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Managing Endocrine Conditions in the Modern Treatment Era

  • Authors: Maria Fleseriu, MD, FACE
  • CME / ABIM MOC / CE Released: 6/22/2021
  • 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


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  • 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


    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


  • Kimberly Storck, PharmD, RPh

    Senior Medical Writer, Medscape, LLC


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

  • Joy Marko, MS, APN-C, CCMEP

    Senior Medical Education Director, Medscape, LLC


    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


    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.

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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.

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Managing Endocrine Conditions in the Modern Treatment Era

Authors: Maria Fleseriu, MD, FACEFaculty and Disclosures

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

Valid for credit through: 6/22/2022


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




T2D and hypertension for 1 year

Current medications

Metformin; lisinopril


Project manager at a technology company; recently married

Physical exam



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


35 kg/m2





Metabolic panel




Lipid panel

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


0.8 ng/dL


0.88 ng/dL

BUN, creatinine

20 mg/dL, 0.8 mg/dL

Serum glucose

115 mg/dL


31 U/L, 35 U/L


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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