Oxford Handbook of Endocrinology and Diabetes

Oxford Handbook of Endocrinology and Diabetes

Oxford Medicine Online

Contents

Front matter
- Quick Reference Material
- Foreword
- Preface
- Contributors
- Specialist readers
- Symbols and abbreviations

Part 1 Thyroid
- Anatomy and physiology of the thyroid
  - Anatomy
  - Physiology
- Thyroid investigations
  - Tests of hormone concentration
  - Tests of homeostatic control
  - Antibody screen
  - Scintiscanning
  - Ultrasound (US) scanning
  - Fine needle aspiration (FNAC) cytology
  - Computed tomography (CT)
  - Additional laboratory investigations
  - Sick euthyroid syndrome (non-thyroidal illness syndrome)
  - Atypical clinical situations
- Thyrotoxicosis
  - Aetiology
  - Manifestations of hyperthyroidism
  - Treatment
  - Thyroid crisis (storm)
  - Thyrotoxicosis in pregnancy
  - Hyperthyroidism in children
  - Secondary hyperthyroidism
- Graves' ophthalmopathy, dermopathy, and acropachy
  - Graves' ophthalmopathy
  - Graves' dermopathy
  - Thyroid acropachy
- Multinodular goitre and solitary adenomas
  - Background
  - Clinical evaluation
  - Investigations
  - Treatment
- Thyroiditis
  - Background
  - Chronic autoimmune (atrophic or Hashimoto's) thyroiditis
  - Other types of thyroiditis
- Hypothyroidism
  - Background
  - Clinical picture
  - Subclinical hypothyroidism
  - Treatment of hypothyroidism
  - Congenital hypothyroidism
- Amiodarone and thyroid function
  - Background
  - Pathogenesis
  - Diagnosis and treatment
- Thyroid cancer
  - Epidemiology
  - Aetiology
  - Papillary thyroid carcinoma
  - Follicular carcinoma (FTC)
  - Follow-up of papillary and FTC
  - Medullary thyroid carcinoma (MTC)
  - Anaplastic (undifferentiated) thyroid cancer
  - Lymphoma

Part 2 Pituitary
- Anatomy and physiology of anterior pituitary gland
  - Anatomy
  - Physiology
- Imaging
  - Background
  - MRI appearances
  - Pituitary adenomas
  - Craniopharyngiomas
- Pituitary function—dynamic tests
  - Insulin tolerance test (ITT)
  - Glucagon test
  - ACTH stimulation test
  - Arginine test
  - Clomifene test
  - hCG test
  - GnRH test
  - TRH test
- Hypopituitarism
  - Definition
  - Causes
  - Features
  - Investigations
  - Treatment
- Anterior pituitary hormone replacement
  - Background
  - Thyroid hormone replacement
  - Sex hormone replacement
  - Glucocorticoids
- Growth hormone (GH) replacement therapy in adults
  - Background
  - Definition
  - Prevalence
  - Benefits of GH replacement
  - NICE guidelines for GH replacement
  - Diagnosis
  - Who should be tested?
  - Investigation of GH deficiency
  - Treatment of GH deficiency
- Pituitary tumours
  - Pathogenesis
  - Molecular mechanisms of pituitary tumour pathogenesis
- Prolactinomas
  - Epidemiology
  - Pathogenesis
  - Clinical features
  - Investigations
  - Hyperprolactinaemia and drugs
  - ‘Idiopathic’ hyperprolactinaemia
  - Treatment
  - Management of prolactinomas in pregnancy
- Acromegaly
  - Definition
  - Epidemiology
  - Causes
  - Associations
  - Clinical features
  - Investigations
  - Management
  - Mortality data
- Cushing's disease
  - Definition
  - Epidemiology
  - Pathophysiology
  - Clinical features
  - Investigations
  - Treatment
  - Follow-up
  - Prognosis
  - Cushing's syndrome in children
- Non-functioning pituitary tumours
  - Background
  - Epidemiology
  - Pathology
  - Clinical features
  - Investigations
  - Management
  - Follow-up
  - Prognosis
- Gonadotrophinomas
  - Background
  - Clinical features
  - Investigations
  - Management
- Thyrotrophinomas
  - Epidemiology
  - Tumour biology and behaviour
  - Clinical features
  - Investigations
  - Management
- Pituitary incidentalomas
  - Definition
  - Epidemiology
  - Natural history
  - Clinical features
  - Investigations
- Pituitary carcinoma
  - Definition
  - Epidemiology
  - Pathology and pathogenesis
  - Features
  - Invasive adenomas
  - Neuroradiological classification of pituitary adenomas (modified Hardy criteria)
  - Treatment
  - Prognosis
  - Pituitary metastases
- Craniopharyngiomas and perisellar cysts
  - Prevalence
  - Epidemiology
  - Pathology
  - Features
  - Investigations
  - Management
  - Prognosis
- Parasellar tumours
  - Meningiomas
  - Clivus chordomas
  - Hamartomas
  - Ependymomas
- Parasellar inflammatory conditions
  - Neurosarcoidosis
  - Langerhans' cell histiocytosis
  - Tuberculosis
- Lymphocytic hypophysitis
  - Background
  - Epidemiology
  - Pathogenesis
  - Pathology
  - Clinical features
  - Investigations
  - Treatment
  - Natural history
  - Relationship to other conditions
- Surgical treatment of pituitary tumours
  - Trans-sphenoidal surgery
  - Trans-frontal craniotomy
- Pituitary radiotherapy
  - Indications
  - Technique
  - Efficacy
  - Complications
- Drug treatment of pituitary tumours
  - Dopamine agonists
  - Somatostatin analogues
  - Growth hormone receptor antagonist
- Posterior pituitary
  - Physiology and pathology
  - Oxytocin
  - Vasopressin and neurophysin
- Diabetes insipidus (DI)
  - Definition
  - Classification
  - Features
  - Investigations
  - Treatment
- Hyponatraemia
  - Hyponatraemia
  - Incidence
  - Causes
  - Features
  - Investigations
  - Treatment
  - Neurosugical hyponatraemia
  - Unexplained hyponatraemia
- Syndrome of inappropriate ADH (SIADH)
  - Definition
  - Criteria for diagnosis
  - Types of SIADH
  - Investigation of aetiology of SIADH
  - Treatment
- Hypothalamus
  - Pathophysiology
  - Hypothalamic syndrome
- Eating disorders
  - Anorexia nervosa
  - Bulimia
- Pineal gland
  - Physiology
  - Pineal and intracranial germ cell tumours
  - Features
  - Investigations
  - Management
  - Prognosis

