Case Study On Endocrine and Metabolic Disorders PDF

CASE STUDY ON
ENDOCRINE AND METABOLIC DISORDERS
Learning Objectives
1. Differentiate between the diagnostic and classification criteria for various endocrine
and metabolic disorders, including type 1 and type 2 diabetes mellitus, diabetes
insipidus, polycystic ovary syndrome, obesity, and disorders of the thyroid, adrenal,
and pituitary glands.
2. Review the various therapeutic agents used in treating endocrine and metabolic
disorders.
3. Select appropriate treatment and monitoring options for a given patient presenting
with one of the above endocrine or metabolic disorders.
4. Recommend appropriate therapeutic management for secondary complications from
diabetes or thyroid disorders.
QUESTIONS: ANSWER AND EXPLAIN (cite your reference)
1. A 66-year-old Hispanic man with a history of myocardial infarction, dyslipidemia, and

hypertension received a diagnosis of type 2 diabetes mellitus (DM). After 1 month of exercise
and dietary changes and no diabetes medications, his hemoglobin A1C and fasting glucose
concentration today are 11.5% and 362 mg/dL, respectively. He weighs 123.8 kg, with a body
mass index (BMI) of 42 kg/ m2. Which set of drugs is best to initiate?
A. Metformin and Glipizide. B. Glipizide and Insulin Glulisine.
C. Pioglitazone and Acarbose. D. Insulin Detemir and Glulisine.
2. A 21-year-old patient is given a diagnosis of type 1 DM after the discovery of elevated

glucose concentrations (average 326 mg/dL) and is showing signs and symptoms of
hyperglycemia. Her weight is 80 kg. Which is the most appropriate initial dosage of rapid-acting
insulin before breakfast for this patient? Assume a total daily insulin (TDI) regimen of 0.5
unit/kg/day.
A. 2 units. B. 4 units. C. 7 units. D. 14 units.
3. A patient with type 2 DM has a blood pressure reading of 152/84 mm Hg, a serum creatinine
of 1.8 mg/dL, and two recent spot urine albumin/creatinine concentrations of 420 and 395 mg/g.
Which class of drugs (barring any contraindications) is best to initiate in this patient?
A. Thiazide diuretic. B. Dihydropyridine calcium channel blocker.
C. Angiotensin receptor blocker (ARB). D. Nondihydropyridine calcium channel blocker.
4. Regarding propylthiouracil (PTU) and methimazole in the treatment of hyperthyroidism,

