Handbook of Endocrine Protocols Simon Rajaratnam, Anulekha Mary John
INDEX
A
Acarbose 46, 66
Acetazolamide 57
Acidosis, metabolic 52
Acromegaly 9, 15
Adrenal gland 6, 25
Adrenal hyperplasia, congenital 18, 26
Adrenal insufficiency 36, 41
primary 26
secondary 26
Adrenaline 72
Adrenocorticotropic hormone, assessment of 11
Adrogue formula 32
Aldosterone receptor blockers 49
Alendronate 70
Alpha glucosidase inhibitors 46
Amiloride 64
Amitriptyline 70
Amlodipine 64
Anastrazole 67
Androgen excess 7
Angiotensin converting enzyme inhibitors 51
Anion gap 57
metabolic acidosis 57
Anterior pituitary function, assessment of 11
Antibody titers 45
Anticoagulation 43
Anticonvulsants 51
Antidepressants 51
Anxiety 42
Arrhythmias 42
cardiac 27
Arteritis, temporal 43
Atenolol 64
Atropine 72
B
Basal bolus insulin 48
Basal energy expenditure 57
Basal metabolic rate 57
Bethesda system 61
Bicarbonate 52, 53, 58
fractional excretion of 59
Biguanides 46
Bijovet index 59
Biopsy proven malignancy 60
Bisoprolol 64
Blood
glucose 52
pressure 46, 52
sugar 45, 52
Body mass index 56
Body surface area 56
Bone profile 1, 40
Bradycardia 39
Broad spectrum antibiotic cover 39
Burch-Wartofsky score 37
C
Cabergoline 43
Calcitonin 70
Calcitriol 70
Calcium 70
correction 58
infusion test 23
interpretation 24
preparation 23
procedures 23
Canagliflozin 46, 66
Candesartan 64
Carbamazepine 63
Carbimazole 38
Carcinoid tumors 28
Cardiovascular dysfunction 37
Caruncle, inflammation of 62
Carvedilol 64
Cavernous sinus thrombosis 43
Central nervous system disturbance 38
Central venous pressure 53
Cerebral edema
signs of 53
treatment of 54
Cerebrovascular
accidents 42
seizures 42
Charcot's arthropathy 50
Chemosis 62
Chemotherapy 41
Chromogranin A 28
Chronic kidney disease, classification of 49
Cilnidipine 64
Cinacalcet 70
Clinical biochemistry, reference ranges 1
Clomiphene 67
Clonidine 64
dose 14
test 14
indication 14
interpretation 14
precaution 14
procedures 14
Common calculations and scoring systems 56
Conjunctival redness 62
Corticosteroids 47
Cortisol day curve 21
indication 21
interpretation 21
preparation 21
procedure 21
Creatinine 40, 43
CRH stimulation test 19
indication 19
procedures 19
Cushing's disease 9, 17, 20, 21
Cushing's syndrome 17, 19
D
Dapagliflozin 46, 66
Deflazacort 68
Dehydration 23
Denosumab 70
Desmopressin 68
test 20, 22
indication 20
interpretation 21
procedures 21
DEXA-CRH test 19
indication 19
interpretations 19
procedures 19
Dexamethasone 68, 69
Diabetes
duration of 50
insipidus 10, 43
mellitus 5, 45
gestational 47, 51
protocols 45
secondary 47
type 1 47
type 2 47
Diabetic cardiovascular disease, management of 48
Diabetic foot 50
Diabetic kidney disease, management of 49
Diarrhea 38, 57
Diazoxide 71
Dihydrotestosterone 28
Diltiazem 64
Dipeptidyl peptidase IV inhibitors 46
Dobutamine 72
Dopamine 72
Drugs 6372
Dulaglutide 67
Duloxetine 51
Dyslipidemia 48, 50
E
Edema
pedal 38
pulmonary 38, 42
Empagliflozin 46, 67
Enalapril 65
Encephalopathy, hypertensive 43
Endocrine
disorders, evaluation of 4
emergencies 37
test protocols 11
Enoxaparin 71
Epilepsy 11
Eplerenone 65
Estradiol 15
Ethylene glycol 57
Exenetide 67
Eyelid
erythema 62
swelling 62
F
Fasting glucose 45
Fludrocortisone 68
Follicle-stimulating hormone 15
Fondaparinux 71
Forty eight or seventy two hour fast 24
indications 24
interpretations 25
preparation 24
procedures 24
Furosemide 65
G
Gabapentin 51, 63
Gastrointestinal dysfunction 38
Gaze evoked orbital pain 61
