Endocrinology Review - Lecture Notes

Question 1: SIADH in Lung Cancer

• Patient: 61-year-old male, Stage 3B small cell lung cancer, lethargy, stable BP (125/80)
• Labs: Sodium 121, Potassium 3.8, Urine osmolarity 355 mOsm/kg
• Diagnosis: SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
• Management: Fluid restriction
• Note: SIADH often linked with small cell lung cancer; treat slowly to prevent central pontine myelinolysis.

Question 2: Thyroid Nodule Management

• Patient: 48-year-old woman, thyroid nodule, normal TSH
• Next Step: Fine needle aspiration (FNA)
• Rationale: Concerned about cancer; FNA is diagnostic for thyroid nodules.

Question 3: Pheochromocytoma

• Patient: 29-year-old woman, severe headache, elevated BP
• Clue: Elevated plasma metanephrines
• Management: Phentolamine (alpha-blocker)
• Note: Avoid beta blockers first as they can worsen conditions.

Question 4: MEN 2A Syndrome

• Patient: Previous pheochromocytoma diagnosis; elevated serum calcium
• Diagnosis: MEN 2A Syndrome (Medullary thyroid carcinoma, Pheochromocytoma, Parathyroid hyperplasia)

Question 5: Klinefelter Syndrome

• Patient: 16-year-old male, sparse pubic hair, learning difficulties
• Diagnosis: 47,XXY karyotype (Klinefelter Syndrome)
• Management: Intramuscular testosterone to promote development of male secondary characteristics.

Question 6: Cushing Syndrome Diagnostic Approach

• Patient: 42-year-old woman, weight gain, faint straie
• Initial Test: Low-dose dexamethasone suppression test
• Note: Best initial test for suspected Cushing Syndrome.

Question 7: Hypocalcemia and Seizure

• Patient: 20-year-old male, seizure, low calcium
• Management: Calcium gluconate

Question 8: Addisonian Crisis

• Patient: 39-year-old male, appendicitis, hypotension
• Management: Methylprednisolone (glucocorticoid replacement)

Question 9: Prolactinoma

• Patient: 27-year-old male, vision loss
• Diagnosis: Prolactinoma (indicated by bitemporal hemianopsia)
• Next Step: Serum prolactin level

Question 10: Type 2 Diabetes Management

• Patient: 47-year-old woman, elevated fasting glucose
• Management: Start Metformin

Question 11: Diabetic Neuropathy and Insulin Therapy

• Patient: 65-year-old male, diabetic neuropathy
• Management: Switch to insulin therapy

Question 12: Weight Gain in Diabetes

• Patient: 56-year-old man, weight gain on Glipizide
• Management: Stop Glipizide, start Exenatide

Question 13: Thyroid Storm

• Patient: 17-year-old female, tachycardia, fever
• Management: IV Propylthiouracil (PTU)

Question 14: Sheehan's Syndrome

• Patient: 26-year-old postpartum woman, amenorrhea
• Diagnosis: Sheehan’s Syndrome (ischemic necrosis of pituitary gland)

Question 15: Acromegaly

• Patient: 51-year-old male, enlarged jaw, separated teeth
• Diagnosis: Acromegaly
• Initial Test: IGF-1 levels

Question 16: Polycystic Ovarian Syndrome (PCOS)

• Patient: 33-year-old woman, hirsutism, irregular periods
• Management: Medroxyprogesterone

Question 17: Hypothyroidism

• Patient: 42-year-old male, weight gain, fatigue
• Diagnosis: Hypothyroidism
• Next Step: Serum TSH level

Question 18: Osteoporosis Screening

• Patient: 51-year-old woman
• Threshold for Treatment: T-score below -2.5

Question 19: De Quervain Thyroiditis

• Patient: 36-year-old woman, neck pain
• Diagnosis: De Quervain Thyroiditis (subacute thyroiditis)
• Management: Prednisone to reduce inflammation

These notes summarize key points from endocrinology questions, emphasizing diagnosis, management, and clinical reasoning for USMLE preparation.