{"id":121399,"date":"2023-10-20T00:03:16","date_gmt":"2023-10-20T00:03:16","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=121399"},"modified":"2023-10-20T00:03:18","modified_gmt":"2023-10-20T00:03:18","slug":"endocrinology-boards-abim-exam-latest-version-2023-2024-actual-exam","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/10\/20\/endocrinology-boards-abim-exam-latest-version-2023-2024-actual-exam\/","title":{"rendered":"ENDOCRINOLOGY BOARDS ABIM EXAM LATEST VERSION 2023-2024 ACTUAL EXAM"},"content":{"rendered":"\n<p>What are primary, secondary, and tertiary disease? &#8211; ANSWER- Primary<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>problem with the gland that secretes the hormone (ie: thyroid doesn&#8217;t<br>produce thyroid hormone)<br>Secondary &#8211; problem is the gland that controls the primary gland (ie.<br>pituitary doesn&#8217;t produce TSH to stimulate the thyroid)<br>Tertiary &#8211; problem with the gland that controls the secondary gland that<br>controls the primary gland (ie. hypothalamus not producing TRH ->no<br>TSH from pituitary -> no T3\/T4 from thyroid)<br>How does the hypothalamus control the pituitary? &#8211; ANSWER- Controls<br>the anterior pituitary via hormones<br>Controls the posterior pituitary via neurohypophysis &#8211; direct nerve<br>stimulation<br>Posterior pituitary functions &#8211; ANSWER- Secrete ADH and oxytocin<br>ADH regulation &#8211; ANSWER- Anterior pituitary &#8211; osmoreceptors to<br>control ADH release and thirst<br>Increased release rapidly with elevated osmolarity<br>Also see increased release with nausea<br><br>ADH osmolar release set point is affected by:<br>Lower set point (release at lower osm) with pregnancy and pre-menses<br>Higher set point with chronic hypovolemia, acute HTN, corticosteroids<br>Anterior pituitary &#8211; hormones and controls (6 hormones) &#8211; ANSWER- 1.<br>ACTH &#8211; peak 3-4 am, nadir 10-11pm; stimulates corticosteroids and<br>androgens from adrenals; increase with corticotropin releasing hormone,<br>physical\/psych stress<\/li>\n<\/ul>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Growth hormone &#8211; GHRH increases, somatastatin decreases, both<br>from hypothalamus<\/li>\n\n\n\n<li>LH &amp; FSH &#8211; produced by gonadotrophs; increased by pulsatile<br>secretion of GnRH from hypothalamus; Inhibin from ovary &amp; testes<br>decreases FSH (only) production<\/li>\n\n\n\n<li>PRL &#8211; tonic inhibition from hypothalamic dopamine; increase with<br>sleep, stress, lactation, nipple stimulation; Metaclopramine,<br>phenothiazines (decrease dopamine) increase PRL; Hypothyroid<br>modestly increases PRL<\/li>\n\n\n\n<li>TSH &#8211; stim by TRH from hypothalamus, inhibited by T3, T4,<br>somatastatin<br>Pituitary adenoma cell types &#8211; ANSWER- 1. Lactotrophs &#8211; secrete PRL;<br>tied, most common macroademona<\/li>\n\n\n\n<li>Gonadotrophs -tied, most common macroademona; presents as mass<br>effect +\/- silent or panhypopit or gonadotropin hypersecretion<\/li>\n\n\n\n<li>Somatotrophs- acromegaly<\/li>\n\n\n\n<li>Corticotrophs &#8211; cushings<\/li>\n\n\n\n<li>Thyrotrophs &#8211; hyperthyroidism (least common)<br><\/li>\n\n\n\n<li>Mixed (somatotrophs+lactotrophs) &#8211; acromegaly + hyperPRL<br>Mass effect sx of pituitary mass &#8211; ANSWER- HA, diplopia, visual field<br>defect, seizures; occasionally can get CNS rhinorrhea<br>Dx of pituitary adenoma &#8211; ANSWER- Sx first<br>Check MRI<br>Labs &#8211; PRL, IGF-1 (for acromegaly), 24 hr urine free cortisol or 1mg<br>overnight dexamethasone suppression test (for excess) or ACTH stim<br>test (for deficiency), TSH, FT4, alpha subunit of FSH, LH (confirms<br>pituitary origin)<br>If mass on MRI, but all labs normal, likely a non-pituitary tumor &#8211;<br>craniopharyngioma, meningioma, eosinophilic granuloma, histiocytosis<br>X, pituitary mets<br>Empty sella syndrome &#8211; ANSWER- Can be misread and be normal<br>multiparous women in 90% &#8211; pituitary compressed by CSF, but<br>functions normally<br>No treatment if no hormone abnormalities<br>Symptoms and labs in prolactinoma &#8211; ANSWER- Most common<br>functional tumors; usually microadenomas, can be space occupying<br>lesions<br>Elevated PRL-&gt;decreased release of GnRH-&gt;decreased LH\/FSH-&gt;<br>decreased libido, ED in men, amennorhea and hirsutism in females;<br>Increased size=increased PRL, so if &gt; 1cm and PRL&lt;100, it&#8217;s not a prolactinoma 3 \/ 4 Men present later-&gt;only decreased libido, so present as space occupying<br>lesion (visual field defects)<br>Can cause galactorrhea in women, decreased bone mineralization<br>Causes of increased PRL &#8211; ANSWER- Prolactinoma, phenothiazines,<br>amitriptyline, metaclopramide (all decreased dopamine), estrogen<br>(inhibits dopamine-&gt;elevated PRL in pregnancy), hypothyroidism<br>Treatment for prolactinoma &#8211; ANSWER- Begin treatment when neuro sx<br>from size or sx of hypogonadism<br>Medical &#8211; dopamine agonists: Cabergoline and bromocriptine<br>Cabergoline -better tolerated, less nausea, 2x\/wk dosing; increased valve<br>dz if high doses, contraindicated with valve dz, known lung dz,<br>retroperitoneal fibrosis<br>Surgery &#8211; is can&#8217;t tolerate meds; trtanssphenoidal; ofter rucurs<br>Radiation- to eradicate residual tumor post-surgery<br>Treating prolactinoma in pregnancy &#8211; ANSWER- Stop meds<br>Observe for sx, do visual field testing<br>1\/3 enlarge in pregnancy &#8211; if enlarges enough to cause sx, restart<br>bromocriptine (safe in pregnancy)<br>Growth hormone regulation &#8211; ANSWER- Suppressed &#8211; hyperglycemia,<br>somatastatin, chronic steroids<br>Stimulated by &#8211; hypoglycemia, estrogens<\/li>\n<\/ol>\n\n\n\n<p>Download full pdf here <a href=\"https:\/\/learnexams.com\/search\/study?query=\" target=\"_blank\" rel=\"noopener\">https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What are primary, secondary, and tertiary disease? &#8211; ANSWER- Primary Download full pdf here https:\/\/learnexams.com\/search\/study?query=<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-121399","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/121399","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=121399"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/121399\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=121399"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=121399"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=121399"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}