Glibenclamide 46, 67
Gliclazide 46, 67
Glimiperide 46, 67
Glipizide 46, 67
Glucagon dose 13
Glucagon test 13
contraindications 13
indications 13
procedures 13
Glucocorticoid excess 6
Glucose 58
Glyburide 51
Glycemic criteria 46
Glyceryl trinitrate 72
Gonadal function 15
Gonadotroph adenomas 10
Gonadotropin releasing hormone
analog dose 15
therapy 43
Gonadotropin releasing hormone analog test 15
indications 15
interpretations 15
procedures 15
Goserelin 68
Graves’ ophthalmopathy 61
Growth hormone 16, 60
reserve, assessment of 11
status after surgery, assessment of 16
H
Head injury 43
Headache 42
Heart
disease, ischemic 11
failure, congestive 38
Hemorrhage
cerebral 43
subarachnoid 43
Heparin 71
High-dose dexamethasone suppression test 19
contraindications 19
interpretations 20
procedures 20
Hormone 67
assays 2
replacement therapy 17
Hounsfield units 60
Human chorionic gonadotropin 68
stimulation test 27
indications 27
interpretations 28
procedures 28
Hungry bone syndrome 41
Hydralazine 65
Hydrochlorothiazide 65
Hydrocortisone 39, 69
replacement 36
Hydroxylase deficiency, partial 18
Hyperaldosteronism 27, 60
Hypercalcemia 35, 40
classification 35
treatment 35
Hypercortisolemic state, establishing 17
Hyperglycemia 48
sodium correction for 58
symptoms of 45
Hyperkalemia 33
classification 33
treatment 33
Hypernatremia 32
calculation 32
classification 32, 33
treatment 33
Hyperosmolar hyperglycemic state 47, 54
Hyperphosphatemia 41
Hypertension 48, 50
uncontrolled 27
Hypertensive crises, treatment of 42
Hypocalcemia 34, 41
classification 34
mild 34
severe 34
Hypoglycemia 39, 52
classification of 46
correction of 39
Hypokalemia 33, 35
classification 33
mild to moderate 33
severe 27
treatment 33
Hypomagnesemia 35, 41
grading 35
treatment 35
Hyponatremia 31, 39
asymptomatic 32
calculation 31
classification 31
postoperative 10
severe 39
treatment 32
Hypoparathyroidism 41
Hypopituitarism 11
Hypotension 39
treatment of 39
Hypothermia 39
Hypothyroidism, severe 11, 13
Hypoventilation 39
I
Ibandronate 70
Impaired fasting glucose 45
Impaired glucose tolerance 45
Infection 37
Inferior petrosal sinus sampling 20
indication 20
interpretations 20
procedures 20
Insulin 58
classification of 47
infusion 55
tolerance test 11, 13
contraindications 11
indications 11
Insulinoma 13
Intravenous fluids, sodium content of 32
Irbesartan 65
Isoniazid 57
J
Jaundice 38
K
Ketoacidosis
alcoholic 57
diabetic 37, 47, 52, 57
L
Labetalol 65
Lactic acidosis 57
Lamotrigine 63
Laser photocoagulation 50
Letrozole 69
Leuprorelin 69
Levetiracetam 63
Linagliptin 46, 67
Liraglutide 67
Lisinopril 65
Liver
disease, chronic 13
function tests 1
Lixisenatide 67
Losartan 65
Low-dose dexamethasone suppression test 18
contraindications 18
indications 18
interpretations 18
procedures 18
Luteinizing hormone 15
M
Magnesium sulfate 42
Mean arterial pressure 56
Mean growth hormone 16
Medullary thyroid carcinoma 23
Meglitinides 46
Meningitis 43
Metformin 46, 47, 51, 67
Methanol 57
Methylcobalamin 71
Methyldopa 65
Methyl-prednisolone 69
Metoprolol 65
Microalbuminuria 4850
Monotherapy 46
Mosteller formula 56
Myxedema coma 39
N
Nateglinide 46, 67
Nausea 38, 42
Nebivolol 65
Nephropathy 49
Neuropathy
diabetic peripheral 51
severe 47
Nifedipine 65
Night-time salivary cortisol 17
Non-anion gap acidosis 57
Noradrenaline 72
O
Obesity, central 57
Octreotide lar 69
Olmesartan 66
Ophthalmoplegia 42
Opiate analgesics 51
Oral antidiabetic drugs 46
