PANCE Endocrine System 5 — Questions and Answers
Question 1: A 55-year-old man with type 2 diabetes and a history of heart failure with reduced ejection fraction (HFrEF) needs better glycemic control. Which agent provides the most cardiovascular benefit?
- Glipizide
- Sitagliptin
- Empagliflozin (SGLT-2 inhibitor) (Correct answer)
- Pioglitazone
Correct answer: Empagliflozin (SGLT-2 inhibitor)
SGLT-2 inhibitors like empagliflozin have demonstrated significant reduction in HF hospitalizations and cardiovascular mortality in patients with HFrEF.
Question 2: A 22-year-old woman presents with salt craving, hyperpigmentation, hypotension, and hyponatremia with hyperkalemia. Morning cortisol is 3 mcg/dL. What is the diagnosis?
- Secondary adrenal insufficiency
- Primary adrenal insufficiency (Addison disease) (Correct answer)
- Cushing syndrome
- Hyperaldosteronism
Correct answer: Primary adrenal insufficiency (Addison disease)
Primary adrenal insufficiency causes hyperpigmentation (elevated ACTH) and both glucocorticoid and mineralocorticoid deficiency, causing hyperkalemia and hyponatremia.
Question 3: A 30-year-old woman with Hashimoto thyroiditis is euthyroid. She asks about her risk for other autoimmune conditions. Which condition is she at increased risk for?
- Type 2 diabetes mellitus
- Vitiligo and type 1 diabetes (Correct answer)
- Cushing disease
- Hyperaldosteronism
Correct answer: Vitiligo and type 1 diabetes
Hashimoto thyroiditis is associated with other organ-specific autoimmune diseases including type 1 DM, vitiligo, and Addison disease.
Question 4: A newborn has ambiguous genitalia, hyponatremia, hyperkalemia, and low cortisol. 17-hydroxyprogesterone is markedly elevated. What is the most likely diagnosis?
- Congenital adrenal hyperplasia due to 21-hydroxylase deficiency (Correct answer)
- Primary hyperaldosteronism
- Adrenal adenoma
- Congenital hypothyroidism
Correct answer: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
21-hydroxylase deficiency is the most common form of CAH, causing cortisol and aldosterone deficiency with androgen excess and markedly elevated 17-OHP.
Question 5: A 65-year-old woman on alendronate for 5 years asks about continuing therapy. What is the most serious rare adverse effect associated with long-term bisphosphonate use?
- Hypercalcemia
- Atypical femur fracture (Correct answer)
- Hypomagnesemia
- Adrenal suppression
Correct answer: Atypical femur fracture
Long-term bisphosphonate use is associated with atypical subtrochanteric or diaphyseal femur fractures.
Question 6: A patient with acromegaly would most commonly present with which cardiovascular complication?
- Mitral valve prolapse
- Left ventricular hypertrophy and cardiomyopathy (Correct answer)
- Pericardial effusion
- Aortic stenosis
Correct answer: Left ventricular hypertrophy and cardiomyopathy
Excess GH/IGF-1 in acromegaly causes left ventricular hypertrophy and acromegalic cardiomyopathy, the leading cause of death.
Question 7: A 50-year-old man is found to have a serum calcium of 9.0 mg/dL and PTH of 12 pg/mL (low). He complains of muscle cramps and perioral tingling. Which condition is most likely?
- Primary hyperparathyroidism
- Hypoparathyroidism (Correct answer)
- Secondary hyperparathyroidism
- Familial hypocalciuric hypercalcemia
Correct answer: Hypoparathyroidism
Low PTH with low-normal calcium and symptoms of hypocalcemia (cramps, tingling) is consistent with hypoparathyroidism.
PANCE Endocrine System 5
A 55-year-old man with type 2 diabetes and a history of heart failure with reduced ejection fraction (HFrEF) needs better glycemic control.
Which agent provides the most cardiovascular benefit?