N6647 Metabolic and Endocrine Disorders Clinical Examination: Metabolic
Syndrome Risk Factors and Lifestyle Management, Insulin Resistance, Type 1
and Type 2 Diabetes Mellitus with Diagnostic Criteria, Microvascular and
Macrovascular Complications, Insulin Therapy Basal and Prandial Phases, Oral
Antihyperglycemics Including Biguanides, Sulfonylureas, Glinides,
Thiazolidinediones, GLP-1 Agonists, DPP-4 Inhibitors, SGLT2 Inhibitors, Nutrition
Therapy and Exercise in Diabetes Management, Cushing Syndrome
Glucocorticoid Excess Clinical Presentation, Diagnostics and Treatment, Addison
Disease Autoimmune Primary Adrenal Insufficiency, Steroid Replacement
Therapy, Thyroid Disorders Hyperthyroidism and Hypothyroidism Etiologies,
Clinical Presentations, Diagnostics, Graves Disease, Hashimoto’s Thyroiditis,
Goiter, Thyroid Nodules, Subclinical Hypothyroidism, Pharmacologic
Management with Thioamides Exam Questions Verified and Provided with
Complete A+ Graded Rationales Latest Updated 2026
met syndrome risk factors
htn, hld, insulin resistance
People with metabolic syndrome have twice the risk of developing: cardiovascular disease and Type 2
diabetes as well as:
Atherosclerosis
Heart attack
Kidney disease
Fatty liver disease
PAD
Stroke
met syndrome criteria
Waist circumference >35w & >40m
BP > or = 130/ > or = 85
,Triglycerides > 150
HDL < 50w & <40 m
FPG >100
Patients may only need to have 3 of the 5 to have metabolic syndrome
met syndrome lifestyle treatment
Aggressive lifestyle modification
Lose weight
Exercise
Quit smoking
Eat fish or take fish oil supplements
Lower BP according to established guidelines
Correct TG, LDL-C and HDL-C according to established guidelines
Correct blood glucose according to established guidelines
If the patient is considered very high risk for CVD, consider ASA therapy
Treat obstructive sleep apnea
Cushing syndrome
Adrenal glands produce several steroid products: glucocorticoids (cortisol), mineralcorticoids
(aldosterone), and adrenal androgens.
Cushing disease/syndromes predominantly affect the secretion of one or the other of these hormones.
Glucocorticoid excess
Adrenal androgen excess
Aldosterone excess
Cushing syndrome: clinical presentation
,Signs and symptoms depend on the magnitude of steroid excess, the rapidity it develops, and the
degree to which androgen production is increased.
Increased deposition of subcutaneous fat in the face (moon face), and in the upper body (buffalo hump,
supracavicular fat pads, truncal obesity).
Skin changes: facial erythema, telangiectasia, atrophy and thinning of the skin, bruising, ecchymosis,
abdominal striae.
Muscle weakness from steroid myopathy.
Bone mineral loss, osteoporosis & compression fx.
HTN & diabetes
Hyperkalemia
Lability of mood, depression, mania, psychoses.
cushing syndrome diagnosis
Measurement of serum cortisol and ACTH.
24-hour urine for free cortisol and creatinine (cortisol elevated more than 3 times the normal is
suggestive of chushings)
Overnight dexamethasone test: 1 mg is given between 11p.m. and midnight. Serum cortisol is measured
at 8 to 9 am. Normal should be < 2.
cushing syndrome treatment
Measurement of serum cortisol and ACTH.
24-hour urine for free cortisol and creatinine (cortisol elevated more than 3 times the normal is
suggestive of cushings)
Overnight dexamethasone test: 1 mg is given between 11p.m. and midnight. Serum cortisol is measured
at 8 to 9 am. Normal should be < 2.
Addison disease
Primary adrenal insufficiency is rare, 100 cases per 1 million people.
