Source / episode info

• **Episode:**75
• **Title:**Divine Intervention Episode 75 – USMLE Step 3/Medicine ITE/ABIM Board Review Series 2 (Endocrinology)
• **Published:**2019-01-15
• Source:Episode page

One-liner

This episode provides a comprehensive review of endocrine pathology, covering adrenal insufficiency differentiation (primary vs. secondary), hyperaldosteronism workup, various causes of amenorrhea/infertility, and pituitary-related disorders like prolactinomas and hypopituitarism.

High-yield summary

• Conn Syndrome: Characterized by a plasma Aldosterone/Renin ratio >20 (high aldosterone, suppressed renin).
• Primary Adrenal Insufficiency (Addison's): Deficiency in both glucocorticoids and mineralocorticoids; requires replacement of both.
• Secondary Adrenal Insufficiency: Deficiency primarily in glucocorticoids due to pituitary failure; the mineralocorticoid axis remains intact because it is regulated by the Renin-Angiotensin System, not ACTH.
• PCOS Diagnosis: Requires meeting 2 out of 3 criteria: Oligo/anovulation, Hyperandrogenism (hirsutism/acne), and Polycystic ovaries on ultrasound.
• Asherman Syndrome: Characterized by intrauterine adhesions following D&C; diagnosed by a negative Progesterone Withdrawal Test.
• Hypogonadotropic Hypogonadism: Low estrogen levels are often due to lack of negative feedback (e.g., in primary ovarian failure or hypothalamic amenorrhea).

Learning objectives

• Differentiate the hormonal profiles and management strategies for primary vs. secondary adrenal insufficiency.
• Recognize the diagnostic criteria and appropriate treatment modalities for Polycystic Ovary Syndrome (PCOS).
• Interpret reproductive hormone testing (e.g., Progesterone Withdrawal Test) in the context of uterine pathology.
• Correlate pituitary tumor findings (e.g., prolactinoma, adenomas) with specific endocrine symptoms and imaging findings.
• Apply knowledge of developmental anomalies (AIS, MRKH) to clinical presentations of ambiguous genitalia or primary amenorrhea.