which statement is most appropriate?
A. PTU is clinically superior to methimazole in efficacy.
B. PTU may be associated with greater liver toxicity than methimazole.
C. Both agents are equally efficacious in the treatment of Hashimoto’s disease.
D. Both medications should be administered three times daily.
5. Which medication is the most appropriate choice for a patient with a diagnosis of Cushing’s
syndrome who did not experience adequate symptom relief after surgical resection for a
pituitary adenoma?
A. Ketoconazole. B. Spironolactone.
C. Hydrocortisone. D. Bromocriptine.
6. A physician is asking for a recommendation for initial therapy for a patient with type 2 DM.
The physician states that metformin is no longer an option for this patient. An A1C obtained
today is 9.4% (personal goal 7%), and the patient’s estimated glomerular filtration rate (eGFR)
is 29 mL/ min. Which of the following agents would be the best recommendation?
A. Canagliflozin. B. Alogliptin. C. Glargine. D. Exenatide.
7. A 76-year-old woman recently given a diagnosis of Hashimoto’s disease presents with mild
symptoms of lethargy, weight gain, and intolerance to cold. Her thyroid-stimulating hormone
(TSH) level is 12.2 mIU/L, and her free thyroxine (T4) is below normal limits. Her current weight
is 47 kg. She has a history of hypertension and underwent a coronary artery bypass surgery 2
years ago. Which would be the most appropriate initial treatment for this patient?
A. Levothyroxine 25 mcg once daily. B. Levothyroxine 75 mcg once daily.
C. Liothyronine 25 mcg once daily. D. Liothyronine 75 mcg once daily.
8. A woman with type 2 DM has an A1C of 8.6%. She is receiving insulin glargine (60 units
once daily at bedtime) and insulin Aspart (8 units before breakfast, 7 units before lunch, and 12
units before dinner). She is consistent in her carbohydrate intake at each meal. Her morning
fasting plasma glucose (FPG) and premeal blood glucose (BG) readings have consistently
averaged 112 mg/dL. Her bedtime readings are averaging between 185 and 200 mg/dL. Which
is the best insulin adjustment to improve her overall glycemic control?
A. Increase her prebreakfast Aspart to 10 units.
B. Increase her predinner Aspart to 14 units.
C. Increase her bedtime Glargine to 65 units.
D. Increase her prelunch Aspart to 9 units.
9. A 53-year-old woman with a history of Graves’ disease underwent ablative therapy 3 years
ago. She experienced significant symptom relief and became euthyroid. Her thyroid laboratory
values today include TSH 0.12 mIU/L (normal 0.5–4.5 mIU/L) and a free T4 concentration of 3.8
g/dL (normal 0.8–1.9 ng/dL). She states that many of her previous symptoms have returned but
are mild. Which would be the most appropriate treatment for her condition?
A. Methimazole. B. Thyroidectomy. C. Propylthiouracil. D. Metoprolol.
10. A 65-year-old man with type 2 DM has been receiving metformin 1000 mg twice daily for
the past 2 years. His A1C today is 7.8%. His morning fasting blood glucose (FBG) readings are
consistently at goal. His after-meal glucose readings average 190–200 mg/dL. Which option
would be most appropriate for this patient?
A. Increase Metformin to 1000 mg three times daily.
B. Add insulin Glargine 10 units once daily.
C. Switch from Metformin to insulin glargine 10 units once daily.
D. Add Saxagliptin 5 mg once daily.
11. A 34-year-old woman has a BMI of 33 kg/m2. With dietary changes, she has lost 2 lb in 6
months. She exercises regularly but is unable to do more because she has two jobs and young
children. Her medical history is significant for depression, type 2 DM, and substance abuse. Her
current medications include metformin 1000 mg twice daily, aspirin 81 mg once daily, and
sertraline 100 mg once daily. She is most concerned about weight loss. Which would be the
best recommendation to help her lose weight?
A. Continue her diet and exercise routine; additional intervention is unwarranted.
B. Initiate Lorcaserin 10 mg twice daily.
C. Initiate Phentermine/topiramate 3.75/23 mg once daily.
D. Initiate Orlistat 120 mg three times daily with meals.
12. A 53-year-old Hispanic woman has a BMI of 44 kg/m2 and a history of gestational diabetes.
Her mother and sister both have type 2 DM. Two weeks ago she had an A1C of 7.4%. Her
fasting glucose concentration is 178 mg/dL. She is asymptomatic. Which is the best course of
action?
A. Diagnose type 2 DM and begin treatment.
B. Diagnose type 1 DM and begin treatment.
C. Obtain another A1C today.
D. Obtain another glucose concentration another day.
13. A 42-year-old man has a history of type 2 DM. His current therapy includes metformin 1000
mg twice daily, glyburide 10 mg twice daily, and aspirin 81 mg once daily. Today, his A1C is
6.9%, blood pressure is 126/78 mm Hg, and fasting lipid panel is as follows: total cholesterol
212 mg/dL, low-density lipoprotein cholesterol (LDL-C) 98 mg/dL, high-density lipoprotein
cholesterol (HDL-C) 45 mg/dL, and triglycerides (TG) 145 mg/dL. Which would be the most
appropriate choice for this patient?
A. Add insulin Detemir 10 units once daily.
B. Add Lisinopril 10 mg once daily.
C. Add Atorvastatin 10 mg once daily.
D. Add Fenofibrate 145 mg once daily.

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What are the learning objectives of the case study?

What is the most appropriate initial dosage of rapid-acting insulin for a 21-year old patient newly diagnosed with type 1 diabetes?

CASE STUDY ON

ENDOCRINE AND METABOLIC DISORDERS

QUESTIONS: ANSWER AND EXPLAIN (cite your reference)

1. A 66-year-old Hispanic man with a history of myocardial infarction, dyslipidemia, and

2. A 21-year-old patient is given a diagnosis of type 1 DM after the discovery of elevated

4. Regarding propylthiouracil (PTU) and methimazole in the treatment of hyperthyroidism,

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