ESI Manual of Clinical Endocrinology RV Jayakumar, Nihal Thomas, Sarita Bajaj, Sanjay Kalra, Rakesh Sahay, Nalini S Shah, Ambrish Mithal, GR Sridhar, Anil Bhansali, KM Prasanna Kumar, Nikhil Tandon, Shashank R Joshi, AC Ammini, Subhankar Chowdhury
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1ESI Manual of Clinical Endocrinology2
3ESI Manual of Clinical Endocrinology
Second Edition
Editor-in-Chief Sarita Bajaj Consultant Endocrinologist Director-Professor and Head Department of Medicine MLN Medical College Allahabad, Uttar Pradesh, India Editors GR Sridhar Director Endocrine and Diabetes Center Visakhapatnam Andhra Pradesh, India Sanjay Kalra Consultant Endocrinologist Bharti Hospital BRIDE Karnal, Haryana, India Rakesh Sahay Professor Department of Endocrinology Osmania Medical College, Hyderabad Andhra Pradesh, India RV Jayakumar Professor Department of Endocrinology Amrita Institute of Medical Sciences Kochi, Kerala, India Nikhil Tandon Professor Department of Endocrinology All India Institute of Medical Sciences New Delhi, India Nihal Thomas Professor and Head Department of Endocrinology Diabetes and Metabolism Christian Medical College, Vellore Tamil Nadu, India Anil Bhansali Professor and Head Department of Endocrinology Postgraduate Institute of Medical Education and Research, Chandigarh, India Ambrish Mithal Chairman Division of Endocrinology and Diabetes Medanta the Medicity Gurgaon, Haryana, India AC Ammini Professor and Head Department of Endocrinology All India Institute of Medical Sciences New Delhi, India KM Prasanna Kumar Honorary Professor and Ex HOD Department of Endocrinology and Metabolism, MS Ramaiah Medical College, Bengaluru, Karnataka, India Nalini Shah Professor and Head Department of Endocrinology KEM Hospital Mumbai, Maharashtra, India Subhankar Chowdhury Professor and Head Department of Endocrinology Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India Shashank R Joshi Consultant Endocrinologist Division of Endocrinology Lilavati and Bhatia Hospital Department of Endocrinology Grant Medical College and Sir JJ Group of Hospitals Mumbai, Maharashtra, India
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ESI Manual of Clinical Endocrinology
Second Edition: 2015
Printed at
5 Dedicated to
The Endocrine Society of India
As a team of editors we would each like to dedicate it to our families, friends and colleagues for their unstinted support during times when our work on the ESI Manual of Clinical Endocrinology has meant less time for them 6
7 Contributors 15Foreword
Physicians, engaged in pursuit of excellence, often devise a code that lays out perimeter of influence, in order to ensure uniformity in approaches to inquest and disposition. Manuals evolved over time to consolidate and distill knowledge, acquired through systematic study of human disease. Carefully organized and arranged manuals serve the purpose of simplifying investigative procedures, as well as ensuring a consistency in undertaking investigation. Information is backed by evidence and presented in a manner that both informs and educates. In this manual, many veterans of Indian endocrinology have been assembled to offer thoughtful write ups that will take reader through a simplified version of otherwise complicated maze. Manuals run the risk of oversimplification, but a discerning reader will understand that certain information may be left out because inferences may be questionable, or its application in Indian context may be impractical. Having worked in India for a brief period, I became quite aware of need to have a compendium of procedures and practices, that would ensure uniformity in how endocrine disorders were investigated and managed. This manual serves that purpose admirably. Editors and contributors deserve thumbs up for their effort.
Romesh Khardori MD PhD
Division of Endocrinology and Metabolism
Strelitz Center for Endocrine and Metabolic Disorders
Department of Internal Medicine
Eastern Virginia Medical School
Norfolk, Virginia, USA
16 17Preface
Advances in endocrine science and practice continue at a breathtaking pace. As the knowledge base expands, it is important to adapt our learning systems to keep up with progress in our field. This second edition of ESI manual of Endocrinology retains the fundamental nature to provide a concise but comprehensive and fully updated treatise on endocrinology covering the breadth of endocrine practice, stressing the Indian perspective, highlighting new advances and their potential to transform the established paradigms of prevention, diagnosis and treatment.
The chapters are written by clinicians and basic scientists from a variety of fields. There is an entirely new section on obesity. 27 of the 127 chapters are totally new covering topics not addressed in the first edition. There are 146 authors, in total; many are contributing for the first time, all highly accomplished and recognized in their respective disciplines. All chapters carried over from the first edition have been extensively updated or entirely rewritten. As in the previous edition, the book makes abundant use of four-color illustrations, tabular material, and particularly algorithms for evaluating the functions of different systems and the diseases of those systems. The reader will be impressed by ongoing development with respect to the appearance of the book. The cover and layout have been redesigned to make information more accessible and figures have been redrawn to ensure clarity and ease of interpretation.