Part 3 Adrenals
- Anatomy and physiology
  - Anatomy
  - Physiology
- Imaging
  - Computed tomography (CT) scanning
  - Magnetic resonance imaging (MRI)
  - Ultrasound (US) imaging
  - Normal adrenal
  - Radionucleotide imaging
  - Positron emission tomography (PET)
  - Venous sampling
- Mineralocorticoid excess
  - Definitions
- Primary aldosteronism
  - Epidemiology
  - Pathophysiology
  - Clinical features
  - Conn's syndrome—aldosterone-producing adenoma
  - Bilateral adrenal hyperplasia (bilateral idiopathic hyperaldosteronism)
  - Glucocorticoid-remedial aldosteronism (GRA)
  - Aldosterone-producing carcinoma
  - Screening
  - Confirmation of diagnosis
  - Localization and confirmation of differential diagnosis
  - Treatment
- Excess other mineralocorticoids
  - Epidemiology
  - Apparent mineralocorticoid excess
  - Liquorice ingestion
  - Ectopic ACTH syndrome
  - Deoxycorticosterone (DOC) excess
- Adrenal Cushing's syndrome
  - Definition and epidemiology
  - Pathophysiology
  - Clinical features
  - Investigations
  - Treatment
  - Prognosis
  - Subclinical Cushing's syndrome
- Adrenal surgery
  - Adrenalectomy
- Renal tubular abnormalities
  - Background
  - Liddle's syndrome
  - Bartter's syndrome
  - Gitelman's syndrome
- Mineralocorticoid deficiency
  - Epidemiology
  - Causes
  - Treatment
- Adrenal insufficiency
  - Definition
  - Epidemiology
  - Pathophysiology
- Addison's disease
  - Causes of primary adrenal insufficiency
  - Autoimmune adrenalitis
  - Clinical features
  - Autoimmune polyglandular syndrome (APS) type 1
  - APS types 2–4
  - Investigation of primary adrenal insufficiency
  - Treatment
- Long-term glucocorticoid administration
  - Long-term glucocorticoid administration
  - Short-term steroids
  - Steroid cover
  - Long-term steroids
  - Cushing's syndrome
- Adrenal incidentalomas
  - Definition and epidemiology
  - Importance
  - Differential diagnosis of an incidentally detected adrenal nodule
  - Investigations
  - Management
- Phaeochromocytomas and paragangliomas
  - Definition
  - Incidence
  - Epidemiology
  - Pathophysiology
  - Clinical features
  - Complications
  - Investigations
  - Management

