Clinical Cases in Endocrinology Pramila Kalra
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Acromegaly
approach to 1
clinical features of 2
diagnosis of 1, 3
differential diagnosis of 1
genetics of 4
in male, typical features of 2f
prevalence of 2
surgery for 5
suspect 1
treatment for 6, 810
Addison's disease 148
Adrenal adenomas, nonfunctioning 110
Adrenal hyperfunction 109, 112
Adrenal incidentaloma 109, 118
evaluation of 110, 112
malignant transformation of 116
management of 117
on imaging, characteristics of 111t
patient with 114t
Adrenal mass
incidental 110
size of 110
Adrenocortical adenoma 111
Adrenocortical carcinoma 111, 113
Adrenocorticotropic hormone 16
dependent causes 15
Albright's hereditary osteodystrophy 130
Alcoholism 36
Aldosteronism, primary 113, 115
Aluminum intoxication 145
Amenorrhea 1
approach to 120
case of 125fc
case of primary 126
causes of secondary 120
in athletes, pathophysiology of 124
physiological 126
primary 125
secondary 120, 121, 122
American Diabetes Association Recommendations 167
Aminoglutethimide 20
Amiodarone 91
induced thyrotoxicosis, types of 92t, 93
therapy 93
use of 93
Amiodarone-induced hypothyroidism 94
incidence of 94
management of 94
Amiodarone-induced thyrotoxicosis 92
management of 93
Androgen therapy, benefit of 124
Anthropometry 177
Antidiuretic hormone secretion, syndrome of in appropriate 157
Antithyroid drugs 55, 56
adverse effects of 56
side effects of 56
start 55
Antithyroid peroxidase antibodies 49
Ascher's syndrome 1
Asherman's syndrome 120
Aspermia 101
Assisted reproductive techniques 105
Atherogenic lipids 47
Autonomic symptoms 134
B
Bethesda
diagnostic category 67
system 67
Blood
glucose levels
in pregnant women, normal 160
monitor 160
urea nitrogen 157
Breastfeeding 26
Burns 78
C
Cabergoline 24
dose of 29
Calcium
absorbed in the body 140
deficiency 178
from circulation, loss of 131
gastrointestinal absorption of 140
in body, functions of 140
metabolism, organs in 140
renal absorption of 141
replacement 135
salts 149
Carbimazole 55
Cardiac dysfunction 78
Cardiovascular manifestations 134
Cerebral ataxia 43
Cerebral salt wasting 157
pathophysiology of 157f
syndrome 156
Cervical stenosis 120
Child with delayed puberty 40
Child with rickets
approach to 176
birth history 176
diet history 176
family history 177
physical examination 177
social history 177
Cholestatic hepatitis 56
Chvostek's sign 129, 134
Cirrhosis of liver, mechanism in 86
Combination therapy, status of 7
Congestive heart failure 152
Constitutes hypercalcemia 140
Corticotropin releasing hormone 16
Cortisol-binding globulin 32
Cowden's disease 70
Cumulative illness rating scale 80
Cushing's disease 12
complications with 17
Cushing's features
symptoms of
endogenous 31
iatrogenic 31
Cushing's syndrome 13, 15, 18, 30, 34, 37, 112, 114
causes of 14
development of iatrogenic 32
diagnosis of 30
exogenous 33
ectopic ACTH–dependent 19
etiology of 15b
exogenous 18
iatrogenic 31
medical therapy of 19t
morbidity of subclinical 116
mortality of subclinical 116
origin of 16t
pseudo- and iatrogenic 30
striae of 12f
subclinical 113, 115
suspected 13fc
symptoms 112
treatment modalities for 18
Cytotoxic T-cells 95
D
Decide interval growth 69
Delayed puberty, causes of 41
Depression 36
Dermatologic manifestations 17
Dexamethasone 37
suppression test
high-dose 16
low-dose 13, 14
test, low-dose 37
Diabetes
educators 168
in pregnancy 159, 166
mellitus, pregnancy and 159, 160
pre-existing 169
Diagnose amiodarone-induced thyrotoxicosis 92
Digeorge syndrome 129
Dopamine 6
Dopamine agonist
agents, side effects of 25
stop 29
therapy 25, 26
Dronedarone 94
E
Ejaculation, complete absence of 101
Electrolytes 114
Empirical therapy 105
Endocrine
organs 123
tests 104
Erb's palsy 163
Erb's sign 134
Erythrocyte sedimentation rate 54
Estrogens 159
F
Familial acromegaly 5
Familial hypocalciuric hypercalcemia 146
Fasting blood sugar 12
