Endocrine Board Review 12th Edition [12 ed.] 9781879225657, 2019954327, 9781879225688, 1879225689

Citation preview

ENDOCRINE BOARD REVIEW 12TH EDITION

S E R G E A . J A B B O U R , M D, P R O G R A M C H A I R

ENDOCRINE SOCIETY

ENDOCRINE BOARD REVIEW Serge A. Jabbour, MD, Program Chair

Professor of Medicine Director, Division of Endocrinology, Diabetes & Metaboiic Diseases Sidney Kimmei Medical College Thomas Jefferson University

Andrea D. Coviello, MD Associate Professor of Medicine

Frances J. Hayes, MB BCh , BAO Ciinica! Director

Michelle F. Magee, MD

Division of Endocrinology, Metabolism, and Nutrition Duke University School of Medicine

Endocrine Division Massachusetts General Hospital

MedStar Diabetes, Research and innovation institutes Professor of Medicine Georgetown University

Natalie Cusano, MD, MS Associate Professor of Medicine Zucker School of Medicine

Jacqueline jonklaas, MD, PhD, MPH Professor Division of Endocrinology Georgetown University Medicai Center

at Hofstra/Northweli

Director of the Bone Metaboiism Program

Division of Endocrinology at Lenox Hill Hospital

Laurence Katznelson, MD

Professor of Neurosurgery

and Medicine Division of Endocrinology Stanford University

Tobias Else, MD Associate Professor

Division of Metabolism, Endocrinology, and Diabetes

Director

School of Medicine Kathryn A . Martin, MD Assistant Professor of Medicine

Harvard Medical School Practicing Clinician Massachusetts General Hospital Senior Physician Editor, Endocrinology and Diabetes

UpToDate

Abbie L. Young, MS, CGC , ELS (D) Medical Editor

University of Michigan

Endocrine Society 2055 L Street NW, Suite 600, Washington, DC 20036 1- 888 - ENDOCRINE © www.endocrine.org

ENDOCRINE

i

ma

m m m1 m V/ f

SI 4 V

ENDOCRINE 4

Hormone Stfence ft? Health

v

The Endocrine Society is the world’s largest, oldest, and most

active organization working to advance the clinical practice of

endocrinology and hormone research. Founded in 1916, the : Society now has more than 18,000 global members across a : / / /;/

.

L'

range of disciplines The Society has earned an international reputation for excellence in the quality of its peer- reviewed journals, educational resources, meetings, and programs that improve public health through the practice and science of endocrinology. .

: ;v

V

'

Visit us at: educatfon.endocrine.org endocrine.org

Other Publications;

endocrine.org/publications

The statements and opinions expressed in this publication are those of the individual authors and do not necessarily reflect the views of the Endocrine Society The Endocrine Society is not responsible or liable in any way for the currency of the information, for any errors, omissions, or inaccuracies, or for any consequences arising therefrom. With respect to any drugs mentioned, / the reader is advised to refer to the appropriate medical literature and the product information currently provided by the manufacturer to verify appropriate dosage, method and duration of administration, and other relevant information; In all instances, : it is the responsibility of the treating physician or other health care professional, relying on independent experience and expertise, as well as knowledge of the patient, to determine the best treatment

1 %

/

%

for the patient /: / '

•

. -V '

PERMISSIONS: For permission to reuse material, please visit the

Copyright Clearance Center {CCCJ at www.copyright.com or call 978-750-8400. CCC is a non-for- profit organization that provides licenses and registration for a variety of uses.

Copyright © 2020 by the Endocrine Society, 2055 L Street NW, Suite 600, Washington, DC 20036. All rights reserved;No part of

1

M

,

~

this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted in any form, by any means, electronic, mechanical, photocopying, recording, or otherwise,

without written permission of the publisher, /

4

TRANSLATIONS AND LICENSING: Rights to translate and reproduce Endocrine Society publications internationally are extended through a licensing agreement on full or partial editions; To request rights for a local edition, please visit:

.

endocnne.org/products-and- services/licensing

ISBN: 978-1-879225-65- 7 Library of Congress Control Number; 2019954327

ti

Esidocrime Board Review

1 m

responsibility to submit participant completion information to the ACCME for the purpose of granting ABIM MOC points.