Part 4 Reproductive endocrinology
- Hirsutism
  - Definition
  - Physiology of hair growth
  - Androgen production in women
  - Evaluation
- Polycystic ovary syndrome (PCOS)
  - Definition
  - Epidemiology
  - Secondary causes of PCOS
  - Features
  - Investigations
  - Management
- Congenital adrenal hyperplasia (CAH) in adults
  - Definition
  - Epidemiology
  - Pathogenesis
  - Biochemistry
  - Clinical presentation
  - Investigations
  - Management
  - Monitoring of treatment
  - Prognosis
- Androgen-secreting tumours
  - Definition
  - Epidemiology and pathology
  - Clinical features
  - Investigations
  - Management
  - Prognosis
- Menstrual function disorders—assessment and investigation
  - Definitions
  - Clinical evaluation
  - Investigations
  - Management
- Chapter 58 Premature ovarian failure (POF)
  - Definition
  - Epidemiology
  - Pathogenesis
  - Clinical presentation
  - Investigation
  - Management
  - Prognosis
- Menopause
  - Definition
  - Long-term consequences
  - Clinical presentation
  - Evaluation (e.g. if HRT is being considered)
  - Hormone replacement therapy (HRT)
- Combined oral contraceptive pill (COCP)
  - Introduction
  - Benefits
  - Risks
  - Practical issues
- Testicular physiology
  - Anatomy
  - Regulation of testicular function
  - Physiology
- Male hypogonadism
  - Definition
  - Epidemiology
  - Secondary hypogonadism
  - Primary hypogonadism
  - Clinical assessment
- Androgen replacement therapy
  - Treatment aims
  - Indications for treatment
  - Risks and side effects
- Gynaecomastia
  - Definition
  - Evaluation
  - Management
- Erectile dysfunction
  - Definition
  - Physiology of male sexual function
  - Pathophysiology
  - Evaluation
  - Management
- Testicular tumours
  - Epidemiology
  - Risk factors
  - Prognosis
- Infertility
  - Definition
  - Causes
  - Evaluation
  - Management
  - Ovulation induction
- Disorders of sexual differentiation
  - Clinical presentation
  - Evaluation
  - Androgen insensitivity syndrome
  - True hermaphroditism
  - General principles of management
- Transsexualism
  - Definition
  - Epidemiology
  - Aetiology
  - Management

Part 5 Endocrine disorders of pregnancy
- Thyroid disorders
  - Normal physiology
  - Maternal hyperthyroidism
  - Maternal hypothyroidism
  - Postpartum thyroid dysfunction
  - Thyroid cancer in pregnancy
- Pituitary disorders
  - Normal anatomical changes during pregnancy
  - Normal physiology during pregnancy
  - Prolactinoma in pregnancy
  - Cushing's syndrome
  - Acromegaly
  - Hypopituitarism in pregnancy
- Adrenal disorders during pregnancy
  - Normal changes during pregnancy
  - Addison's disease in pregnancy
  - Congenital adrenal hyperplasia
  - Phaeochromocytoma

Part 6 Calcium and bone metabolism
- Calcium and bone physiology
  - Bone turnover
  - Bone mass during life
  - Calcium
- Investigation of bone
  - Bone turnover markers
  - Bone imaging
  - Bone mass measurements
  - Bone biopsy
- Investigation of calcium, phosphate, and magnesium
  - Blood concentration
  - Urine excretion
  - Calcium-regulating hormones
- Hypercalcaemia
  - Epidemiology
  - Causes
  - Clinical features
  - Hyperparathyroidism
  - Treatment
  - Complications of parathyroidectomy
  - Other causes of hypercalcaemia
  - Familial hypocalciuric hypercalcaemia (FHH)
  - Vitamin D intoxication
  - Sarcoidosis
- Hypocalcaemia
  - Causes
  - Clinical features
  - Investigation
  - Treatment
- Rickets and osteomalacia
  - Definitions
  - Clinical features
  - Diagnosis
  - Vitamin D deficiency
  - Hypophosphataemia
- Hypomagnesaemia
  - Introduction
  - Treatment
- Osteoporosis
  - Introduction
  - Pathology
  - Epidemiology
  - Presentation
  - Investigation
  - Treatment
  - Complications of therapy
- Paget's disease
  - Paget's disease
  - Pathology
  - Epidemiology
  - Clinical features
  - Investigation
  - Complications
  - Treatment
  - Monitoring therapy
- Inherited disorders of bone
  - Osteogenesis imperfecta