Fasting lipid profile 114
Fecundability 97
Fertility, normal trends of 98
Fetal risks 162
Fine-needle aspiration 68
cytology 67, 71
Follicle-stimulating hormone 89, 103, 105
G
Gardner's syndrome 70
Gastric inhibitory polypeptide 15
Genu valgum deformity 176
Gestational diabetes
prevalence of 160
screening tools for 167
Gestational hyperthyroidism 59
Gigantism 10
Glucocorticoid 64
induced osteoporosis 35
Goiter, cause of 96
Gonadal disorders, primary 99
Gonadotropin-releasing hormone therapy 105
Graves’ disease 53, 54, 57
diagnosis of 60
Graves’ ophthalmopathy 61
grading of severity of 61t
Graves’ orbitopathy 63fc
Growth hormone
causes of 4, 10
suppression tests 3
Gynecomastia 8486, 88, 90
approach to 83
cause of 86, 87
etiology of 85, 86b
family history of 88
management of 89fc
pathophysiology of 84
physiological 84
refeeding 85
H
Hashimoto's thyroiditis, autoimmune disorders associated 48b
Hashimotos thyroiditis 48
Hepatic disease 78
Hernia 101
Hormonal evaluation 42
Hormonal factors, local and 85
Hormone 6
replacement regimens
in boys 44
in girls 44
supplementation 80
therapy 124, 126
Human chorionic gonadotropin 87, 89
Human immunodeficiency virus 89
Hyperbilirubinemia 165
Hypercalcemia
approach to 139, 149
case of 139
causes of 143
drugs for treating 142
grading of 143
malignancy-related 146
manifestations of 139
sarcoidosis lead to 144
treat case of 141
Hypercalciuria, causes of 148
Hypergonadotropic hypogonadism 43
Hyperparathyroidism
case of primary 148
primary 143, 146, 147
surgery in primary 148
Hyperprolactinemia 6, 28, 84, 104, 121
approach to 22
causes of 23
diagnosed 22
Hyperthyroidism 55, 87, 145
cause of 96
drugs and agents causing 95b
mechanism of 96
Hypervolemic patients 154
Hypocalcemia 129, 132, 133, 165
approach to 129
causes of 130, 133
clinical manifestations of 134
high PTH causes of 131
imbalance precipitate 133
low PTH causes of 131
patient with 132fc
postoperative 148
postradioiodine ablation for 137
symptoms 179
Hypoglycemia 165
Hypogonadism
causes of 45
management of 8
primary 87
syndromes associated with 43
treat 43
type of 42
Hypogonadotropic hypogonadism 43
Hypomagnesemia, coexisting 135
Hyponatremia 151
by plasma tonicity, classification of 153t
case of 152, 153fc
causes of 152, 152fc
clinical manifestations of 152
management of 155
mild 154
severe 155
treatment of 153
types of 152
Hypophosphatasia 178
disorders leading to 181
Hypophosphatemic rickets
clinical manifestations of 181
pathophysiology of 181
treatment of 181
Hypothalamic amenorrhea 121
Hypothalamic pituitary
axis 50b
disorders 99
Hypothyroidism
drugs and agents causing 95b
monitoring of 51
primary 1
subclinical 49
to obesity, relationship of 48
treating subclinical 47
treatment of 49
subclinical 48
Hypovolemia 154
I
Immobilization 145
Inappropriate antidiuretic hormone secretion, syndrome of 152, 156
causes of 156
Incidental adrenal mass, causes of 109
Incidentaloma 109
Infertile male, physical examination in 100
Infertile man, evaluation of 100
Infertility 97
etiology of 98
evaluation 98
Insulin resistance, severe 1
Intracytoplasmic sperm injection 106
Intrapartum glycemic management 174
Intrauterine growth retardation 164
Intrauterine insemination 106
Intrauterine synechiae 120
Intravenous glucocorticoids pulses 62
J
Jansen disease 147
Jod-Basedow effect 94
K
Kidney
disease, chronic 152
injury, acute 152
Klinefelter's syndrome 88, 100, 106
L
Leukocytes 102
Levothyroxine
absorption of 50b
supplementation, less 51
Leydig cell tumors 86
Lithium cause autoimmunity 95
Lithium treatment, starting 96
Lithium-induced hypothyroidism, mechanism of 94
Loperamide test 38
Low serum calcium, cause of 136
L-tyrosine, role of 51
Luteinizing hormone 89, 103
levels of 84
M
Macroadenoma 26
Macroprolactin 27
Macroprolactinoma 29
Macrosomia 163
Macrosomic fetus 163
Male factor infertility
causes of 107
unexplained 99
Male infertility
approach to 97, 103fc
