PANCE ENDOCRINOLOGY UPDATED
SCRIPT 2026 PRACTICE SOLUTIONS
GRADED A+
● A 66 yo male presents to the office today because his diabetes is out of
control lately and he would like some help getting his blood sugars back
to normal. He only currently takes Metformin 1000 mg BID. You
discuss a few different medications with him including Glipizide, Insulin
Glargine, and Empagliflozin. He states his only fear with starting a new
medication if low blood sugars. Which one of the medications discussed
with the patient is least likely to cause hypoglycemia? Answer:
Empagliflozin
Notes: Glipizide is a sulfonylurea which are notorious as a class for
causing low blood sugars, all types of insulin have potential to cause
hypoglycemia. Empagliflozin (Jardiance) is an SGLT2 inhibitor which
does not usually cause low blood sugar
● What is the most common type of thyroid cancer? Answer: Papillary
thyroid carcinoma (roughly 8 out of 10 cases)
● A nonpregnant adult with Subclinical Hypothyroidism should be
treated with thyroid hormone replacement (Levothyroxine) when they
TSH reaches what level? Answer: TSH of 10 mU/L or higher
, ● A 27 yo female with history of bipolar disorder presents to the office
complaining of fatigue, constipation, and weight gain. Labs are ordered
and it is determined she is biochemically hypothyroid. What medication
is this patient likely taking that lead to her diagnosis of hypothyroidism?
Answer: Lithium
Notes: Lithium is first line for bipolar, need TSH levels checked every 6-
12 months on lithium since hypothyroidism is so prevalent. Lithium and
amiodarone are infamous for causing hypothyroidism
● A 37 yo female presents to the office complaining that she is having
trouble losing weight despite following a strict diet and exercising daily.
On physical exam, you note central obesity, thin extremities, oily skin,
and striae across her abdomen. A screening test to check for excess of
what hormone should be checked in this patient? Answer: Serum cortisol
Notes: Patient has classic signs of Cushing's (only classic sign missing is
"buffalo hump")
● A patient with secondary hypothyroidism will have an abnormality in
which part of the Hypothalamic-Pituitary-Thyroid Axis? Answer:
Pituitary gland
● What is the most common cause overall for Cushing's Syndrome?
Answer: Long-term, high dose use of glucocorticoids
SCRIPT 2026 PRACTICE SOLUTIONS
GRADED A+
● A 66 yo male presents to the office today because his diabetes is out of
control lately and he would like some help getting his blood sugars back
to normal. He only currently takes Metformin 1000 mg BID. You
discuss a few different medications with him including Glipizide, Insulin
Glargine, and Empagliflozin. He states his only fear with starting a new
medication if low blood sugars. Which one of the medications discussed
with the patient is least likely to cause hypoglycemia? Answer:
Empagliflozin
Notes: Glipizide is a sulfonylurea which are notorious as a class for
causing low blood sugars, all types of insulin have potential to cause
hypoglycemia. Empagliflozin (Jardiance) is an SGLT2 inhibitor which
does not usually cause low blood sugar
● What is the most common type of thyroid cancer? Answer: Papillary
thyroid carcinoma (roughly 8 out of 10 cases)
● A nonpregnant adult with Subclinical Hypothyroidism should be
treated with thyroid hormone replacement (Levothyroxine) when they
TSH reaches what level? Answer: TSH of 10 mU/L or higher
, ● A 27 yo female with history of bipolar disorder presents to the office
complaining of fatigue, constipation, and weight gain. Labs are ordered
and it is determined she is biochemically hypothyroid. What medication
is this patient likely taking that lead to her diagnosis of hypothyroidism?
Answer: Lithium
Notes: Lithium is first line for bipolar, need TSH levels checked every 6-
12 months on lithium since hypothyroidism is so prevalent. Lithium and
amiodarone are infamous for causing hypothyroidism
● A 37 yo female presents to the office complaining that she is having
trouble losing weight despite following a strict diet and exercising daily.
On physical exam, you note central obesity, thin extremities, oily skin,
and striae across her abdomen. A screening test to check for excess of
what hormone should be checked in this patient? Answer: Serum cortisol
Notes: Patient has classic signs of Cushing's (only classic sign missing is
"buffalo hump")
● A patient with secondary hypothyroidism will have an abnormality in
which part of the Hypothalamic-Pituitary-Thyroid Axis? Answer:
Pituitary gland
● What is the most common cause overall for Cushing's Syndrome?
Answer: Long-term, high dose use of glucocorticoids