Oral glucose tolerance test 15, 16, 51
for assessment of diabetic status 24
interpretation 24
preparations 24
procedure 24
indication 15
interpretation 16
precaution 15
procedures 15
Oral iodine 39
Orbital pain, spontaneous 61
Osteopenia 60
Osteoporosis 60
classification of 60
severe 60
Ovary 8
Overnight dexamethasone suppression test 17
contraindications 17
interpretation 18
procedures 18
indication 17, 18
Oxcarbazepine 63
P
Pain 38
Pamidronate 70
Pancreas 5, 24
Pancreatic neuroendocrine tumors 28
Pancreatitis 41, 47
Paraldehyde 57
Parathyroid 5
hormone 40
Paresthesia 41
Peak postprandial capillary plasma glucose 45
Peptide analogs, glucagon-like 47
Phenobarbitone 63
Phenoxybenzamine 66
Phenytoin 63
Pheochromocytoma 7, 13, 42
Phosphate 53
renal tubular reabsorption of 59
Pioglitazone 46, 67
Pitressin 69
Pituitary apoplexy 42
Plasma
creatinine 59
sodium 59
Polycystic ovary syndrome 18, 58
Poor glycemic control 50
Potassium, fractional excretion of 59
Pramlintide 67
Prazosin 66
Prediabetes 45
Prednisolone 69
Pregabalin 51, 64
Pregnancy, toxemia of 37
Preprandial capillary plasma glucose 45
Prolactinomas 9
Propranolol 66
Propylthiouracil 38
Proteinuria 50
Pseudo-Cushing's syndrome 19
Puberty
central precocious 15
disorders of 15
peripheral precocious 15
R
Radioiodine therapy 37
Ramipril 66
Random plasma glucose 45
Rapid-acting insulin 47
Renal tubular acidosis 57
Repaglinide 46
Retinopathy
diabetic 50
progressive 47
S
Salbutamol 71
Salicylates 57
Saline infusion test 27
contraindications 27
indication 27
interpretations 27
preparations 27
procedures 27
Saxagliptin 46, 67
Seizures 41
Serum electrolytes 40, 43
creatinine 41
Short synacthen test 25
indications 25
interpretations 26
preparations 25
procedures 26
Sildenafil 71
Sitagliptin 46, 67
Sliding scale 55
Small fiber function 51
Sodium
bicarbonate 72
fractional excretion of 59
glucose cotransporter 2 46
nitroprusside 66
infusion 42
total body deficit of 31
valproate 64
Spironolactone 57, 66
Stress situations 47
Sulfonylurea 46, 47
Sweating 42
T
Tachycardia 37
Tadalafil 71
Tamoxifen 69
Telmisartan 66
Teneligliptin 67
Teriparatide 70
Testis 8, 27
Testosterone 15, 28, 69
Tetany 41
Thermoregulatory dysfunction 37
Thiamine 71
Thiazolidinedione 46, 47
Third nerve palsy, diabetic 43
Thyroid 4
cytopathology 61
gland, normal 60
image reporting and data system 60
malignancy 4
profile 38
storm 37
Thyroxine 39
Topiramate 64
Torsemide 66
Total parenteral nutrition 48
Trauma 37
Triglycerides 46
Triple therapy 47
Tube feeds 48
Twenty-four hour urinary free cortisol 17
U
Uremia 57
Ureteropelvic shunt 57
Urine
creatinine 59
osmolality 43
sodium 59
V
Valsartan 66
Vasopressin 72
Venlafaxine 51
Verapamil 66
Vertigo 42
Vildagliptin 46, 67
Visual acuity 42
Vitamin D 40, 70
deficiency 41
Voglibose 46, 67
Vomiting 38, 42
W
Waist
circumference 57
hip ratio 57
Water deprivation test 21, 22
interpretation 23
preparations 21
procedure 22
Z
Zinc transporter 8 islet antibody 45
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Handbook of Endocrine Protocols
Handbook of Endocrine Protocols
Second Edition
Simon Rajaratnam MBBS MD DNB (Endo) MNAMS FRACP (Endo) PhD (Endo) FRCP (Edin) Head Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore, Tamil Nadu, India Anulekha Mary John MBBS MD Fellowship (Endo) Endocrinologist and Associate Professor Believers Church Medical College Hospital Thiruvalla, Kerala, India Foreword Nihal Thomas
Jaypee Brothers Medical Publishers (P) Ltd.
