Plasma renin activity is markedly elevated, as is aldosterone. CT shows a 3 cm right renal artery mass. What is the most likely diagnosis?

    Answer: Juxtaglomerular cell tumor (reninoma)

    A juxtaglomerular cell tumor (reninoma) secretes renin autonomously, causing secondary hyperaldosteronism with high renin; in primary hyperaldosteronism, renin would be suppressed.

  3. A 68-year-old woman with osteoporosis and a T-score of −3.0 at the hip has been on denosumab for 3 years. She asks about stopping therapy. What is the most important risk to counsel her about?

    Answer: Rapid bone loss and increased vertebral fracture risk upon discontinuation

    Denosumab discontinuation causes a rebound increase in bone turnover markers and rapid bone loss, significantly increasing vertebral fracture risk; transition to a bisphosphonate is recommended before stopping.

  4. A 52-year-old man presents with increased hat and shoe size over 5 years, jaw prominence, and hyperhidrosis. Random GH is 12 ng/mL. What is the confirmatory test for acromegaly?

    Answer: GH after oral glucose tolerance test (OGTT)

    In acromegaly, GH fails to suppress to <1 ng/mL after 75 g oral glucose load (OGTT); this is the gold-standard confirmatory test because random GH levels fluctuate.

  5. A 29-year-old woman presents with weakness, hyperpigmentation, salt craving, and orthostatic hypotension. Labs show Na 128 mEq/L, K 5.8 mEq/L, and glucose 62 mg/dL. ACTH stimulation test shows a peak cortisol of 10 mcg/dL at 60 minutes. What is the most likely diagnosis?

    Answer: Primary adrenal insufficiency (Addison's disease)

    Primary adrenal insufficiency (Addison's disease) is characterized by loss of both cortisol and aldosterone, causing hyponatremia, hyperkalemia, hyperpigmentation (elevated ACTH), and a blunted cortisol response to ACTH stimulation.

  6. A 45-year-old woman presents with palpitations, tremor, and a painless diffuse goiter. TSH is 0.01 mIU/L, free T4 is 3.2 ng/dL. TSH receptor antibodies are positive. She wants the most definitive long-term cure. What is the best option?

    Answer: Total thyroidectomy

    Total thyroidectomy provides the most immediate and definitive cure for Graves' disease and is preferred when the patient desires rapid, definitive resolution; RAI is effective but slower and may worsen ophthalmopathy.

  7. A 38-year-old man with MEN1 syndrome undergoes screening. He is found to have a fasting gastrin level of 890 pg/mL (normal <100) and multiple small duodenal ulcers. What syndrome is he most likely developing?

    Answer: Zollinger-Ellison syndrome (gastrinoma)

    Markedly elevated gastrin causing refractory peptic ulcer disease is diagnostic of Zollinger-Ellison syndrome (gastrinoma), which occurs in 20–30% of MEN1 patients and is the most common functional pancreatic tumor in MEN1.