Self Assessment

Updates to Endocrine Self-Assessment Program (ESAP)

August 04, 2021

Updates to ESAP can be found on this page.

ESAP 2021 UPDATES

Question 3 – Answer Rationale 
Deepika Reddy, MD
Diabetes; pp. 84-85
Update date: August 5, 2021

Information as Originally Published: Although dietary counseling (Answer A) to help her make better food choices is a good idea, and the addition of glimepiride (Answer D) might lower her blood glucose, the unexpected rise in hemoglobin A1c with no identifiable cause should prompt evaluation for a secondary etiology. 

Information as Currently Updated: While adding insulin (Answer A) or glimepiride (Answer D) could address her hyperglycemia, the unexpected rise in hemoglobin A1c with no identifiable cause should prompt evaluation for a secondary etiology.

Question 5
Kevin Pantalone, DO
Diabetes; p. 12
Update date: August 5, 2021

Updated Information—At the time this question was written, SGLT-2 inhibitors were contraindicated in patients with an estimated glomerular filtration rate less than 30 mL/min per 1.73 m2. However, more recent trial evidence has supported the use of these drugs, even in stage 4 chronic kidney disease. Thus, Answer A could also be considered correct at this time. 

Question 46
Savitha Subramanian, MD
Lipids-Obesity; pp. 36-37
Update date: August 5, 2021

Updated Information—New guidelines released since this question was written have provided an alternative correct answer. The 2021 American Diabetes Association guidelines would now recommend adding a GLP-1 receptor agonist or an SGLT-2 inhibitor in this setting, regardless of hemoglobin A1c, due to the additional cardiovascular risk benefit. Thus, Answer D could also be considered correct at this time.

ESAP 2020 Updates

Question 2 – Answer Rationale
Aniket Sidhaye, MD
Diabetes; pp. 88-89
Update date: August 5, 2021

Information as Originally Published: When the plasma glucose concentration was 53 mg/dL (2.9 mmol/L), the insulin concentration was greater than 3.0 µIU/mL (>20.8 pmol/L) and the C-peptide concentration was greater than 0.2 ng/mL (>0.07 nmol/L), thus confirming excess endogenous insulin production.

Information as Currently Updated: When the plasma glucose concentration was 53 mg/dL (2.9 mmol/L), the insulin concentration was greater than 3.0 µIU/mL (>20.8 pmol/L) and the C-peptide concentration was greater than 0.5 ng/mL (≥0.2 nmol/L), thus confirming excess endogenous insulin production.

Question 9 – Answer Rationale
Mathis Grossmann, MD, PhD, FRACP
Male Reproduction; p. 96
Update date: August 26, 2020

Information as originally published: Assessing free testosterone is indicated when total testosterone concentrations are borderline, or if conditions that alter SHBG are suspected, such as increased levels with obesity, diabetes mellitus, use of exogenous androgens, or hypothyroidism or decreased levels with aging, hyperthyroidism, liver disease, anticonvulsant medications, HIV, or use of estrogens.

Information as currently updated: Assessing free testosterone is indicated when total testosterone concentrations are borderline, or if conditions that alter SHBG are suspected, such as decreased levels with obesity, diabetes mellitus, use of exogenous androgens, or hypothyroidism or increased levels with aging, hyperthyroidism, liver disease, anticonvulsant medications, HIV, or use of estrogens.

Question 20
Savitha Subramanian, MD
Lipids/Obesity; pp. 23-24
Update date: August 26, 2020

Information as originally published: Fasting plasma glucose: 78 mg/dL (70-99 mg/dL) (SI: 7.3 mmol/L)
Information as currently updated: Fasting plasma glucose: 78 mg/dL (70-99 mg/dL) (SI: 4.3 mmol/L)

Question 87
Thomas J. Weber, MD
Bone and Mineral Metabolism; pp. 65-66
Update date: August 26, 2020

Information as originally published: Urinary creatinine = 1.2 mg/24h (1.0-2.0 g/24h)
Information as currently updated: Urinary creatinine = 1.2 g/24h (1.0-2.0 g/24h)

Question 103
Thomas J. Weber, MD
Bone and Mineral Metabolism; pp. 75-76
Update date: August 26, 2020

Information as originally published: Urinary creatinine = 1.0 mg/24h (1.0-2.0 g/24h)
Information as currently updated: Urinary creatinine = 1.0 g/24h (1.0-2.0 g/24h)

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