Errors in First Aid for the USMLE (2007): Endocrine System

As always, this comes from an email sent to the First Aid team. If you find any problems here or things that I’ve missed, please note them in the comments.

Endocrine (all references from Merck Manual, Robbins Basic Pathology)

  1. P.267, Cushing’s Syndrome
    1. The left sidebar states that ACTH-producing tumors can be identified after a high dose of dexamethasone as having “[down arrow] cortisol.” This is not the case for ACTH-producing Small Cell Lung Cancers which do not respond to feedback inhibition of cortisol or its analogues. Instead, these tumors have the same profile in the Dex test as Cortisone-producing tumors described in the sidebar. The sidebar should be changed:
      1. Healthy — [down arrow] cortisol after low dose
      2. ACTH-producing Pituitary tumor — [up arrow] after low dose; [down arrow] after high dose
      3. Cortisone-producing tumor — [up arrow] after low and high doses, unilateral adrenal atrophy (or hyperplasia)
      4. Ectopic ACTH-producing tumor — [up arrow] after low and high doses, bilateral adrenal hyperplasia
      5. Iatrogenic Cortisol administration — [up arrow] after low and high doses, bilateral adrenal atrophy
  2. P.269, Subacute thryoiditis (de Quervian’s)
    1. No mention made that this condition involves granulomatous inflammation of the thyroid, a major characteristic.
  3. P.269, Thyroid Cancer
    1. I think this section should be retitled “Thyroid Tumor” and the following bullet point added first to highlight that the majority of nodes are not malignant:
      1. 90% Benign, adenoma – “hot” on scintigram, Hurthle cells

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15 Responses to Errors in First Aid for the USMLE (2007): Endocrine System

  1. Sanjay Linganna says:

    Pg 274, Endocrine Pharm, Other Hypothalamic/pituitary drugs:

    Perhaps not high yield, but ADH/Desmopressin has a few hemodynamic uses:

    Vasopressin (V1 and V2 agonist): Can also be used in the treatment of Esophageal Varices

    Desmopressin (V2 selective agonist): Increase Factor VIII levels in mild Hemophiliacs, and it increases von Willebrand factor in some patients with vWD

    Ref Baby Katzung 7ed, pg 536; Goodman and Gilman 11ed pg 786

  2. candi says:

    Page 269: I think that de Quervain’s thyroiditis first goes through a HYPERthyroid period, followed by a hypothyroid period, followed by euthyroid.

  3. steph says:

    From 2006 version
    p. 259
    Endocrine Pharm
    GH is not somatostatin it is somatotropin
    Octreotide is the somatostatin drug

  4. Imran says:

    The Hypercalcemia mnemonic CHIMPANZEES has P standing for ‘Paget’s’ Ds. on pg 328 (and BRS Path) it states that Paget’s Disease of the bone does not cause an increase or decrease in either calcium or phosphorus.

  5. Vamshi says:

    Pg 262

    Says that somatostatin inhibits GH, TSH

    somatostatin also inhibits prolactin.

    Could not find a source that states thta somatostatin inhibits TSH.

  6. winston says:

    pg 269

    FA states that in Secondary Hyperparathyroidism you have hypocalcemia and hyperphosphatemia. However, the kaplan notes state and explain that in a matter of fact you have hypocalcemia and hypophosphatemia…….you can actually differentiate primary and secondary hyperparathyroidism this way…in primary calcium and phosphate levels usually move in opposite directions while in secondary they move in the same direction with exception to chronic renal failure…..

    what do you guys think?

  7. winston says:

    pg 269

    Secondary Hyperparathyroidism will have:
    Low plasma phosphate in absorption problems
    Highplasma phosphate in renal failure

    I think that explains it thebest

  8. Ian says:

    In reference to thyroid nodules and scintigrams, a I-13I scan will be “hot” with Grave’s disease or a toxic multinodular goiter, where cancers and cysts of the thyroid are actually “cold”. Showing a “hot” nodule, accompanied by a lower than normal TSH, is strong evidence that the nodule is not cancerous. In women, a “cold” nodule is most likely a benign mass; however, in men and children a “cold” nodule is malignant until proven otherwise with a fine needle aspiration. Moreover, inactivity of the gland (e.g., a pt. is taking exogenous thyroid hormone, i.e., synthroid) and inflammation of the gland, whether it be acute, subacute or chronic, will show decreased uptake of I-131. And finally, just to clarify, not only are Hurthle cells seen with Hashimoto’s thyroiditis, but also with follicular carcinoma of the thyroid. Thanks for all your help with First Aid’s errata!

  9. JC says:

    On p. 267, hyperpigmentation is listed as the way to discern primary adrenal insufficiency from secondary. This would be a good time to mention ACTH stimulation tests, which clinch the diagnosis by demonstrating either:

    1. Adequate rise of cortisol/aldo (indicating adrenal insufficiency secondary to poor pituitary ACTH production) or
    2. Inadequate rise of cortisol/aldo (indicating a primary adrenal insufficiency)

  10. JC says:

    On p. 268, the description of Pheochromocytoma should really mention that serum metanephrines are elevated (diagnostic test).

  11. Useful information there

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