A Case-Based Guide to Clinical Endocrinology

Preface to the Third Edition
Contents
Contributors
Part I: Pituitary Disorders
Chapter 1: Preface: Pituitary Tumors Are More Frequent Than Previously Thought
Introduction
Updates in the World Health Organization Classification
Timeline for Follow-Up Imaging
Pearls: Screening, Differential Diagnosis, and Localization of Cushing’s Syndrome
Medical Therapy for Functioning Pituitary Adenomas
Conclusion
References
Chapter 2: Pituitary Tumor Behavior and Disease Severity in Patients with Acromegaly
Overview
Case Presentation
Case 1
Case 2
Case 3
How Does the Clinical Presentation of Acromegaly Relate to Tumor Behavior?
Which Mechanisms Determine the Diverse Tumor Aggressiveness and Disease Activity Among These Patients?
Which Are the Pitfalls in the Diagnostic Workup of Acromegaly?
Which Therapeutic Options Are Currently Available for Acromegaly?
How Should Patient Comorbidities Be Screened, Treated, and Followed?
Conclusions
References
Chapter 3: Abrupt Weight Gain, Hypertension, and Severe Hypokalemia in a Young Male
Case Presentation
Does This Patient Have Cushing’s Syndrome?
How to Determine an ACTH Source?
Treatment in Severe Cases with Rapid Clinical Deterioration
Evaluation and Treatment of Complications
Conclusions
References
Chapter 4: Dopamine Agonist-Induced Impulse Control Disorders
Overview
Case Presentation
What Are Impulse Control Disorders and How Common Are They in the General Population?
How Common Are Dopamine Agonist-Related Impulse Control Disorders?
What Is the Mechanism of Dopamine Agonist-Related Impulse Control Disorders?
How Should Dopamine Agonist-Related Impulse Control Disorders Be Managed?
Conclusions
References
Part II: Thyroid Overactivity
Chapter 5: Introduction to Thyroid Overactivity
Introduction
References
Chapter 6: Immunoglobulin G4 and Graves’ Orbitopathy
Case Report
Review of How the Diagnosis Was Made
Lessons Learned
References
Chapter 7: Subclinical Hyperthyroidism: Case Report and Review of the Literature
Case Presentation
Discussion
References
Chapter 8: A Case of Gestational Thyrotoxicosis
Case Presentation
Lessons Learned
References
Part III: Thyroid Underactivity
Chapter 9: Introduction
Causes of Thyroid Underactivity
Diagnosis
Clinical Manifestations
Treatment of Hypothyroidism
References
Chapter 10: Managing Hypothyroidism: Increasing Levothyroxine Requirements
Case
Review of How the Diagnosis Was Made
Lessons Learned
References
Chapter 11: Gastrointestinal Disease and Levothyroxine Absorption
Case
Review of how the Diagnosis Was Made
Lessons Learned
References
Chapter 12: Drug-Induced Central Hypothyroidism
Case
Review of How the Diagnosis Was Made
Lessons Learned
References
Part IV: Thyroid Cancer
Chapter 13: Introduction
References
Chapter 14: Papillary Thyroid Cancer
Case Presentation
Fundamentals of Well-Differentiated Thyroid Cancer
Molecular Genetics of Papillary Thyroid Cancer
Surgical Considerations in Papillary Thyroid Cancer
Utility of Radioactive Iodine Ablation
Hormone Suppressive Therapy and Long-Term Follow-Up
Therapeutic Options in Patients with Iodine Refractory Metastatic Disease
References
Chapter 15: Anaplastic Thyroid Carcinoma
Case Presentation
Introduction
Methods
Pathogenesis
Staging and Evaluation
Treatment and Recent Therapeutic Advances
Surgery
Chemotherapy
External Radiation
Tyrosine Kinase Inhibitors
Recent Advances
Single-Agent Pembrolizumab in Anaplastic Thyroid Carcinoma
Non-conventional Therapies
Conclusion
References
Chapter 16: Medullary Thyroid Carcinoma
Case Presentation
Overview of Medullary Thyroid Carcinoma
Metastatic Medullary Thyroid Carcinoma
How the Diagnosis Was Made
Role of Calcitonin and CEA Monitoring Post-Total Thyroidectomy
Evaluation for Metastatic Disease and Comparison of Imaging Modalities
Approach to Systemic Treatment
References
Part V: Adrenal Disorders
Chapter 17: Introduction
Chapter 18: Adrenal Incidentalomas and Autonomous Cortisol Secretion
Case Description
What Is the Prevalence of Incidentally Identified Adrenal Nodules?
Is the Nodule Malignant?
