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CME / ABIM MOC / CE

Managing Endocrine Conditions in the Modern Treatment Era

  • Authors: Maria Fleseriu, MD, FACE
  • CME / ABIM MOC / CE Released: 6/22/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 6/22/2022
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Target Audience and Goal Statement

This activity is intended for primary care clinicians, diabetologists, and endocrinologists, nurses and other healthcare providers who care for patients with Cushing syndrome.

The goal of this activity is to improve earlier recognition, prompt diagnosis, and effective management of Cushing syndrome.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Treatment options for a patient with persistent or recurrent Cushing disease (CD)
  • Have greater competence related to the
    • Recognition of CD
    • Individualized treatment of newly diagnosed CD
    • Individualized treatment for a patient with CD who is not under biochemical control


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Faculty

  • Maria Fleseriu, MD, FACE

    Professor of Medicine
    Division of Endocrinology
    Diabetes and Clinical Nutrition
    Professor of Neurological Surgery
    Director, OHSU Pituitary Center
    Oregon Health & Science University
    Portland, Oregon

    Disclosures

    Disclosure: Maria Fleseriu, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Chiasma; Crinetics; Ipsen; Pfizer; Recordati
    Received grants for clinical research from: Chiasma; Crinetics; Ionis; Novartis

Editors

  • Kimberly Storck, PharmD, RPh

    Senior Medical Writer, Medscape, LLC

    Disclosures

    Disclosure: Kimberly Storck, PharmD, RPh, has disclosed no relevant financial relationships.

  • Joy Marko, MS, APN-C, CCMEP

    Senior Medical Education Director, Medscape, LLC

    Disclosures

    Disclosure: Joy Marko, MS, APN-C, CCMEP, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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    For Nurses

  • Awarded 1.0 contact hour(s) of continuing nursing education for RNs and APNs; 0.50 contact hours are in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC / CE

Managing Endocrine Conditions in the Modern Treatment Era

Authors: Maria Fleseriu, MD, FACEFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC / CE Released: 6/22/2021

Valid for credit through: 6/22/2022

processing....

The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

Case 1: Tammy, 35-year-old woman with a 40-pound weight gain over 9 months.

Tammy came to her appointment last week being distraught over a recent 40-pound weight gain. "My friends tell me not to worry about it," she explained during her initial visit. "The pandemic has caused most of them to gain weight, too, but not one of my friends has put on 40 pounds!" Unappeased by her friends' attempts to comfort her, she felt that something was amiss with her body. "I have stretch marks on my stomach from all the weight gain. It's awful! I'm growing hair places it shouldn't be growing, and I haven't had a period for 6 months," she confided.

On physical examination, Tammy's weight gain was centripetal with supraclavicular fat. Her stretch marks were purple and notably wide (> 1 cm). Tammy was sent for blood work and returns to the clinic today to discuss her results. Her current medical history and most recent lab results are shown in Table 1.

Table 1. Tammy's Medical Record

History

Findings

Medical

T2D and hypertension for 1 year

Current medications

Metformin; lisinopril

Social/occupational

Project manager at a technology company; recently married

Physical exam

Findings

General

Coarse, dark hair on upper lip and chin; purple stretch marks on abdomen of > 1 cm; complains of muscle weakness; bruising

Vital signs

BP: 147/95 mm Hg

Heart rate: 67 bpm

BMI

35 kg/m2

CBC

Results

 

Normal

Metabolic panel

Results

HbA1c

9%

Lipid panel

LDL: 100 mg/dL; HDL: 45 mg/dL; TG: 250 mg/dL

FT4

0.8 ng/dL

TSH

0.88 ng/dL

BUN, creatinine

20 mg/dL, 0.8 mg/dL

Serum glucose

115 mg/dL

AST/ALT

31 U/L, 35 U/L

Albumin

4.4 mg/dL

ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index; BP = blood pressure; bpm = beats per minute; BUN = serum urea nitrogen; CBC = complete blood count; FT4 = free T4; HbA1c = glycated hemoglobin; HDL-C= high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; T2D = type 2 diabetes; TG = triglycerides; TSH = thyroid-stimulating hormone.

Tammy has a 2-year history of T2D. Her T2D had been well controlled on metformin; however, last week's blood draw returned a glycated hemoglobin (HbA1c) level of 9%. "I eat more vegetables and salad now than ever before, but it doesn't seem to matter," she laments, "I'm overweight. I'm tired all the time." When asked if she is experiencing muscle weakness or fatigue, she responds, "I notice that I'm holding the railing when I go up or down the stairs, and I'm having some trouble walking. I feel like my legs may give out."

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