Mary, a 32-year-old woman, presents to the endocrinology clinic with complaints of chronic fatigue, cold intolerance, weight gain, and irregular menstrual cycles. She also reports difficulty breastfeeding after the birth of her last child three years ago, despite being able to breastfeed her first child without issues. She has noticed thinning of her pubic and axillary hair and decreased libido. Her history reveals that her last delivery was complicated by severe postpartum hemorrhage requiring blood transfusions. She has not received regular medical follow-ups since then. Physical Examination: •Pale skin and thinning of axillary and pubic hair. •Her temperature is 99 °F, heart rate is 62 beats/min, blood pressure is 98/68 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. •No palpable goiter. •Generalized fatigue and lethargy without focal neurological deficits. Diagnostic Workup: 1.Laboratory Results: Test Result Reference TSH 0.1 µg/mL 0.4 – 4.0 µg/mL Free T₄ 0.3 ng/dL 0.9 – 1.7 ng/dL Cortisol 0800h: 2 µg/dL 0800 h: 5-23 µg/dL//1600 h:3-15 µg/dL; 2000 h: <50% of 0800 h Follicle-stimulating hormone 2 mIU/mL Male: 4 - 25 mIU/mL Female: premenopause 4-30 mIU/mL; midcycle peak 10-90 mIU/mL; postmenopause 40 - 250 mIU/mL Luteinizing hormone 1 mIU/mL Male: 6 - 23 mIU/mL Female: follicular phase 5 - 30 mIU/mL midcycle 75 - 150 mIU/ml postmenopausal 30 - 200 mIU/mL Prolactin (hPRL) 6 ng/mL Male: <17 ng/mL Female: <25 ng/mL Sodium (Na⁺) 136 mEq/L 136 - 146 mEq/L ACTH 2 pg/mL 0800 hr: 10-60 pg/mL Estradiol 4 pg/mL 20-200 pg/mL 2.Imaging: MRI of the pituitary shows an empty sella. What is the first hormone deficiency that should be addressed in the treatment of this disorder?

Mary, a 30-year-old woman, presents to the endocrinology clinic with complaints of chronic fatigue, cold intolerance, weight gain, and irregular menstrual cycles. She has noticed thinning of her pubic and axillary hair and decreased libido. Her history reveals that her last delivery was complicated by severe postpartum hemorrhage requiring blood transfusions. She has not received regular medical follow-ups since then. Physical Examination: •Pale skin and thinning of axillary and pubic hair. •Her temperature is 99 °F, heart rate is 62 beats/min, blood pressure is 98/68 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. •No palpable goiter. •Generalized fatigue and lethargy without focal neurological deficits. Diagnostic Workup: 1.Laboratory Results: Test Result Reference TSH 0.1 µg/mL 0.4 – 4.0 µg/mL Free T₄ 0.3 ng/dL 0.9 – 1.7 ng/dL Cortisol 0800h: 2 µg/dL 0800 h: 5-23 µg/dL//1600 h:3-15 µg/dL; 2000 h: <50% of 0800 h Follicle-stimulating hormone 2 mIU/mL Male: 4 - 25 mIU/mL Female: premenopause 4-30 mIU/mL; midcycle peak 10-90 mIU/mL; postmenopause 40 - 250 mIU/mL Luteinizing hormone 1 mIU/mL Male: 6 - 23 mIU/mL Female: follicular phase 5 - 30 mIU/mL midcycle 75 - 150 mIU/ml postmenopausal 30 - 200 mIU/mL Prolactin (hPRL) 6 ng/mL Male: <17 ng/mL Female: <25 ng/mL Sodium (Na⁺) 136 mEq/L 136 - 146 mEq/L ACTH 2 pg/mL 0800 hr: 10-60 pg/mL Estradiol 4 pg/mL 20-200 pg/mL 2.Imaging: MRI of the pituitary shows an empty sella. Which of the following is an early symptom of this disorder (Sheehan syndrome)?

Mary, a 32-year-old woman, presents to the endocrinology clinic with complaints of chronic fatigue, cold intolerance, weight gain, and irregular menstrual cycles. She also reports difficulty breastfeeding after the birth of her last child three years ago, despite being able to breastfeed her first child without issues. She has noticed thinning of her pubic and axillary hair and decreased libido. Her history reveals that her last delivery was complicated by severe postpartum hemorrhage requiring blood transfusions. She has not received regular medical follow-ups since then. Physical Examination: •Pale skin and thinning of axillary and pubic hair. •Her temperature is 99 °F, heart rate is 62 beats/min, blood pressure is 98/68 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. •No palpable goiter. •Generalized fatigue and lethargy without focal neurological deficits. Diagnostic Workup: 1.Laboratory Results: Test Result Reference TSH 0.1 µg/mL 0.4 – 4.0 µg/mL Free T₄ 0.3 ng/dL 0.9 – 1.7 ng/dL Cortisol 0800h: 2 µg/dL 0800 h: 5-23 µg/dL//1600 h:3-15 µg/dL; 2000 h: <50% of 0800 h Follicle-stimulating hormone 2 mIU/mL Male: 4 - 25 mIU/mL Female: premenopause 4-30 mIU/mL; midcycle peak 10-90 mIU/mL; postmenopause 40 - 250 mIU/mL Luteinizing hormone 1 mIU/mL Male: 6 - 23 mIU/mL Female: follicular phase 5 - 30 mIU/mL midcycle 75 - 150 mIU/ml postmenopausal 30 - 200 mIU/mL Prolactin (hPRL) 6 ng/mL Male: <17 ng/mL Female: <25 ng/mL Sodium (Na⁺) 136 mEq/L 136 - 146 mEq/L ACTH 2 pg/mL 0800 hr: 10-60 pg/mL Estradiol 4 pg/mL 20-200 pg/mL 2.Imaging: MRI of the pituitary shows an empty sella What is the primary cause of this disorder?