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© 2019, Jaypee Brothers Medical Publishers
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
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Handbook of Endocrine Protocols
First Edition: 2015
Second Edition: 2019
9789352706983
Printed at
Our Alma mater
Christian Medical College, Vellore
Tamil Nadu, India
Foreword
The beginning of any good book is like the source of a river on top of a mountain. The view from there is magnificent, the water is clean and a cool-breeze kisses your skin as you gaze at the swirling ripples cascade down into the valley.
Akin to this allegory, is the opportunity that I have had when reviewing the contents of this book.
Just as a few thousand readers have had the chance to gain knowledge from this little mini-encyclopedia on endocrinology through the first edition; so may many thousands more refresh themselves in their few precious moments that follow the many hours of toil and work in their busy days as clinicians, thereby enabling them to fill in the missing links and gaps in their knowledge.
Having an approach and algorithm to medical disorders and diseases is extremely important to help in the development of a robust differential diagnosis and an accurate therapeutic plan.
With the increasing diversity of clinical endocrinology being supported by a rapidly growing armamentarium of diagnostic tests, the tendency for an experienced clinician is to assume that what has been known and is time tested is a foregone conclusion of being precise. However, knowledge needs updation to supplement experience-based wisdom.
Similarly, therapeutic agents have also undergone a certain degree of advancement and evolution. Their availability may vary from continent to continent. Taking this into account, the authors have spent many months in trying to modify chapters to suit the needs of the practicing physician in South Asia.
The wonder that one experiences when practicing clinical endocrinology is like that of a child taking a tour in a zoological park. This book only helps enhance our starry-eyed gazed of this beautiful science.
All-in-all Drs Simon Rajaratnam and Anulekha Mary John have burnt the midnight oil in manufacturing a top class product.
As our finger tips caress the margins of the pages, I am certain that pages will turn brown, through use and reuse, and like any book which stands the test of time as a classic, the binding may loosen as an indicator of excellence.
Once again I wish one and all: “Bonne Lecture!”
Nihal Thomas
MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin)
FRCP (Glas) FRCP (London) PhD (Copenhagen)
Professor and Head, Unit-1
Department of Endocrinology, Diabetes and Metabolism
Associate Director
Christian Medical College
Vellore, Tamil Nadu, India
Preface to the Second Edition
What I love about Medicine is that it keeps constantly changing as new discoveries are made. To keep up-to-date with current literature we have had to revise and come up a new edition of this booklet. We have strived to keep it simple and user friendly. We have introduced a new tabular format for the testing protocols. Most of the diagnostic tests can be easily completed as a day-care. All the reference ranges mentioned in this booklet are taken from the Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India. These treatment protocols are for adult patients and they should never be extrapolated for the pediatric age group.
Simon Rajaratnam
Preface to the First Edition
From my experience both as a student and as a teacher I felt the need for a small handbook which will serve as a ready reckoner for those working in the field of Endocrinology. With this in mind I tried to simplify details and present information in a simple format.
The Biochemistry reference ranges mentioned in this book are taken from the Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India. The section on Endocrine Test Protocols is specifically written as to enable these tests being performed as Day Care, with all the patients coming in by 8 AM. The treatment protocols in this book are meant only for adult patients and these should not be extrapolated for pediatric patients.
I am grateful to my teacher Dr MS Seshadri who nurtured my career in Endocrinology. I would also like to acknowledge the contribution of my coauthor Dr Anulekha Mary John who has been my student. This knowledge continues to be passed on from one generation to another.
Simon Rajaratnam
Acknowledgments
A great teacher inspires his students and I am fortunate to have had Dr MS Seshadri as my mentor and my guide. I am also fortunate to have my former student Dr Anulekha Mary John as my co-author. We are all grateful to our Alma mater The Christian Medical College, Vellore, Tamil Nadu, India, for molding and making us what we are today.
I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and the staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India.