Is the Nodule Secreting Any Hormones?
What Are the Clinical Sequelae of ACS?
Does Treatment Improve ACS?
How Should This Nodule Be Monitored?
Summary
References
Chapter 19: Pheochromocytoma
How Could the Location of the Patient’s Pheochromocytoma Be Predicted by the Biochemical Profile?
Why Was This Patient Evaluated for Pheochromocytoma? What Is the Danger of Missing the Diagnosis? Who Should Be Screened for the Presence of a Pheochromocytoma?
How Are Patients with Suspected Pheochromocytoma Diagnosed?
What Are the Relative Contributions of Epinephrine Versus Norepinephrine Excess in this Patient’s Signs and Symptoms?
Once Confirmed Biochemically, What Is the Best Tumor Localization Study?
How Should the Patient Be Managed Preoperatively?
What Is the Expected Intraoperative Course? What Precautions Are Required?
What Post-operative Monitoring Is Required for the Patient?
Should This Patient Be Tested for Genetic Syndromes/What Is This Patient’s Risk of Genetic Syndromes?
Can We Predict the Malignant Potential for This Patient?
References
Chapter 20: Ectopic ACTH Syndrome
Case #1: The Presentation and Diagnosis of Ectopic ACTH Syndrome
How Do You Establish the Diagnosis of ACTH-Dependent CS?
How Can the Source of ACTH Secretion Be Determined from the Biochemical Profile?
What Is the Role of Imaging in the Diagnosis of Ectopic ACTH Syndrome?
What Is the Postoperative Management After Removal of the Primary Tumor?
Case #2: The Acute Presentation of Severe Hypercortisolism from Ectopic ACTH Syndrome and the Need for Urgent Medical and Surgical Management
What Are the Clinical Features That Necessitate Urgent Surgical Management in Patients with Ectopic ACTH Syndrome?
What Medications Are Available to Manage Severe Hypercortisolism Preoperatively?
What Are the Perioperative Risks and How Should They Be Addressed? What Are the Considerations in Determining the Type of Surgery?
What Is the Postoperative Management for Patients Who Have Undergone Bilateral Adrenalectomy?
References
Part VI: Primary Hyperparathyroidism
Chapter 21: Primary Hyperparathyroidism
Calcium in the Body
Calcium in Blood
Calcium in the Cell
Calcium in Bone
Regulation of Calcium Homeostasis
Primary Hyperparathyroidism
Clinical Presentation
Evaluation and Diagnosis
Natural Course
Management
Surgical Management
Nonsurgical Management
Monitoring
Medical Treatment
Pregnancy
References
Chapter 22: Cinacalcet Use in Primary Hyperparathyroidism
Case Presentation
Discussion
References
Chapter 23: A Case of Apparently Sporadic Primary Hyperparathyroidism Carrying a Germline Mutation of CDC73 Gene
Case Presentation
Review of How the Diagnosis Was Made
References
Chapter 24: Challenges in the Preoperative Localization of Hyperfunctioning Parathyroid Tissue in a Patient with Primary Hyperparathyroidism
Case Presentation
Discussion
References
Part VII: Metabolic Bone Diseases
Chapter 25: New Insights into Diagnosing Bone Diseases
References
Chapter 26: Type 2 Diabetes and Bone
Case Presentation
Lessons to be Learned
The Risk of Fracture and Pathophysiology of T2D-Related Bone Disease
Evaluation of Diabetes-Related Bone Disease
Treatment of Diabetes-Related Bone Disease
References
Chapter 27: Hypercalcemia and High Bone Mineral Density
Case Presentation
Lessons to Be Learned
Overview and Evaluation of Hypercalcemia
Differential Diagnosis of High Bone Density
References
Chapter 28: Rare Presentation of Severe Pediatric Rickets
Case Presentation
How the Diagnosis Was Made
Diagnosis: Severe rickets Caused by Primary Hyperparathyroidism
Lessons Learned
References
Part VIII: Endocrine Disorders in Men
Chapter 29: Introduction to Endocrine Disorders in Men
Introduction
Chapter 30: Adult Onset Hypogonadism
Case Presentation
Review of How the Diagnosis Was Made
Lessons Learned
Treatment Strategies
Other Effects of Testosterone Treatment
References
Chapter 31: Congenital Hypogonadotropic Hypogonadism
Case Presentation
Review of How the Diagnosis Was Made
Lessons Learned
Neurodevelopmental Genes
CHH Without Developmental Defects