Part 7 Paediatric endocrinology
- Growth and stature
  - Growth
  - Short stature
  - Genetic short stature
  - Constitutional delay of growth and puberty
  - Growth hormone deficiency
  - Tall stature and rapid growth
- Puberty
  - Normal puberty
  - Precocious puberty
  - Delayed/absent puberty
- Sexual differentiation
  - Normal sexual differentiation
  - Assessment of ambiguous genitalia
  - Disorders of sex development (DSD)
  - Congenital adrenal hyperplasia

Part 8 Neuroendocrine disorders
- The neuroendocrine system
  - Introduction
- Carcinoid tumours
  - Definition and classification
  - Incidence
  - Carcinoid syndrome
  - Diagnostic investigations
  - Tumour localization and staging
  - Treatment
  - Prognosis
- Insulinomas
  - Definitions
  - Incidence
  - Clinical presentation
  - Biochemical investigations
  - Tumour localization
  - Treatment
  - Prognosis
- Gastrinomas
  - Definitions
  - Prevalence
  - Clinical presentation
  - Biochemical investigations
  - Treatment
- Glucagonomas
  - Definitions
  - Incidence
  - Clinical presentation
  - Biochemical investigations
  - Tumour localization
  - Treatment
- VIPomas
  - Definitions
  - Clinical presentation
  - Biochemical investigations
  - Tumour localization
  - Treatment
- Somatostatinomas
  - Definitions
  - Clinical features
  - Biochemical investigations
  - Tumour localization
  - Treatment

Part 9 Inherited endocrine syndromes and multiple endocrine neoplasia (MEN)
- McCune–Albright syndrome
  - Definitions
  - Genetics
  - Clinical features
  - Prognosis
- Neurofibromatosis
  - Definitions
  - NF1
- Von Hippel–Lindau disease
  - Definitions
  - Genetics
  - Clinical features
  - Prognosis
- Carney complex
  - Definitions
  - Genetics
  - Clinical presentation
- Cowden syndrome
  - Definitions
  - Genetics
  - Clinical presentation
- POEMS syndrome
  - Definitions
  - Clinical presentation
  - Treatments
- MEN type 1
  - Definitions
  - Genetics
  - Clinical features
  - Management
  - Mutational analysis
  - Screening
- MEN type 2
  - Definitions
  - Genetics
  - Clinical features—MEN2a
  - Clinical features—MEN2b
  - Management
  - Mutational analysis
  - Screening
- Inherited primary hyperparathyroidism
  - Definitions
  - Causes
  - HPT-JT
  - FIHP
- Inherited renal calculi
  - Definitions
  - Genetics
  - Management

Part 10 Miscellaneous endocrinology
- Hypoglycaemia
  - Definition (Whipple's triad)
  - Epidemiology
  - Pathophysiology
  - Clinical features
  - Management
  - Post-prandial reactive hypoglycaemia (PRH)
- Obesity
  - Definition
  - Epidemiology
  - Aetiology
  - Pathophysiology
  - Consequences of obesity
  - Evaluation of an obese patient
  - Investigations
  - Management
- Endocrinology and ageing
  - Introduction
  - Fluid and electrolyte homeostasis in the elderly
  - Bone disease
  - GH and IGF-1 in the elderly
  - Gonadal function in the elderly
  - Adrenal function in the elderly
  - Thyroid disease
- Endocrinology of critical illness
  - Endocrine dysfunction and AIDS
  - Cancer
  - Syndromes of ectopic hormone production
  - Liver disease
  - Renal disease
  - Endocrinology in the critically ill
- Perioperative management of endocrine patients
  - Trans-sphenoidal surgery/craniotomy
  - Thyroidectomy
  - Parathyroidectomy
  - Phaeochromocytoma
- Syndromes of hormone resistance
  - Definition
  - Thyroid hormone resistance
  - Androgen resistance
  - Glucocorticoid resistance
  - ACTH resistance
  - Mineralocorticoid resistance
  - Differential diagnosis of possible manifestations of endocrine disorders
- Stress and the endocrine system
  - Definition
  - Endocrine effects of stress
  - Metabolism
- Alternative or complementary therapy and endocrinology
  - Introduction
  - Alternative therapy used in patients with diabetes mellitus
  - Alternative therapy used in menopause
  - Alternative therapy used by patients with osteoporosis
  - Miscellaneous

