Endocrinology and metabolism （memo from NEJM Knowledge plus and MKSAP）

・Tx for acute episode of diabetic neuropathy

glucose control, low-dose tricycle antidepressant (desipramine), capsaicin cream

・mechanism of hypercalcemia due to disseminated tuberculosis

macrophages in tuberculous granuloma activate vitamin D

・diagnosis of diabetes by HbA1c

> 6.5% in separate occasion 

・outcome of laser photocoagulation for diabetic retionpathy

diminished peripheral and night vision with retention of central vision

・evaluation of secondary amenorrhea with normal labs work-up

progesterone challenge test (evaluate whether estrogen is low or normal)

・management of bilateral adrenal hyperplasia

conservative management with spironolactone

・Tx for myxedema coma

thyroid hormone and stress-dose glucocorticoid until excluding concurrent adrenal insufficiency

・maturity-onset diabetes of the young

diagnosed in adolescence, deteriorate slowly, strong family history

・monophilament test for diabetic neuropathy

plantar surface of distal hallux and 1st, 3rd, 5th metatarsal head of each foot

・Tx of Graves disease ophthalmopathy in the setting of intolerance to anti-thyroid Tx

trial of prednisone, thyroidectomy

・indication of parathyroidectomy for primary hyperparathyroidism

symptomatic hypercalcemia (nephrolithiasis, arrhythmia), or regardless of Sx with GFR<60, or T score <-2.5, or fragility fracture, or < 50 yo

・gynecomastia in male

imbalance in testosterone-to-estrogen ratio -> check serum levels

・euthyroid sick syndrome

TSH no more than 10

・hormone deficiency after traumatic brain injury

GH 

・Tx for large papirally thryoid cancer (> 4cm)

surgery followed by radioactive iodine therapy 

・sudden discontinuation of megestrol for anorexia

cause adrenal insufficiency due to its glucocorticoid activity 

・indication of surgery for primary hyperparathyroidism

Ca  > 1mg/dl + upper limit, GFR < 60, osteoporosis, fracture

・next management for patient with Sx of thyrotoxicosis, significantly elevated T3, TSH of 1.5

pituitary MRI to evalute TSH-secreting pituitary tumor (TSH usually not detectable in primary thyroid disorder)

・next step for patient with persistently elevated ALP (bone isoform), bone scan showing uptake in multiple bones

plain radiograph of bones to diagnose Paget disease (osteitis deformans)

・elevated testosterone in female

from ovary or adrenal gland

adrenal gland produce dehydroepiandrosterone sulfate (DHEAS) 

・Tx for macroprolactinoma

first line: dopamine agonist

surgery only when failure of medical management or visual deterioration

・Somogyi phenomenon

(hypoglycemia during night leads to rebound hyperglycemia in the morning)

this theoretical concept has been disproven as a cause of fasting hyperglycemia

・Dawn phenomenon

elevation in glucose during the morning (4AM-8AM) result from physiolosic release of cortisol and GH

・adverse effect of chronic opioid use

central hypogonadism -> low libido, erectile dysfunction 

・central adrenocorticotropic hormone deficiency during pregnancy

lymphocytic hypophysitis (rare autoimmune disorder)

・benign familial hypocalciuric hypercalcemia

high-normal PTH level and family history 

・above what of random cortisol level make diagnosis of adrenal insufficiency unlikely in critically ill patients

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・evaluation of male hypogonadism

measure of morning total testosterone level (not free testosterone)

・Tx for hirsutism from polycystic ovary syndrome

oral contraceptive which decrease testosterone production by ovary

・management of abdominal pain in the setting of DKA (general tenderness, leukocytosis, AMY 1000)

serial abdominal exam

・suggestive finding of malignant adrenal incidentaloma

> 4cm,  attenuation > 20

・management of amiodarone-induced thyrotoxicosis

prednisone and beta blocker