Treatment Strategies
References
Chapter 32: Klinefelter Syndrome
Case Presentation
Review of How the Diagnosis Was Made
Genetics/Etiology
Phenotypic Manifestations
Comorbid Conditions
Treatment Strategies
References
Part IX: Endocrine Disorders in Pregnancy
Chapter 33: Introduction to Endocrine Disorders in Pregnancy
References
Chapter 34: Prolactinoma in Pregnancy
Case Description
Introduction
Physiology: Prolactin and Lactation
The Role of Prolactin in Hypogonadism and Fertility
Counseling Women with Prolactinoma
Management of Prolactinoma in Pregnancy
Breastfeeding for Patients with a Prolactinoma
References
Chapter 35: Adrenal Insufficiency in Pregnancy
Case Presentation
Introduction
Types of Adrenal Insufficiency
Normal Fetoplacental Steroidogenesis
Challenges in Diagnosing Adrenal Insufficiency in Pregnancy
Treatment of Adrenal Insufficiency in Pregnancy
References
Chapter 36: Pheochromocytoma in Pregnancy
Case Description
Introduction
Physiology and Pathophysiology of Catecholamines in Pregnancy
Diagnosis of Pheochromocytoma in Pregnancy
Clinical Presentation: Signs and Symptoms
Differential Diagnosis
Biochemical Studies
Imaging Studies
Genetic Screening
Treatment
Preoperative Medical Management
Management of Hypertensive Crisis
Surgery
Timing of Surgical Intervention
Surgical Approach
Postsurgical Acute Catecholamine Deficiency
Evaluating the Appropriate Timing and Route of Delivery
Follow-Up
Effects of Preoperative Medication on Neonates During Lactation
References
Chapter 37: Diagnosis and Management of Thyroid Cancer in Pregnant Women
Case Presentation
Thyroid Nodules and Thyroid Cancer in Pregnant Women
Workup of Thyroid Nodules in Pregnant Women
Management of Thyroid Cancer in Pregnancy
Postpartum Considerations
Management Considerations in Pregnant Thyroid Cancer Survivors
References
Part X: Type 2 Diabetes Mellitus
Chapter 38: Introduction to Type 2 Diabetes Mellitus
References
Chapter 39: Initial Diagnosis and Management of Type 2 Diabetes Mellitus
Case Description
Who Should Be Screened for T2DM?
How Is T2DM Diagnosed?
What Are the Evidence-Based Optimal Glycemic and HbA1c Targets for T2DM?
What Is the Time in Range (TIR)?
What Is the Utility of Continuous Glucose Monitoring in T2DM?
What Are the Benefits of Weight Loss in T2DM?
Micro- and Macrovascular Complications of T2DM
How Can Microvascular Complications Be Prevented and Managed?
Nephropathy
Retinopathy
Peripheral Neuropathy
How Should CVD Risk Factors Be Managed in T2DM?
Hypertension
Hyperlipidemia
Aspirin Use
How Was Our Patient Diagnosed with T2DM and What Was the Initial Management?
Lessons Learned
References
Chapter 40: Outpatient Management of Type 2 Diabetes Mellitus
Case Description
Introduction
Pathophysiology
Treatment
Can Diabetes Be Prevented?
How Can Patients Learn Diabetes Self-Care?
How Has the Treatment Paradigm of T2DM Evolved?
What Distinguishes Twenty-First Century Pharmacotherapy?
Does Combination Therapy Provide Additive Beneficial Effects?
Do Single-Pill or Single-Injection Combination Therapies Exist?
What Is the Ideal Regimen for Our Patient Described in the Case?
Is Surgical Management of Diabetes an Option?
Diabetes and COVID-19
How Can We Treat Individuals with T2DM and COVID-19 in the Outpatient Setting?
References
Chapter 41: Inpatient Management of Type 2 Diabetes Mellitus
Case Description
Introduction
Glycemic Goals
What Are the Glycemic Targets for Critically Ill Patients in the ICU?
What Are the Risks of Inpatient Hypoglycemia?
What Are the Glycemic Targets for Non-critically Ill Patients in the Hospital?
Inpatient Treatment of Hyperglycemia and T2DM
Should Oral Antihyperglycemic Therapies Be Used in the Hospital Setting?
How Can Glycemic Control Be Achieved in the ICU?
How Can Glycemic Control Be Achieved in the Non-critically Ill Patient?
How Is Glucocorticoid-Induced Hyperglycemia Managed?
Has the COVID-19 Pandemic Changed How Inpatient T2DM and Hyperglycemia Are Managed?
How Was Our Patient’s Uncontrolled T2DM and Hyperglycemia Managed in the Hospital?