Part 11 Diabetes
- Classification and diagnosis
  - Background
  - Diagnosis
  - Classification
  - Genetics
- General management and treatment
  - Background
  - Assessment of the newly diagnosed patient
  - Dietary advice
  - Oral hypoglycaemic agents
  - Insulin
- Diabetic eye disease
  - Epidemiology
  - Clinical features and histological features
  - Eye screening
  - Treatment
  - Surgical treatment
- Diabetic renal disease
  - Background
  - Definition
  - Epidemiology
  - Making the diagnosis
  - Pathology
  - Pathogenesis
  - Natural history
  - Treatment
- Diabetic neuropathy
  - Definition
  - Pathology
  - Pathogenesis
  - Peripheral sensorimotor neuropathy
  - Autonomic neuropathy
- Macrovascular disease
  - Macrovascular disease
  - Epidemiology
  - Pathogenesis
  - Lipid abnormalities found in patients with diabetes
  - Hypertension
- Diabetic foot
  - Diabetic foot
  - Risk factors for foot ulcer development
  - Treatment
- Diabetes and pregnancy
  - Background
  - Risks
  - Known diabetics and pregnancy
  - Gestational diabetes
- Intercurrent events or disease
  - Surgery
  - Skin/connective tissue/joint disease
- Social and practical aspects
  - Current regulations for fitness to drive motor vehicles
  - Complications from diabetes and driving
- Emergencies in diabetes
  - Diabetic ketoacidosis
  - Hyperosmolar, non-ketotic hyperglycaemia
  - Hypoglycaemia

Part 12 Lipids and hyperlipidaemia
- Lipids and coronary heart disease
  - Physiology
  - Pathogenesis
  - Atherosclerosis
  - CHD/atherosclerosis risk factors
  - Assessment of CHD risk
  - Individuals at risk with hyperlipidaemia
- Primary hyperlipidaemias
  - Background
  - Polygenic hypercholesterolaemia
  - Familial hypercholesterolaemia (FH)
  - Clinical characterization
  - Familial defective apolipoprotein B-100 (FDB)
  - Familial hypertriglyceridaemia
  - Rare genetic hypertriglyceridaemias
  - Familial combined hyperlipidaemia (FCHL)
  - Familial dysbetalipoproteinaemia
  - Rare familial mixed dyslipidaemias
- Secondary hyperlipidaemias
  - Background
  - Causes
- Management of dyslipidaemia
  - Background
  - Primary and secondary prevention
  - Drug therapy
  - Aims of treatment

Part 13 Endocrine and diabetes nursing and dietetics
- Endocrine and diabetes nursing
  - Insulin regimens
  - Injection technique: practical advice
  - Continuous subcutaneous insulin infusion (CSII)
  - Travel
  - Hypoglycaemia
  - Pituitary function: dynamic tests
  - Education of the patient
- Nutrition
  - Dietary treatment of endocrine disorders
  - Diabetes
  - Hyperlipidaemia
  - Polycystic ovary syndrome
  - Amenorrhea
  - Reactive hypoglycaemia
  - Physical activity
  - Weight management

Part 14 Laboratory endocrinology
- Pitfalls in laboratory endocrinology
  - Introduction
  - Pre-analytical factors
  - Analytical factors
  - Post-analytical factors
- Reference intervals
  - Introduction
  - Thyroid function
  - Adrenal and gonadal function
  - Pituitary hormones
  - Bone biochemistry
  - Plasma gastrointestinal and pancreatic hormones
  - Tumour markers
  - Urinary collections

Appendix
- Patient support groups and other endocrine organizations

Index
- Index

2nd edition

All the content in this practical and concise guide to endocrinology and diabetes has been fully revised to reflect latest best practice. Covering clinical investigations and management of both common and rare conditions, it includes the protocols and clinical information necessary for the management of patients with endocrine and diabetic disorders.

About the Authors

Helen Turner Consultant, Department of Endocrinology, Churchill Hospital, Oxford, UK

John Wass Professor of Endocrinology, Department of Endocrinology, Churchill Hospital, Oxford, UK

Disclaimer: Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.

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