, More commonly the result of an autoimmune disorder (Schmidt syndrome)
1.Autoimmune thyroiditis
2.Autoimmune gonadal failure
3.Polyglandular failure
4.Pernicious anemia
5.Sjogren syndrome
6.Systemic lupus erythematosus
Addison disease: clinical presentation
Symptoms:
Anorexia
Weight loss
Weakness
Decreased physical endurance
Nausea and vomiting
Abdominal pain
mental sluggishness
Irritability
Postural hypotension
Hypoglycemia
Darkening of the skin
Loss of axillary and pubic hair
Physical exam:
Postural hypotension
Pigmentation (diffuse)
Lymphadenopathy
Headache
Syndrome Risk Factors and Lifestyle Management, Insulin Resistance, Type 1
and Type 2 Diabetes Mellitus with Diagnostic Criteria, Microvascular and
Macrovascular Complications, Insulin Therapy Basal and Prandial Phases, Oral
Antihyperglycemics Including Biguanides, Sulfonylureas, Glinides,
Thiazolidinediones, GLP-1 Agonists, DPP-4 Inhibitors, SGLT2 Inhibitors, Nutrition
Therapy and Exercise in Diabetes Management, Cushing Syndrome
Glucocorticoid Excess Clinical Presentation, Diagnostics and Treatment, Addison
Disease Autoimmune Primary Adrenal Insufficiency, Steroid Replacement
Therapy, Thyroid Disorders Hyperthyroidism and Hypothyroidism Etiologies,
Clinical Presentations, Diagnostics, Graves Disease, Hashimoto’s Thyroiditis,
Goiter, Thyroid Nodules, Subclinical Hypothyroidism, Pharmacologic
Management with Thioamides Exam Questions Verified and Provided with
Complete A+ Graded Rationales Latest Updated 2026
met syndrome risk factors
htn, hld, insulin resistance
People with metabolic syndrome have twice the risk of developing: cardiovascular disease and Type 2
diabetes as well as:
Atherosclerosis
Heart attack
Kidney disease
Fatty liver disease
PAD
Stroke
met syndrome criteria
Waist circumference >35w & >40m
BP > or = 130/ > or = 85
,Triglycerides > 150
HDL < 50w & <40 m
FPG >100
Patients may only need to have 3 of the 5 to have metabolic syndrome
met syndrome lifestyle treatment
Aggressive lifestyle modification
Lose weight
Exercise
Quit smoking
Eat fish or take fish oil supplements
Lower BP according to established guidelines
Correct TG, LDL-C and HDL-C according to established guidelines
Correct blood glucose according to established guidelines
If the patient is considered very high risk for CVD, consider ASA therapy
Treat obstructive sleep apnea
Cushing syndrome
Adrenal glands produce several steroid products: glucocorticoids (cortisol), mineralcorticoids
(aldosterone), and adrenal androgens.
Cushing disease/syndromes predominantly affect the secretion of one or the other of these hormones.
Glucocorticoid excess
Adrenal androgen excess
Aldosterone excess
Cushing syndrome: clinical presentation
,Signs and symptoms depend on the magnitude of steroid excess, the rapidity it develops, and the
degree to which androgen production is increased.
Increased deposition of subcutaneous fat in the face (moon face), and in the upper body (buffalo hump,
supracavicular fat pads, truncal obesity).
Skin changes: facial erythema, telangiectasia, atrophy and thinning of the skin, bruising, ecchymosis,
abdominal striae.
Muscle weakness from steroid myopathy.
Bone mineral loss, osteoporosis & compression fx.
HTN & diabetes
Hyperkalemia
Lability of mood, depression, mania, psychoses.
cushing syndrome diagnosis
Measurement of serum cortisol and ACTH.
24-hour urine for free cortisol and creatinine (cortisol elevated more than 3 times the normal is
suggestive of chushings)
Overnight dexamethasone test: 1 mg is given between 11p.m. and midnight. Serum cortisol is measured
at 8 to 9 am. Normal should be < 2.
cushing syndrome treatment
Measurement of serum cortisol and ACTH.
24-hour urine for free cortisol and creatinine (cortisol elevated more than 3 times the normal is
suggestive of cushings)
Overnight dexamethasone test: 1 mg is given between 11p.m. and midnight. Serum cortisol is measured
at 8 to 9 am. Normal should be < 2.
Addison disease
Primary adrenal insufficiency is rare, 100 cases per 1 million people.
, More commonly the result of an autoimmune disorder (Schmidt syndrome)
1.Autoimmune thyroiditis
2.Autoimmune gonadal failure
3.Polyglandular failure
4.Pernicious anemia
5.Sjogren syndrome
6.Systemic lupus erythematosus
Addison disease: clinical presentation
Symptoms:
Anorexia
Weight loss
Weakness
Decreased physical endurance
Nausea and vomiting
Abdominal pain
mental sluggishness
Irritability
Postural hypotension
Hypoglycemia
Darkening of the skin
Loss of axillary and pubic hair
Physical exam:
Postural hypotension
Pigmentation (diffuse)
Lymphadenopathy
Headache
