Endocrine Board Review (EBR) is case-based course designed as a mock exam, with rapid-fire questions emulating the format and subject matter of the ABIM's Endocrinology, Diabetes, and Metabolism Certification Examination. EBR provides a consolidated review for endocrine fellows planning to take the upcoming 2019 endocrine board exam and offers an early start for trainees preparing for the 2020 exam. It is also an ideal tool for practicing physicians preparing to re-certify, or for those seeking an intensive knowledge assessment.
EBR 2019 Seattle will take place September 17-18, 2019
at the Hyatt Regency Seattle.
In conjunction with EBR 2019, CEU 2019 Seattle will take place September 19-21, 2019. Discounts are available for attendees of both meetings.
Assess Your Clinical Knowledge of Adrenal Care with This Case-Based Question
You are asked to evaluate for Cushing syndrome in a 49-year-old man in the intensive care unit. Small cell lung cancer was previously diagnosed, and he began chemotherapy 3 months ago. Over the last 4 weeks following his last cycle of chemotherapy, he has experienced rapid onset of hyperglycemia, hypertension, muscle weakness, and psychosis. He was taken to the emergency department by ambulance, where he was confused and hypoxic.
Drugs that inhibit cortisol synthesis include aminoglutethimide, ketoconazole, metyrapone, and etomidate (Answer C), as well as new drugs under development such as the 11beta-hydroxylase inhibitor osilodrostat. Etomidate is frequently administered intravenously in preparation for rapid intubation in the emergency department. Etomidate inhibits 11beta-hydroxylase, the last step in cortisol synthesis and an enzyme unique to the cortisol pathway. Etomidate is very effective for control of hypercortisolemia in acutely ill patients with Cushing syndrome. Sedation is the limiting adverse effect, which is why it is usually used in intubated patients as in the stem. It has the advantages of intravenous administration and rapid onset.
Mitotane (Answer A) is adrenolytic, but it takes weeks to have an effect. Pasireotide (Answer B) is only effective in treating Cushing disease. Ketoconazole (Answer D) is relatively contraindicated due to elevated transaminases and must be administered orally. Mifepristone (Answer E) can be used to treat any form of hypercortisolemia and it might be effective in this patient, but it is orally administered, and hypokalemia should be corrected before dosing.