causes of 98, 99b
treatment for 104
Malformations 162
Maternal
complications 166
diabetes complications 166
hypertension 166
Metabolic complications 17
Metyrapone 20
Microadenoma 25
Microprolactinoma, treatment of 24
Milk alkali syndrome 146
Minoxidil therapy 1
Miscarriages 162
Mitotane 20
Multinodular goiter 72
Multiple endocrine neoplasia 69
Multiple neuroma syndrome 1
Musculoskeletal manifestations 17
N
Nephrocalcinosis 148
Nephrolithiasis, causes of 148
Neuropsychiatric changes 17
Nonseptic shock 78
Nonsteroidal anti-inflammatory drug 152
Nonthyroidal illness syndrome 75, 76, 79
O
Obesity 36
Obstructive azoospermia, evaluate 103
Ophthalmopathy 64
mild 64
moderate-to-severe 62, 64
smoking to 64
Oral glucose tolerance test 5, 168
Oral steroids 62
Oral therapy 172
glyburide 172
metformin 172
Orbital radiotherapy in ophthalmopathy, role of 62
Ovarian insufficiency, primary 120, 121
Overnight dexamethasone suppression test 14
P
Pachydermoperiositis syndrome 1
Parathyroid hormone resistance 131
Pasireotide, status of 6
Pegvisomant 7
Peptide hormones 159
Percutaneous transluminal coronary angioplasty 91
Perinatal complications 164
birth trauma 164
Periodic fetal biophysical testing 173
Peripartum injury, risk of 163
Perrault syndrome 123
Petrosal sinus sampling, bilateral inferior 16
Peutz-Jeghers syndrome 87
Phenotypic female 126
Phenytoin therapy 1
Pheochromocytoma 111, 114
clinically silent 115
Phosphorus
deficiency 178
levels in children, normal 181
Pigmented nodular adrenal hyperplasia, primary 15
Pituitary
gigantism 10
postoperative 6
tumor 5
grading of 4
Placental steroid 159
Plasma osmolality 153
Polycystic ovary syndrome 13, 15, 121
Polycythemia 165
Pre-existing diabetes mellitus 162
Pregnancy, MRI in 9
Premature ovarian failure 123, 124
etiology of 123
infertile 123
Prenatal obstetric management 173
Primigravida 60
Progesterone 159
Prolactin, discrepancy in 27
Prolactinomas, management of 24
Propylthiouracil 55
Pseudo-Cushing's
state, diagnosing 36
syndrome 14, 15, 35
causes of 36
pathogenesis of 36
treatment of 38
Pseudogynecomastia 85
Pseudohyponatremia 154fc
Pseudohypoparathyroidism 130
types of 130
Puberty delayed 41
R
Radioactive iodine uptake 54
Radioiodine
ablation 58
adverse effects of 58
candidate for 57
administration of 57
dose of 58
scan, contraindication for 55
Radiotherapy
options of 7
type of 7
Renal disease 78
Renal rickets
management in 182
pathophysiology in 182
Renal tubular
acidification, disorders of 181
acidosis 181
management of 182
Respiratory
distress syndrome 165
failure 78
Rickets
etiology of 178
features of 178
S
Salivary cortisol, midnight 37
Scrotal ultrasound 104
Selenium, role of 51
Semen
analysis 101
tests, specialized 102
volume 101
Sertoli cell tumors 87
Serum
alkaline phosphatase 149
androgen, decreased 86
calcium 135
after radioiodine ablation 137
in sick patients 134
levels, interpretation of 134
total 133
cortisol, midnight 37
estrogens, increased 86
sodium concentration 153
testosterone 104
Sex hormone binding globulin 84
Sick euthyroid syndrome 75
pathogenesis of 77
pathophysiology of 77
Sight-threatening ophthalmopathy 62
Sleep apnea, assessment of 4
Sodium iodine symporter 54
Somatomammotropin, chronic 159
Sperm
concentration 102
morphology 102
transport, disorders of 99
Starvation 78
Steroids, tapering schedule of 34t
Subclinical hypothyroidism
adverse effects of 47
approach to 47
T
Thiazides 145
Thyroid
disorder, drug-induced 91
dysfunction 93
cause of 94
gland 95
effect on 92
hormone 76
during illness, changes in 76
level of 77, 80
nodule 68, 72
approach to 66
biopsy of 68
causes of 67
classification of 67
diagnosis of malignant 72
predominance of 70
types of 66, 70
peroxidase antibody, positive 48
problem, history of 75
scintigraphy, role of 73
status affect ophthalmopathy 64
stimulating hormone 53, 93
test 47
ultrasound, perform 71
Thyroiditis 55
subacute 54