This manual allows the reader to quickly identify and understand topics of interest which translates into very practical treatment planning. Our authors who are pioneers in the field of endocrinology present relevant pathophysiology with practical protocols for evaluation and treatment. The target audience continues to be any health professional who desires a rapid answer to any challenging question in endocrinology including endocrinologists, diabetologists, endocrine surgeons, general practitioners and students of medicine.
The book is divided into eight sections arranging closely related subjects into clusters. Section 1 on Diabetes commences with a magnificent exposition on the diversity of diabetes moving on to the entire gamut of the subject incorporating the various types of diabetes through the ages, womens’ health, HIV, psychology, circadian rhythms and sleep, vitamin D, testosterone, metabolic syndrome and gut flora. Newer drugs for both type1 and 2 are presented with a targeted goal of optimal glucose control as well as an attempt at retention of beta cell function. Thyroid disorders are described in Section 2 with separate chapters on thyroid function tests hypothyroidism, hyperthyroidism, thyroid cancer and thyroid diseases in special situations. Section 3 addresses disorders of the pituitary and hypothalamus with a new chapter on multiple endocrine neoplasia type 1. The entire spectrum of adrenal disorders is addressed in Section 4. Section 5 encompasses the most recent understanding of calcium metabolism focusing on Vitamin D, osteoporosis, nephrolithiasis and emphasizing prevention as well as immediate and long-term treatment. Pubertal and reproductive endocrinology which are highlighted in Section 6 succinctly covers amenorrhea, hypogonadism, PCOS and erectile dysfunction. Section 7 incorporates pediatric endocrinology with disorders of growth, puberty and sexual differentiation. With the global epidemic of obesity a new section has been devoted to it. The MCQs in the appendix are a novelty and mandate careful attention to detail while reading.
I was extremely fortunate to attract contributors who are renowned as authors and researchers, and who are most importantly consummate physicians. I thank all of them for their diligence, intellectual approach and clinical acumen without which this volume would not have been possible. Dr KM Prasanna Kumar with his clarity of guidance has been a constant source of inspiration, Dr GR Sridhar and Dr Ambrish Mithal have provided tremendous support. Dr Sanjay Kalra with his editorial prowess has been invaluable in coordinating the work on the book. Dr Rakesh Sahay offered sound advice while Dr AG Unnikrishnan has been an enthusiastic motivator. I would like to express my gratitude to all 105 authors who have balanced their many other obligations to prepare truly masterful presentations and for the large amount of work in reviewing and commenting on the chapters.
And although this book was written for clinicians it is my hope that the millions of patients with endocrine disease will be the primary beneficiaries. It is therefore with great humility that I have the distinct honor to be the editor of the second edition of the ESI Manual of Endocrinology.
Sarita Bajaj
ESI Manual of Endocrinology18
Publishing ESI Manual of Clinical Endocrinology is in every way a collaborative effort. My utmost thanks to the Endocrine Society of India for entrusting me with this resposibility. I am deeply indebted to the team of editors Dr GR Sridhar, Dr Sanjay Kalra, Dr Rakesh Sahay, Dr RV Jayakumar, Dr Nikhil Tandon, Dr Nihal Thomas, Dr Anil Bhansali, Dr Ambrish Mithal, Dr AC Ammini, Dr KM Prasanna Kumar, Dr Nalini Shah, Dr Subhankar Chowdhury, Dr Shashank R Joshi and associate editors Dr Manash P Baruah, Dr Manoj Chadha, Dr Krishna G Seshadri, Dr AG Unnikrishnan, Dr Thomas V Paul,Dr Ganapathi Bantwal, Dr Rama Walia, Dr Sanjay Bhadada, Dr Beena Bansal, Dr Bindu Kulshreshta, Dr Rajesh Khadgawat, Dr Tushar Bandgar, Dr Anurag R Lila, Dr SK Singh, Dr Parag Shah who have each made major contributions in edition and writing chapters as well as for their considerable time, effort and commitment to maintaining the high standards of the Manual.
We have assembled an outstanding group of authors, all recognized as leaders in their field and I would like to thank them for taking the time away from their busy clinical schedules and other academic responsibilities to write these chapters. I would also like to thank the editorial staff at Jaypee Brothers Medical Publishers, New Delhi, India, for their patience, encouragement and support. I particularly thank Ms Sheetal Arora (Development Editor) and Ms Chetna Malhotra Vohra, Associate Director of Jaypee Brothers Medical Publishers (P) Ltd. Both Sheetal and Chetna contributed in a very significant way to the concepts, design and preparation of the second edition of ESI Manual of Clinical Endocrinology while Dr Neeraj Choudhary (Senior Medical Editor) was instrumental in ensuring seamless transfer of publication house. Special thanks to Shri Jitendar P Vij, CEO and Group Chairman and Mr Saket Budhiraja, Vice President (Jaypee the Health Science) for their help in publishing this book.20