OVERVIEW

The Endocrine Board Review (EBR ) is a board examination

preparation course designed both for endocrine fellows who have completed or are nearing completion of thenfellowship and are preparing to sit the board certification exam, and for practicing endocrinologists in search of a comprehensive self-assessment of endocrinology, either to prepare for recertification or to update their practice. EBR consists of 220 case-based, American Board oflnternal Medicine ( ABIM ) style, multiple-choice questions, presented in a mock exam format. Each section follows the ABIM Endocrinology, Diabetes, and Metabolism Certification Examination blueprint, covering the breadth and depth of the certification and recertification examinations. Each case is discussed comprehensively with detailed answer explanations and references. A customized score report is provided to those participating in the online courses.

ACCREDITATION STATEMENT

Pi

The Endocrine Society is accredited by the Accreditation Council for ACCME? tACCREDITED WITH Continuing Medical Education COMMENDATION ( ACCME ) to provide continuing medical education for physicians. The Endocrine Society has achieved Accreditation with Commendation. ’

.

METHODS OF PARTICIPATION This material is presented in 3 activities, as follows: . * Endocrine Board Review 2020: interactive online program includes early access to topical on -demand

•

«

presentations and live Q&A sessions with the experts held September 16 - 18, 2020. Endocrine Board Review Online 2020: enduring online activity Endocrine Board Review, 12th Edition: enduring book activity

.

AMA PRA CATEGORY 1 CREDITS (CME) AND MAINTENANCE OF CERTIFICATION (MOC ) The Endocrine Society designates ABIM this activity for a maximum of 21 AMA AzmsDirm PRA Category 1 Credits and 21 points in the ABIM's Maintenance of Certification ( MOC) program. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity.

Successful completion of this CME activity includes participation in the activity evaluation. To complete the activity evaluation and claim CME credits and/ or MOC points, participants must visit the Endocrine Society's Center for Learning at education.endocrine.org . After completing the activity evaluation, participants will be able to save or print a CME certificate. It is the CME activity provider s

.

CME credits and / or MOC points for the activities related to this material must be claimed by the following deadlines. • Endocrine Board Review 2020: December 31, 2022 0 To claim credits, visit education.endocrine .org / EBR2020 Endocrine Board Review Online 2020: October 31, 2022 ° To claim credits, visit education.endocrine.org/ ‘ EBR 2020Recordings « Endocrine Board Review, 12th Edition: October 31, 2022 0 To claim credits, visit education.endocrine .org/ EBR 12Ed ®

'

For questions about content or obtaining CME credit or MOC points, please contact the Endocrine Society at education.endocrine.org/ contact.

LEARNING OBJECTIVES Upon completion of this educational activity, learners will be able to demonstrate enhanced medical knowledge and clinical skills across all major areas of endocrinology; apply knowledge and skills in diagnosing, managing, and treating a wide spectrum of endocrine disorders; and successfully complete the board examination for certification or recertification in the subspecialty of endocrinology, diabetes, and metabolism. TARGET AUDIENCE This CME activity is intended for endocrine fellows planning for initial certification, practicing endocrinologists preparing for an MOC assessment, or physicians seeking an in- depth review of endocrinology. The secondary target audience includes advanced practice nurses and physician assistants. STATEMENT OF INDEPENDENCE As a provider of CME accredited by the ACCME, the Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous. The scientific content of this activity was developed under the supervision of the Endocrine Society's EBR faculty. There are no commercial supporters of this activity and no commercial entities have had influence over the planning of this CME activity. DISCLOSURE POLICY The faculty, committee members, and staff who are in position to control the content of this activity are required to disclose to the Endocrine Society and to learners any relevant financial relationship (s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s ) whose products or services are related to the CME content. Financial relationships are defined by remuneration in any amount

Wmlocrine Board Review

isi

J

1

1 I

from the commercial interest (s) in the form of grants; research support ; consulting fees; salary; ownership interest (eg, stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent CME planners with relevant financial relationships from planning or delivery of content, but rather to provide learners with information that allows them to make their own judgments of whether these financial relationships may have influenced the educational activity with regard to exposition or conclusion. The Endocrine Society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.

The faculty reported the following relevant financial relationship( s ) during the content development process for this activity: Natalie Cusano, MD, MS, has served as a consultant to Shire / Takeda and Radius Pharmaceuticals and has served as a speaker for Shire/ Takeda and Alexion. Tobias Else, MD, has served as an advisory board member to Corcept Therapeutics and HRA Pharma, and his institution has received research support from Corcept Therapeutics, Merck and Strongbridge Biopharma. Serge A, Jabhour, MD, has served as a consultant to AstraZeneca and Janssen, and his institution has received research support from the National Institutes of Health . Laurence Katznelson, MD, has served as a consultant and principal investigator to Chiasma and Camarus, and he has served as an advisory board member to Novo Nordisk . Michelle F. Magee, MD, receives research support from the NIH Diabetes Prevention Program Observational Study and the NIH Grade Study as an investigator on behalf of MedStar Health Research Institute. She serves as a speaker for the American Diabetes Association, the American College of Cardiology, and the Endocrine Society. Kathryn A. Martin, MD, has served as a physician editor for UpToDate.

