Metabolic and Endocrine Health
What the exam tests
This domain tests glucose and insulin regulation, lipid metabolism, thyroid and adrenal physiology, metabolic syndrome, and lifestyle-first strategies for metabolic and endocrine concerns.
Core rules
- Metabolic syndrome requires at least three of: increased waist circumference, elevated triglycerides, low HDL cholesterol, elevated blood pressure, and elevated fasting glucose.
- HbA1c reflects roughly two to three months of average glycemia; fasting glucose and insulin can estimate insulin resistance, but no single value diagnoses it.
- Thyroid assessment usually begins with TSH and free T4; interpret in context, not in isolation.
- Cortisol follows a diurnal rhythm; "adrenal fatigue" is not a recognized diagnosis.
- Evidence-based foundations include reducing added sugar to under 10% of calories, increasing fiber, regular movement, sleep, and stress regulation.
Worked example
A client with prediabetes wants to avoid medication. Reasoning: confirm HbA1c and fasting glucose with the prescriber, assess waist, blood pressure, lipids, sleep, and activity. Recommend a 5-7% weight reduction if indicated, 150 minutes per week of moderate activity, reduced sugar-sweetened beverages, and a fiber-rich pattern. Recheck HbA1c in three to six months. The reasoning is lifestyle-first with measurable targets, not promises to reverse disease.
Traps
- Diagnosing diabetes or thyroid disease from a single lab.
- Selling "adrenal support" for fatigue.
- Ignoring sleep and medications.
- Promoting very-low-calorie diets without monitoring.