References
Part XI: Lipid Abnormalities
Chapter 42: Introduction to Lipid Abnormalities
Chapter 43: A Case of Heterozygous Familial Hypercholesterolemia: Success of Long-Term Management
How the Diagnosis Was Made
References
Chapter 44: Familial Partial Lipodystrophy Presenting as Extreme Hypertriglyceridemia and Acute Pancreatitis
Case Presentation
How the Diagnosis Was Made
References
Chapter 45: Severe Combined Hyperlipidemia and Multiple Medication Sensitivities
Case Presentation
Treatment History
Current Status
Review of How the Diagnosis Was Made
The Lipid Approach
The Lipoprotein Approach
The Syndrome Approach
The Genetic Approach
References
Part XII: Obesity
Chapter 46: Introduction
The Obesity Epidemic
References
Chapter 47: Obesity Case Management: Bariatric Surgery
Case
Review of the Bariatric Surgery in the Management of Obesity
Preoperative Considerations
Post-operative Considerations and Monitoring
Bariatric Surgery Outcomes
References
Chapter 48: Obesity Assessment and Management Using an Illustrative Case in Severe Mental Illness
Case
Review of the Diagnosis
Obesity Classification
Obesity and Severe Mental Illness
Examination
Initial Investigations
Appropriate Interventions
References
Chapter 49: Obesity Management and Use of Very Low-Energy Diets
Case Presentation
Background
Indications for Treatment
Initial Investigations and Monitoring
Adjustment of Medications on a VLED
References
Part XIII: Polycystic Ovary Syndrome
Chapter 50: Introduction to Polycystic Ovary Syndrome
Introduction
What Is the Typical Menstrual Pattern?
What Is Clinical Androgen Excess?
What Is Biochemical Androgen Excess?
How to Assess Ovarian Morphology?
Initial Test Cases
Note
Importance of Personalized Treatment
References
Chapter 51: PCOS and Hirsutism
Reference
Chapter 52: PCOS and Reproduction
References
Chapter 53: PCOS and Insulin Resistance
Reference
Chapter 54: PCOS and the Metabolic Syndrome
References
Part XIV: Transgender Medicine
Chapter 55: Introduction to Transgender Medicine
References
Chapter 56: Transmasculine Therapy
Case Presentation
What Are the Known Side Effects of Testosterone Therapy?
What Additional Evaluation Should Be Performed?
How Should Erythrocytosis Be Managed While on Testosterone Therapy?
Conclusions
References
Chapter 57: Perioperative Estrogen Considerations for Transgender Women Undergoing Vaginoplasty
Case Presentation
Introduction
Assessing VTE Risk
Choosing an Estrogen
Route of Administration
Type of Estrogen
Estrogen Choice Summary
VTE Concern and Perioperative Estrogen
References
Chapter 58: Feminizing Gender-Affirming Hormone Therapy: Special Considerations for Older Adults
Case Presentation
Are There Contraindications to Initiating Feminizing GAHT in This Patient?
How Would You Initiate Feminizing GAHT in This Patient?
Estrogens
Antiandrogens
Case Considerations
How Often Should Labs Visits Take Place for Feminizing GAHT?
What Are the Benefits and Expected Changes of Feminizing GAHT?
What Role Does Progesterone Have in Breast Development and Feminizing GAHT?
How Does Feminizing GAHT Affect Cardiovascular Disease and Ischemic Stroke Risk?
What Is Known About Bone Health in Older Transfeminine Patients?
Are There Data on the Safety of Feminizing GAHT Specifically in Older Transfeminine Adults?
Conclusions
References
Part XV: Endocrine Effects in Virus Infections
Chapter 59: Introduction to Endocrine Effects in Virus Infections
Chapter 60: Endocrinopathies of SARS-CoV-2
Case
Diabetes in COVID-19
Management of Diabetes in Acute COVID-19
The Effects of COVID-19 on Thyroid Function
Management of Preexisting Hyperthyroidism
Considerations on Androgen Therapy in COVID-19: Type II Transmembrane Serine Protease
Vitamin D
Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use in Regard to COVID-19 Severity and Infection Rate
References
Chapter 61: HIV Infection and Lipodystrophy
Case Presentation
Physical Exam
Laboratory Tests
Acquired Generalized Lipodystrophy
Review of How the Diagnosis Was Made
HIV-Associated Lipodystrophy
Growth Hormone
Leptin
PPAR-γ Agonists
References
Chapter 62: Adrenal Function in HIV Infection
Case Presentation
How the Diagnosis Was Made
HIV Infection and Changes to the HPA Axis
Adrenal Insufficiency
Clinical Presentation
Laboratory Testing
Imaging
Pathogenesis
HIV-Related Pharmacotherapy and the HPA Axis
Treatment of HIV-Associated Adrenal Insufficien
References
Index