Sarah Michelle Leik FNP boards
AANP/ANCC Endocrine Exam Questions
and Answers
How can you differentiate between Cushing and Addison disease? (in terms of
secreting hormone). - Correct Answers -Cushing: HYPERsecretion of Cortisol
"C for Cushing, C for Cortisol".
ADDison: HYPOsecretion of Cortisol & Aldosterone
"ADD - Aldosterone"
Mnemonic for Cushing - Correct Answers -Mnemonic STRESSED
Skin fragile
Truncal obesity w/ small arms
Rounded face "Moon face". Reproductive- amenorrhea and ED.
Ecchymosis and Elevated BP
Stretchmark on abdominal (purple color)
Sugar extremely high (HYPERglycemia)- Polyuria & Polydipsia
Excess bodily hair in women (Hirsutism). Electrolyte imbalance: HYPOkalemia.
Dorsocervical fat pad (Buffalo hump) Depression.
Diagnostic criteria for PCOS - Correct Answers -2/3 required:
1. Oligo-and/or anovulation
2. Clinical signs of hyperandrogenism: Hirsutism, Acne and Acanthosis nigrican.
3. Polycystic ovaries by ultrasound
What is 1st line treatment choice for PCOS - Correct Answers -lifestyle: weight loss
How would you treat a woman with PCOS who is dealing with amenorrhea/anovulation,
acne and hirsutism?
How would you treat the woman if she has signs of insulin resistance?
What is another medication that can be used to treat Hirsutism/Acne? What is a side
effect of this medication in men? - Correct Answers -Combined oral contraceptive
Metformin
Spironolactone (use as adjunct)- gynecomastia
,What type of cancer is associated with PCOS? - Correct Answers -Endometrial cancer
(d/t unopposed estrogen-> decreased level of progesterone cause endometrial
hyperplasia)
Mnemonic for Addison disease - Correct Answers -Mnemonic STEROID
Sodium and Sugar LOW: Salt craving.
Tired and muscle weakness
Electrolyte imbalance: HYPERkalemia and HYPERcalcemia.
Reproductive changes: irregular menstrual and ED
lOw BP
Increased pigmentation- Hyperpigmentation (mucus)
Diarrhea Depression.
What are causes of Cushing disease - Correct Answers -chronic steroid therapy or
tumor
What are causes of Addison disease - Correct Answers -Immigrant: Tuberculosis
Infection
Cancer.
Cushing disease is due to _______ secretion of __________ - Correct Answers -excess
secretion of cortisol
Addison disease is due to _______ secretion of ________ - Correct Answers -
Hyposecretion of Cortisol & Aldosterone
A pt presents to the clinic c/o progressive weakness. Pt reports decreased
libido/amenorrhea (women), fatigue and weight gain. Vitals are significant for HTN- BP
at 177/100. On Exam- you note central obesity, moon face, atrophied limbs, purple
striae on abdominal and a hump on the back of his neck.
What does this pt have?
What medication would you use to treat his BP? (Drugs/class)
What BP medication class should you avoid in this pt? Why?
How would his lab look like (electrolytes)? - Correct Answers -Cushing
Aldosterone receptor antagonist- Spironolactone and Eplerenone.
AVOID HCTZ- increases BG and Hypokalemia
Lab: Hypernatremia, Hypokalemia, Metabolic Alkalosis
What diagnostic tests can you order for pt with Cushing disease? What would the result
indicate? - Correct Answers -Initial- 24hr Low-dose dexamethasone suppression test: IF
cortisol >5 (high): indicates Cushing.
OR
24hr Morning Urinary Free Cortisol: If value x3 of normal= Cushing.
*IF either of the 2 tests above demonstrate HIGH cortisol -> order High Dose
Dexamethasone suppression test.
IF ACTH is suppressed by 50%, then it's d/t Cushing. Can order MRI of the brain.
, IF ACTH is NOT suppressed, then it indicates lung cancer or malignancy elsewhere.
Order ACTH level.
IF HIGH ACTH -> order CT of the chest to r/o lung cancer.
IF LOW ACTH -> order CT of the abdomen/pelvis.
How would the electrolytes look in a pt with Cushing disease? - Correct Answers
-"Everything is HIGH, except Potassium"
HYPERnatremia
HIGH cortisol
HYPERglycemia
HYPOkalemia
Metabolic Alkalosis
A pt presents to the clinic c/o fatigue, weight loss, n&v. Pt denies fever or recent
infection. He reports craving everything salty. On Exam- pt looks tanned and has
hyperpigmented buccal mucosa. You ask pt if they have recently traveled and they said
no.
What does this pt likely have?
How would their lab (electrolytes) look?
How would you manage/treat this pt? (drugs) - Correct Answers -Addison disease
Lab: HYPOnatremia, HYPERkalemia, LOW cortisol & Low Aldosterone.
1st line: Glucocorticoid and Mineralocorticoid (Aldosterone) replacement.
Ex: Hydrocortisone & Fludrocortisone.
Give additional dose of Hydrocortisone during stress (surgery, illness) to prevent
Adrenal Crisis.
Pt must carry Steroid Kit with them at all times.
How would management for Addison differ for Infant vs Children? - Correct Answers -
Infant- salt supplement.
Children- supplement not needed.
What diagnostic test would you order for a pt with Addison disease? - Correct Answers -
Morning Serum Cortisol level. LOW cortisol strongly suggests Addison or Primary
Adrenal Insufficiency.
Other tests: plasma ACTH
HIGH ACTH & LOW cortisol-> Addison.