The following faculty reported no relevant financial relationships: Andrea D. Coviello , MD; Frances J. Hayes, MB BCh, BAO; and Jacqueline Jonklaas, MD, PhD, MPH

The medical editor for this activity reported no relevant financial relationships: Abbie L. Young, MS, CGC, ELS ( D ) Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships .

DISCLAIMERS The information presented in this activity represents the opinion of the faculty and is not necessarily the official position of the Endocrine Society. sv

Use of professiona! judgment: The educational content in this activity relates to basic principles of diagnosis and therapy and does not substitute for individual patient assessment based on the health care provider s examination of the patient and consideration of laboratory data and other factors unique to the patient. Standards in medicine change as new data become available.

Drugs and dosages:

\

| 1

"

When prescribing medications , the physician is advised to check the product information sheet accompanying

each drug to verify conditions of use and to identify any changes in drug dosage schedule or contraindications.

POLICY ON UNLABELED/OFF- LABEL USE The Endocrine Society has determined that disclosure of unlabeled/ off -label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation. Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration ( FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.

PRIVACY AND CONFIDENTIALITY STATEMENT The Endocrine Society will record learners personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties. ACKNOWLEDGMENT OF COMMERCIAL SUPPORT The activity is not supported by educational grant (s ) or other funds from any commercial supporters.

Last Review: August 2020 Activity Release: August 2020

Activity Expiration Date: ( date after which this material is no longer certified for credit ): see section titled “ AAIA PIT 4 Category l Credits ( CME ) and Maintenance of Certification ( MGC) ”

$

-I

I®

Contents QUESTIONS ANSWERS

LABORATORY REFERENCE RANGES

1

COMMON ABBREVIATIONS USED IN ENDOCRINE BOARD REVIEW

5 7

93

CALCIUM & BONE BOARD REVIEW Natalie Cusano, MD, MS

18

111

DIABETES MELLITUS SECTION 1BOARD REVIEW Serge A. Jabbour, MD

29

130

DIABETES MELLITUS SECTION 2 BOARD REVIEW Michelle F. Magee, MD

40

149

FEMALE REPRODUCTION BOARD REVIEW Kathryn A. Martin, MD

53

172

MALE REPRODUCTION BOARD REVIEW Frances J. Hayes, MB BCh, BAO

59

182

OBESITY & LIPIDS BOARD REVIEW Andrea D. Coviello, MD

66

196

PITUITARY BOARD REVIEW Laurence Katznelson, MD

74

218

THYROID BOARD REVIEW Jacqueline Jonklaas, MD, PhD , MPH

81

231

ADRENAL BOARD REVIEW Tobias Else, MD

For mid volume updates to this book's content, go to endocrine.org/ bookupdates.

-

Ettdserme Ecsttrd Review

v

LABORATORY REFERENCE RANGES Reference ranges vary among laboratories. Conventional units are listed first with SI units in parentheses.

Lipid Values

Thyroid Values

High- density lipoprotein (HDL) cholesterol >60 mg/dL (>1.55 mmol/L) Optimal

Thyroglobulin

Normal -

40 - 60 mg/dL (1,04- 1.55 mmol/L)

—

< 40 mg/dL (100 pjg /L

Phosphate

2.3 - 4.7 mg/dL (0.7 - 1.5 mmol/L)

17 -Ketosteroids

6.0 - 21.0 mg/ 24 h ( 20.8 - 72.9 pmol/d) (male);

Potassium

3.5 - 5.0 mEq/L (3.5- 5.0 mmol/L)

Prothrombin time

8.3 - 10.8 s

4.0 - 17.0 mg/24 h ( 13.9 - 59.0 pmol/d) (female)

Metanephrine fractionation

!

Serum urea nitrogen -

8- 23 mg/dL ( 2.9 - 8.2 mmol/L)

Sodium

136 - 142 mEq/L (136 - 142 mmol/L) 14% - 50%

Transferrin saturation

Troponin I

Normotensive normal ranges: