A Case-Based Guide to Clinical Endocrinology (eBook)

Terry F. Davies (Herausgeber)

eBook Download: PDF

2008 | 2008
XXII, 504 Seiten
Humana Press (Verlag)
978-1-60327-103-5 (ISBN)

Infos

In this thought-provoking book, distinguished clinicians provide stimulating instruction and insights into a wide variety of endocrine subjects, teaching readers modern management of the conditions described and offering targeted entry into the literature. The text reflects much of the curriculum for clinical endocrine training recommended by the Association of Program Directors in Clinical Endocrinology. Concise cases are followed by multiple choice questions to enhance learning.

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In December 2005 I changed my mind [1]. Up until that time I had put my name on one case history in 400 publications [2]. I changed my mind and realized that reading case histories could be a good learning exercise. I had previously considered useful case histories to be essentially live case demonstrations. Indeed, I had persuaded years of endocrine clinical fellows that writing case histories was not something to be encouraged. But the cheese moved. Livecase historypresentationsbecametoo complexforeasy digestibility. Themany investigations and vast literature review required more contemplation than a live presentation had required in the past. And writing these exercises as a formal case history allowed the complex literature to be better understood. Furthermore, as our evidencebase hasgrown,theidiosyncraticapproachso commoninlivecase dem- strations of the past has become totally unacceptable. The written or prepared case has become the ideal forum for demonstrating how to manage a medical case to the greatest bene?t of the patient. Indeed, written case histories are clearly the very best means of showing medical care guidelines in real practiceandofrevealingtheiradvantagesanddisadvantages[3]. Thatdoesnotmean we should no longer give live case demonstrations. Demonstrating a supportive and knowledgeable patient can be a magni?cent teaching tool. For many years I have presentedendocrinologycasesto our?rst-yearmedicalstudents,andformanyyears these physicians later told me how much they enjoyed them and that they remember them well. So clearly, both formats of delivery remain effective.

Inhalt

Preface 6
References 7
Contents 8
Contributors 16
Part I The Pituitary Gland 24
Introduction 25
Physiology 25
Disorders of the Pituitary Gland 26
Other Etiologies of Sellar Masses 27
Hypopituitarism 28
Suggested Readings 29
Pituitary Apoplexy 31
Objectives 31
Case Presentation 31
How the DiagnosisWas Made 34
Lessons Learned 34
References 38
Multiple-Choice Questions 38
When and How to Stop Cabergoline Treatment in Microprolactinomas 41
Case Presentation 42
Lessons Learned 44
Conclusion 46
References 46
Questions 47
Cushing’s Disease 49
Objectives 49
Case Presentation 49
How the DiagnosisWas Made 51
Lessons Learned 54
Suggested Readings 54
Multiple-Choice Questions 55
Part II Thyroid Overactivity 57
Introduction 59
Amiodarone-Induced Hyperthyroidism 63
Objectives 63
Case Presentation 63
Background 64
Amiodarone-Induced Thyrotoxicosis 65
Type 2 66
Diagnosis 66
Treatment 66
How the DiagnosisWas Made 67
Lessons Learned 67
References 68
Multiple-Choice Questions 69
Interferon-Induced Hyperthyroidism 71
Objectives 71
Case Presentation 71
Background 72
How the DiagnosisWas Made 77
Lessons Learned 78
References 79
Multiple-Choice Questions 80
Subclinical Hyperthyroidism Due to a Multinodular Thyroid 83
Objectives 83
Case Presentation 83
Background 84
How the DiagnosisWas Made 85
Lessons Learned 86
References 86
Multiple-Choice Questions 87
Subacute (De Quervain’s) Thyroiditis 89
Objectives 89
Case Presentation 89
Background 90
How the DiagnosisWas Made 91
Lessons Learned 92
References 92
Multiple-Choice Questions 93
Part III Thyroid Underactivity 95
Introduction 97
Physiology 97
Pathophysiology 97
Treatment 98
References 98
Amiodarone-Induced Hypothyroidism 99
Objectives 99
Case Presentation 99
How the DiagnosisWas Made 100
Lessons Learned 101
References 104
Questions 104
Autoimmune Hypothyroidism with Persistent Elevation of TSH 107
Objectives 107
Case Presentation 107
How the DiagnosisWas Made 109
Lessons Learned 112
References 112
Questions 112
Hashimoto’s Thyroiditis and Type 1 Diabetes 115
Objectives 115
Case Presentation 115
How the DiagnosisWas Made 116
Lessons Learned 117
References 120
Questions 120
Part IV Thyroid Cancer 123
Introduction 124
References 128
Papillary Thyroid Cancer 131
Objectives 131
Case Presentation 131
Risk Factors for Thyroid Cancer 132
Well-Differentiated Thyroid Cancer 132
Risk Factors in Thyroid Cancer for Recurrence and Mortality 133
Surgical Recommendations for Thyroid Cancer 133
Remnant Ablation for Thyroid Cancer 134
Hormone Suppressive Therapy in Thyroid Cancer 136
Long-Term Follow-up and Surveillance for Thyroid Cancer 137
References 138
Multiple-Choice Questions 140
Metastatic Papillary Thyroid Cancer 143
Objectives 143
Case Presentation 143
How the DiagnosisWas Made 144
Lessons Learned 144
References 146
Multiple-Choice Questions (3–5) 146
Medullary Thyroid Cancer 149
Objectives 149
Case Presentation 149
Overview of Medullary Thyroid Cancer 150
How the DiagnosisWas Made 152
Lessons Learned 153
ret 153
References 158
Multiple-Choice Questions 158
Follicular Thyroid Carcinoma with Pulmonary and Osseous Metastases 161
Objectives 161
Case Presentation 161
Lessons Learned 164
Our Approach 171
References 172
Multiple-Choice Questions 173
Part V Adrenal 175
Adrenal Insufficiency 177
Objectives 177
Case Presentation 177
How the DiagnosisWas Made 178
Lessons Learned 178
Cushing’s Syndrome 181
Objective 181
Case Presentation 181
How the DiagnosisWas Made? 182
Lessons Learned 182
An Incidentally Discovered Adrenal Mass 185
Objective 185
Case Presentation 185
How the DiagnosisWas Made? 186
Lessons Learned 186
Part VI Hyperparathyroidism 189
Introduction 191
Pathophysiology of Hyperparathyroidism 192
Clinical Features of Primary Hyperparathyroidism 193
Differential Diagnosis and Investigation 194
Management of Acute Hypercalcemia (see Case 19) 196
Management of Primary Hyperparathyroidism 196
References 198
Differentiation of Primary Hyperparathyroidism for Familial Benign Hypocalciuric Hypercalcemia 201
Case Presentation 201
How the DiagnosisWas Made 202
Diagnosis 202
Lessons Learned 203
Suggested Readings 203
Multiple-Choice Questions 203
Management and Investigation of Acute Hypercalcemia 205
Case Presentation 205
Diagnosis 206
How the DiagnosisWas Made 206
Lessons Learned 207
Suggested Readings 207
Questions 207
Evaluation of Complex Primary Hyperparathyroidism 209
Case Presentation 209
How the DiagnosisWas Made 210
Lessons Learned 211
References 211
Suggested Readings 211
Multiple-Choice Questions 211
Evaluation of Hypercalcemia in Infancy 213
Case Presentation 213
How the DiagnosisWas Made 214
Lessons Learned 214
Suggested Readings 215
Multiple-Choice Questions 215
Part VII Metabolic Bone Diseases 217
Introduction 219
References 223
Osteoporosis Due to Hormonal Withdrawal: Common Mistakes 225
Objectives 225
Case Presentation 225
How the DiagnosisWas Made 227
Lessons Learned 228
References 229
Questions 229
Osteomalacia: A Cause of Bisphosphonate Failure 231
Objectives 231
Case Presentation 231
How the DiagnosisWas Made 232
Lessons Learned 233
References 235
Questions 235
Unusual Manifestations of Paget’s Disease of Bone 237
Objectives 237
Case Presentation 237
How the DiagnosisWas Made 238
Lessons Learned 240
Suggested Readings 243
Questions 243
Solid Organ Transplantation, Chronic Renal Impairment, and Skeletal Complications 245
Objectives 245
Case Presentation 245
How the DiagnosisWas Made 246
Lessons Learned 248
References 249
Questions 250
Part VIII Endocrine Disorders of Males 251
Introduction 253
Congenital Isolated Hypogonadotropic Hypogonadism 255
Objectives 255
Case Presentation 255
How the DiagnosisWas Made 256
Lessons Learned 256
References 260
Multiple-Choice Questions 261
Klinefelter Syndrome 263
Objectives 263
Case Presentation 263
How the DiagnosisWas Made 264
Lessons Learned 265
Treatment 270
References 271
Multiple-Choice Questions 272
Low Testosterone in Obesity and Type 2 Diabetes 275
Objectives 275
Case Presentation 275
How the DiagnosisWas Made 276
Lessons Learned 276
Suggested Readings 280
Multiple-Choice Questions 280
Part IX Female Reproduction 283
Introduction 285
Physiology of the Reproductive System 285
Menstrual Dysfunction 287
Diagnostic Approach to Menstrual Cycle Disorders 291
Suggested Readings 292
Central Hypogonadism 295
Objective 295
Case Presentation 295
How the DiagnosisWas Made 297
Lessons Learned 298
Multiple-Choice Questions 298
Premature Ovarian Failure 301
Objective 301
Case Presentation 301
How the DiagnosisWas Made 302
Lessons Learned 304
Multiple-Choice Questions 305
Oligomenorrhea and Hyperandrogenemia 307
Objective 307
Case Presentation 307
How the DiagnosisWas Made 309
Lessons Learned 312
Multiple-Choice Questions 312
Part X Pregnancy 315
Introduction 317
References 319
Hypertension in Pregnancy and Women with Child- Bearing Potential 321
Objectives 321
Case Presentation 321
Background 321
Lessons Learned 325
References 326
Hashimoto’s Hypothyroidism During Pregnancy 327
Objectives 327
Case Presentation 327
Normal Thyroid Physiology During Pregnancy 328
LT4 Dosage Requirements During Pregnancy 329
Maternal and Fetal Complications of Inadequate Maternal LT4 Therapy 329
Lessons Learned 330
References 330
Type I Diabetes Mellitus During Pregnancy 331
Objectives 331
Case Presentation 331
Physiology of Type 1 Diabetes Mellitus During Pregnancy 333
Lessons Learned 336
References 336
Questions 336
Part XI Type 1 Diabetes 341
Introduction 343
Epidemiology 343
Genetic Etiology 343
Etiologic Factors 345
Pathogenesis 346
Diagnostic Criteria 346
Classification of Diabetes 347
Future Directions 347
References 348
Type 1 Diabetes Onset with Ketoacidosis and Suspected Cerebral Edema 349
Case Presentation 350
How the DiagnosisWas Made 350
Discussion 351
Lesson Learned 352
References 352
En Passant Diagnosis of Type 1 Diabetes in Infancy 353
Objectives 353
Case Presentation 354
How the DiagnosisWas Made 355
Discussion 355
Lesson Learned 356
References 356
Multiple-Choice Questions 356
Type 1 Diabetes and Comorbidity of Addison’s Disease 359
Objectives 359
Case Presentation 360
How the DiagnosisWas Made 360
Discussion 361
Lesson Learned 361
References 361
Multiple-Choice Questions 362
Part XII Type 2 Diabetes 363
Introduction 365
References 366
Exenatide in Type 2 Diabetes: Indications and Initiation 369
Objective 369
Case Presentation 369
How the DiagnosisWas Made 370
Lessons Learned 371
References 373
Multiple-Choice Questions 374
Insulin Therapy in the Management of Diabetes Mellitus Type 2 375
Objective 375
Case Presentation 375
How the DiagnosisWas Made 376
Lessons Learned 376
Suggested Readings 379
Multiple-Choice Questions 379
Treatment of Type 2 Diabetes Mellitus with Oral Agents 381
Objective 381
Case Presentation 381
How the DiagnosisWas Made 382
Lessons Learned 382
References 387
Multiple-Choice Questions 387
Part XIII Lipid Abnormalities 389
Introduction 391
Combination Drug Therapy in a Case of Severe Hypercholesterolemia 393
Objectives 393
Case Presentation 393
How the DiagnosisWas Made 395
Lessons Learned 396
References 399
Multiple-Choice Questions 399
A Young Man with Abdominal Pain and Very High Triglycerides: The Chylomicronemia Syndrome 401
Objective 401
Case Presentation 401
Clinical and Laboratory Characteristics of Chylomicronemia Syndrome 402
Physiology of Triglyceride-Rich Particles 403
Etiology of Chylomicronemia Syndrome 403
Primary (Genetic) Causes of Hypertriglyceridemia 404
Secondary (Acquired) Causes of Hypertriglyceridemia 404
Management of Chylomicronemia Syndrome 405
Suggested Readings 406
Multiple-Choice Questions 406
Roughly Equivalent Lipids in a Middle-Aged Obese Man at Risk for Coronary Disease 409
Objectives 409
Case Presentation 409
How the DiagnosisWas Made 410
Lessons Learned 411
Suggested Readings 412
Multiple-Choice Questions 412
Part XIV Obesity and the Metabolic Syndrome 415
Introduction 417
Epidemic of Obesity 417
Endocrine Control of the Energy Balance System 417
The Present and Future of Obesity Management 418
Suggested Readings 419
Metabolic Syndrome 421
Objectives 421
Case Presentation 421
How the DiagnosisWas Made 422
Lessons Learned 425
References 425
Multiple-Choice Questions 426
Polycystic Ovarian Syndrome 429
Objectives 429
Case Presentation 429
How the DiagnosisWas Made 430
Treatment 432
Long-Term Complications 434
Lessons Learned 434
Suggested Readings 435
Multiple-Choice Questions 435
Bariatric Surgery 439
Objectives 439
Case Presentation 439
How the DiagnosisWas Made 440
Lessons Learned 444
References 444
Multiple-Choice Questions 444
Part XV Puberty 447
Introduction 449
Central Precocious Puberty 450
Delayed Puberty 451
References 453
Suggested Readings 453
Amenorrhea 455
Objectives 455
Case Presentation 455
How the DiagnosisWas Made 456
References 457
Multiple-Choice Questions 457
Early Puberty and Hyperthyroidism 459
Objectives 459
Case Presentation 459
How the DiagnosisWas Made 460
References 462
Multiple-Choice Questions 463
Hypothalamic Hamartoma 467
Objectives 467
Case Presentation 467
Diagnostic Test Results 468
Description 469
Diagnosis 469
Differential Diagnosis 469
How the DiagnosisWas Made 469
Treatment 471
Suggested Readings 471
Multiple-Choice Questions 472
Leydig Cell Adenoma 475
Objective 475
Case Presentation 475
Diagnostic Test Results 476
Diagnosis 477
Differential Diagnosis 477
How the DiagnosisWas Made 477
Suggested Readings 478
Multiple-Choice Questions 478
Prolactinoma 481
Objective 481
Case Presentation 481
Diagnostic Test Results 482
Diagnosis 483
Differential Diagnosis 483
How the DiagnosisWas Made 483
Suggested Readings 485
Multiple-Choice Questions 485
Turner Syndrome 487
Objectives 487
Case Presentation 487
Differential Diagnosis of Primary Amenorrhea 488
The Hypogonadism of Turner Syndrome 489
Suggested Readings 490
Multiple-Choice Questions 490
Part XVI Instructive Rarities 493
Introduction 495
Hypothalamic Damage and Obesity 497
Objectives 497
Case Presentation 497
How the DiagnosisWas Made 499
Lessons Learned 499
References 502
Multiple-Choice Questions 503
Systemic Mastocytosis 505
Objectives 505
Case Presentation 505
How the DiagnosisWas Made 506
Lessons Learned 506
References 507
Multiple-Choice Questions 508
Testosteronoma 511
Objectives 511
Case Presentation 511
How the DiagnosisWas Made 512
Laboratory and Diagnostic Investigations 514
Lessons Learned 517
References 517
Multiple-Choice Questions 517
Index 521

Produkt-Details

• Erscheint lt. Verlag: 6.6.2008
• Reihe/Serie: Contemporary Endocrinology
• Reihe/Serie: Contemporary Endocrinology
• Zusatzinfo: XXII, 504 p.
• Verlagsort: Totowa
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Endokrinologie
• Schlagworte: Case-basaed • Diabetes • Diabetes mellitus • Endocrine disorders • endocrinology • Metabolic Syndrome • Problem-based • Prolactin
• ISBN-10: 1-60327-103-1 / 1603271031
• ISBN-13: 978-1-60327-103-5 / 9781603271035