How would lab (electrolytes) look in a pt with Addison disease? - Correct Answers
-"Everything is LOW, except Potassium"
LOW Cortisol & Aldosterone
HYPOnatremia
HYPOglycemia
HYPERkalemia
Metabolic Acidosis
AANP/ANCC Endocrine Exam Questions
and Answers
How can you differentiate between Cushing and Addison disease? (in terms of
secreting hormone). - Correct Answers -Cushing: HYPERsecretion of Cortisol
"C for Cushing, C for Cortisol".
ADDison: HYPOsecretion of Cortisol & Aldosterone
"ADD - Aldosterone"
Mnemonic for Cushing - Correct Answers -Mnemonic STRESSED
Skin fragile
Truncal obesity w/ small arms
Rounded face "Moon face". Reproductive- amenorrhea and ED.
Ecchymosis and Elevated BP
Stretchmark on abdominal (purple color)
Sugar extremely high (HYPERglycemia)- Polyuria & Polydipsia
Excess bodily hair in women (Hirsutism). Electrolyte imbalance: HYPOkalemia.
Dorsocervical fat pad (Buffalo hump) Depression.
Diagnostic criteria for PCOS - Correct Answers -2/3 required:
1. Oligo-and/or anovulation
2. Clinical signs of hyperandrogenism: Hirsutism, Acne and Acanthosis nigrican.
3. Polycystic ovaries by ultrasound
What is 1st line treatment choice for PCOS - Correct Answers -lifestyle: weight loss
How would you treat a woman with PCOS who is dealing with amenorrhea/anovulation,
acne and hirsutism?
How would you treat the woman if she has signs of insulin resistance?
What is another medication that can be used to treat Hirsutism/Acne? What is a side
effect of this medication in men? - Correct Answers -Combined oral contraceptive
Metformin
Spironolactone (use as adjunct)- gynecomastia
,What type of cancer is associated with PCOS? - Correct Answers -Endometrial cancer
(d/t unopposed estrogen-> decreased level of progesterone cause endometrial
hyperplasia)
Mnemonic for Addison disease - Correct Answers -Mnemonic STEROID
Sodium and Sugar LOW: Salt craving.
Tired and muscle weakness
Electrolyte imbalance: HYPERkalemia and HYPERcalcemia.
Reproductive changes: irregular menstrual and ED
lOw BP
Increased pigmentation- Hyperpigmentation (mucus)
Diarrhea Depression.
What are causes of Cushing disease - Correct Answers -chronic steroid therapy or
tumor
What are causes of Addison disease - Correct Answers -Immigrant: Tuberculosis
Infection
Cancer.
Cushing disease is due to _______ secretion of __________ - Correct Answers -excess
secretion of cortisol
Addison disease is due to _______ secretion of ________ - Correct Answers -
Hyposecretion of Cortisol & Aldosterone
A pt presents to the clinic c/o progressive weakness. Pt reports decreased
libido/amenorrhea (women), fatigue and weight gain. Vitals are significant for HTN- BP
at 177/100. On Exam- you note central obesity, moon face, atrophied limbs, purple
striae on abdominal and a hump on the back of his neck.
What does this pt have?
What medication would you use to treat his BP? (Drugs/class)
What BP medication class should you avoid in this pt? Why?
How would his lab look like (electrolytes)? - Correct Answers -Cushing
Aldosterone receptor antagonist- Spironolactone and Eplerenone.
AVOID HCTZ- increases BG and Hypokalemia
Lab: Hypernatremia, Hypokalemia, Metabolic Alkalosis
What diagnostic tests can you order for pt with Cushing disease? What would the result
indicate? - Correct Answers -Initial- 24hr Low-dose dexamethasone suppression test: IF
cortisol >5 (high): indicates Cushing.
OR
24hr Morning Urinary Free Cortisol: If value x3 of normal= Cushing.
*IF either of the 2 tests above demonstrate HIGH cortisol -> order High Dose
Dexamethasone suppression test.
IF ACTH is suppressed by 50%, then it's d/t Cushing. Can order MRI of the brain.
, IF ACTH is NOT suppressed, then it indicates lung cancer or malignancy elsewhere.
Order ACTH level.
IF HIGH ACTH -> order CT of the chest to r/o lung cancer.
IF LOW ACTH -> order CT of the abdomen/pelvis.
How would the electrolytes look in a pt with Cushing disease? - Correct Answers
-"Everything is HIGH, except Potassium"
HYPERnatremia
HIGH cortisol
HYPERglycemia
HYPOkalemia
Metabolic Alkalosis
A pt presents to the clinic c/o fatigue, weight loss, n&v. Pt denies fever or recent
infection. He reports craving everything salty. On Exam- pt looks tanned and has
hyperpigmented buccal mucosa. You ask pt if they have recently traveled and they said
no.
What does this pt likely have?
How would their lab (electrolytes) look?
How would you manage/treat this pt? (drugs) - Correct Answers -Addison disease
Lab: HYPOnatremia, HYPERkalemia, LOW cortisol & Low Aldosterone.
1st line: Glucocorticoid and Mineralocorticoid (Aldosterone) replacement.
Ex: Hydrocortisone & Fludrocortisone.
Give additional dose of Hydrocortisone during stress (surgery, illness) to prevent
Adrenal Crisis.
Pt must carry Steroid Kit with them at all times.
How would management for Addison differ for Infant vs Children? - Correct Answers -
Infant- salt supplement.
Children- supplement not needed.
What diagnostic test would you order for a pt with Addison disease? - Correct Answers -
Morning Serum Cortisol level. LOW cortisol strongly suggests Addison or Primary
Adrenal Insufficiency.
Other tests: plasma ACTH
HIGH ACTH & LOW cortisol-> Addison.
How would lab (electrolytes) look in a pt with Addison disease? - Correct Answers
-"Everything is LOW, except Potassium"
LOW Cortisol & Aldosterone
HYPOnatremia
HYPOglycemia
HYPERkalemia
Metabolic Acidosis