Thyrotoxicosis 53
approach to 53
causes of 53, 96
etiology of 54
management of 55
mechanism of 96
patient with 55
Thyrotropin releasing hormone 3
Toxic
hepatitis 56
multinodular goiters 54
Trousseau's sign 129, 134
Tumor, nonfunctioning 28
Turner's syndrome 43, 120
U
Urinary
calcium creatinine ratio 179
free cortisol 13, 14
Urine luteinizing hormone 106
V
Vaginal delivery
difficult 164
normal 83
Valsalva maneuver 101
Varicocele 101
Vitamin A intoxication 145
Vitamin D
deficiency 51, 131
in children, treat 179
nutritional 179
disorders 178
in bone metabolism, role of 142
intoxication 144
levels, normal 179
related disorders 130
treatment with 180
W
William's syndrome 145
×
Chapter Notes

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CLINICAL CASES IN ENDOCRINOLOGY
CLINICAL CASES IN ENDOCRINOLOGY
Editors Pramila Kalra MD DM (Endocrinology) MNAMS FACE (USA) Professor Department of Endocrinology and Metabolism Ramaiah Medical College Bengaluru, Karnataka, India Foreword Prasanna Kumar KM
Jaypee Brothers Medical Publishers (P) Ltd
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© 2019, Jaypee Brothers Medical Publishers
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Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Clinical Cases in Endocrinology
First Edition: 2019
9789352705894
Printed at
My parents for their support throughout my career
To my teachers who made me capable of reaching this level
To my husband and my daughter for their constant moral support
To my brother for his moral support
To my patients and individuals who have endocrine problems in
the hope that this book will help to alleviate their sufferings by
spreading some knowledge in the field
Contributors Foreword
The book Clinical Cases in Endocrinology edited by Professor Pramila Kalra is a laudable initiative. The book has a clinical approach which makes it very easy for practicing clinicians to understand and appreciate the intricacies of diagnosis and management of complex endocrine diseases. A unique feature of the book is that, the authors across the country, who are young, enthusiastic and have an evidence-based approach to endocrinology. The approach and investigation and discussion of the cases are highly relevant to our country taking into view the infrastructure and the accessibility for these investigations. The frequently ask questions (FAQs) in each case is pragmatic and simple.
Overall the Clinical Cases in Endocrinology is a fresh and scientific approach to endocrine cases as endocrinology should be practiced. The book will be of great help to postgraduates and medical students interested in endocrinology to learn the skills of management of endocrine cases. I hope physicians will make use of the knowledge and experience imbibed in this book by the authors, to improve their skills in the management of endocrine cases in future.
Prasanna Kumar KM
Former Senior Professor and Head
Department of Endocrinology
Diabetes and Metabolism
Ramaiah Medical College
Former President
Endocrine Society of India (ESI) and
Research Society of Study of Diabetes in India (RSSDI)
Preface
The thought of the book came into my mind about a year back. The typical problem which Endocrinology trainees and broader specialty residents face in India is that they do not have a book in Endocrinology which discusses clinical cases in the real world in a very simple fashion so I thought a case-based approach written in a very straightforward manner would benefit the readers.
The book has been coauthored by many leading Endocrinologists in the field. The book has been written with the daily clinical Endocrinology problems in mind and how the thought process should go further in evaluating these cases.
I have tried to cover most of the important topics in the field of Endocrinology. I hope the book will help residents and upcoming Endocrinology trainees.
Pramila Kalra