A 30-year-old woman, gravida 1 para 0, at 24 weeks of gestation presents to the emergency department with complaints of persistent headache, blurry vision, and swelling in her hands and feet for the past two days. She denies chest pain, but has some shortness of breath. Her antenatal course has been uneventful until now, with no significant medical history. On examination, the patient has a blood pressure of 170/110 mmHg, a pulse rate of 88 beats per minute, and no fever. Which of the following medications is considered safe and commonly used to treat hypertension in pregnancy?

A 32-year-old woman, gravida 1 para 0, at 34 weeks of gestation presents to the emergency department with complaints of persistent headache, blurry vision, and swelling in her hands and feet for the past two days. She denies chest pain, but has some shortness of breath. Her antenatal course has been uneventful until now, with no significant medical history. On examination, the patient has a blood pressure of 170/110 mmHg, a pulse rate of 88 beats per minute, and no fever. She has pitting edema in both lower extremities. Neurological examination reveals hyperreflexia, but no clonus or seizures. Fundoscopy shows no papilledema. Fetal heart tones are reassuring, and the uterus is non-tender. Laboratory tests Test Result Reference urine protein/creatinine 0.6 normal < 0.3 Platelets 90,000/µL 150,000 - 400,000/µL ALT 78 U/L 10-40 U/L AST 95 U/L 12-38 U/L Serum creatinine 1.5 mg/dL 0.6 - 1.2 mg/dL LDH 450 U/L 45-200 U/L What is the definitive treatment for this patient?

A 30-year-old woman, gravida 1 para 0, at 34 weeks of gestation presents to the emergency department with complaints of persistent headache, blurry vision, and swelling in her hands and feet for the past two days. She denies chest pain, but has some shortness of breath. Her antenatal course has been uneventful until now, with no significant medical history. On examination, the patient has a blood pressure of 170/110 mmHg, a pulse rate of 88 beats per minute, and no fever. She has pitting edema in both lower extremities. Neurological examination reveals hyperreflexia, but no clonus or seizures. Fundoscopy shows no papilledema. Fetal heart tones are reassuring, and the uterus is non-tender. You worried about the possibility of preeclampsia in this patient. Which of the following is NOT a feature of severe preeclampsia?

A 32-year-old woman comes to your obstetrics clinic for preconception counseling. She has a history of hypertension and hypothyroidism for over four years. She takes lisinopril 10 mg daily for hypertension and synthroid 50 mcg for hypothyroidism. Her temperature is 99 °F (37.2 °C), heart rate is 92 beats/min, blood pressure is 142/94 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. She has no medical complaints today. Her physical examination is unremarkable. Regarding the management of her hypertension during pregnancy, which is the most appropriate next step?

A 34-year-old primigravida woman, presented at 34 weeks gestation, reporting ‘not feeling well’. Her medical history was unremarkable except for a recent diagnosis of mild hypertension, which was being monitored. She had no significant family history of pregnancy-related complications. Clinical Presentation: Upon arrival at the emergency department, she appeared distressed and pale. Her vital signs showed a blood pressure of 160/110 mmHg, which was significantly elevated compared to her last check-up. Physical Examination: Among other things, there was no evidence of edema, but her face and hands appeared slightly swollen. Her reflexes were brisk, and she exhibited clonus. Laboratory Findings: Her platelet count was 65,000 per microliter, Liver function tests showed an AST of 200 U/L and an ALT of 180 U/L. LDH was elevated at 650 U/L, and blood smear revealed schistocytes. What clinical symptom is most commonly associated with this disorder?

A 32-year-old woman, gravida 2 para 1, at 35 weeks of gestation, presents to the emergency department with complaints of severe epigastric and right upper quadrant (RUQ) pain for the past 8 hours. She also reports nausea, fatigue, and a headache that has not improved with acetaminophen. She denies seizures, visual disturbances, or vaginal bleeding. Her prenatal care had been uneventful until this visit. Examination Findings: Vital Signs: BP 170/110 mmHg, HR 96 bpm, Temp 98.9°F. General Exam: The patient appears uncomfortable and fatigued. Abdominal Exam: RUQ tenderness without rebound or guarding. Neurological Exam: No focal deficits or signs of clonus. Investigations: 1.Laboratory Results: Test Result Reference Alanine aminotransferase (ALT) 140 10 – 40 U/L Aspartate aminotransferase (AST) 120 12 – 38 U/L Platelet count 85,000 150,000 – 400,000/mm³ Lactate dehydrogenase 680 45 – 200 U/L Peripheral smear: Schistocytes Urine 3+ proteins 2.Imaging: Liver Ultrasound: Normal, with no evidence of hematoma or rupture. Fetal Monitoring: Non-stress test shows a reassuring fetal heart rate pattern.What is the definitive treatment for this disorder?