Diagnostic evaluation update:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1997
|
| Schriftenreihe: | Endocrinology and metabolism clinics of North America
26,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | IX S., S. 703 - 1012 Ill., graph. Darst. |
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| adam_text | I DIAGNOSTIC EVALUATION UPDATE
CONTENTS
Preface xi
William F. Young, Jr, and George G. Klee
Acromegaly 703
Shereen Ezzat
Acromegaly can be a serious, chronic, debilitating condition. The
disease is often missed for years, resulting in significantly delayed
diagnosis. This article reviews recent advances in our understand¬
ing of acromegaly and the impact of current approaches on the
diagnosis and monitoring of patients with this disorder.
Pituitary Incidentalomas 725
Mark E. Molitch
Incidental pituitary masses are found commonly during CT and
MR imaging done for a variety of reasons. Screening for hormone
oversecretion by these rumors is warranted. For patients with
lesions greater than 1 cm in diameter, patients should also be
screened for hypopituitarism. In the absence of visual field abnor¬
malities or hypothalamic/stalk compression, it may be appro¬
priate to observe such patients carefully with repeated MR im¬
aging. Surgery is indicated if there is evidence of tumor
enlargement, especially when such growth is accompanied by
compression of the optic chiasm, cavernous sinus invasion, or the
development of pituitary hormone deficiencies.
Clinical and Biochemical Evaluation of Cushing s
Syndrome 741
Christoph A. Meier and Beverly M. K. Biller
The diagnosis and differential diagnosis of Cushing s syndrome
remain a clinical challenge. This article summarizes the clinical
ENDOCRINOLOGY AND METABOLISM
£ CLINICS OF NORTH AMERICA
VOLUME 26 • NUMBER 4 • DECEMBER 1997 V
features of Cushing s syndrome and critically reviews the various
endocrine tests utilized for screening, diagnosis, and localization.
Special consideration is given to several novel tests based on the
administration of corticotropin releasing hormone. The role of
imaging and inferior petrosal sinus catheterization is discussed
within the context of a general algorithm proposed for evaluating
patients with suspected Cushing s syndrome.
Biochemical Thyroid Function Testing 763
George G. Klee and Ian D. Hay
Various published guidelines recommending serum thyrotropin
(TSH) first thyroid testing are outlined. The entities called sub
clinical hypothyroidism and subclinical hyperthyroidism are
defined on the basis of abnormal TSH concentrations and normal
values of other biochemical thyroid tests. The controversies about
follow up and treatment of these disorders are discussed. The
laboratory experience of Mayo Clinic Rochester in using TSH
first thyroid testing and the subsequent implementation of a
thyroid test ordering cascade are presented. Finally, recommen¬
dations are given for further optimizing laboratory testing for
thyroid disorders.
Changing Concepts in the Diagnosis and Management of
Thyroid Nodules 777
Hossein Gharib
Thyroid nodules are extremely common, affecting from 4% to 7%
of the population. Fine needle aspiration biopsy is the most accu¬
rate and cost effective technique for nodule diagnosis. It is simple,
safe, and should be the first test used in patient work up. Routine
thyroxine (T4) suppressive therapy is no longer recommended for
cytologically benign nodules. T4 suppression can cause or aggra¬
vate osteoporosis, especially in postmenopausal women. New
data on T4 suppressive therapy, cost analysis, and nodule guide¬
lines are reviewed.
Pheochromocytoma and Primary Aldosteronism:
Diagnostic Approaches 801
William F. Young, Jr
Although adrenal dependent hypertension is an uncommon form
of hypertension, its diagnosis provides clinicians with a unique
treatment opportunity, that is, to render a surgical care or to
achieve a dramatic response to pharmacologic therapy. The diag¬
nosis of catecholamine secreting tumors has evolved during the
last 70 years into a straightforward, stepwise algorithmic ap¬
proach. Primary aldosteronism is now recognized as the most
common form of secondary hypertension, and the screening
methods are simple and reliable.
vi CONTENTS
Adrenal Mass 829
David M. Cook
This review article discusses the diagnostic possibilities that
might result in an adrenal mass lesion and suggests the most
appropriate diagnostic evaluation to verify the most likely cause.
An algorithm is formulated for lesions that do not have a clini¬
cally apparent reason after initial evaluation, an unfortunately
frequent situation.
Congenital Adrenal Hyperplasia 853
Songya Pang
Congenital adrenal hyperplasia (CAH) is a family of genetic
disorders from a deleterious mutation in a gene encoding adrenal
steroidogenic enzyme essential for cortisol biosynthesis. Recent
molecular advances have provided the genetic basis for the phe
notypic variability in CAH, a means for accurately genotyping
family members of CAH patients including prenatal prediction
of the genotype in fetuses at risk of the disorder, and have helped
to better define the hormonal criteria for the varying spectrum of
CAH disorders. Biochemical advances have simultaneously aided
the diagnosis and therapeutic monitoring of CAH patients. Prena¬
tal maternal dexamethasone therapy for fetal CAH prevents or
minimizes virilizing sequelae in the majority of prenatally treated
affected females, but was associated with significant maternal
side effects. Newborn screening for CAH has contributed to the
prevention of morbidity of delayed diagnosis of CAH in more
than two thirds of affected neonates. Current treatment methods,
however, may not be optimal for achieving normal genetic height
and appropriate weight in CAH patients, and more effective
approaches to CAH therapy remain to be explored.
Polycystic Ovary Syndrome 893
Vasilios T. Goudas and Daniel A. Dumesic
The cardinal clinical features of polycystic ovary syndrome
(PCOS) are hirsutism and menstrual irregularity from anovula
tion. Obesity occurs in one half of these women, some of whom
also have diabetes. Underlying biochemical abnormalities in
PCOS include luteinizing hormone (LH) hypersecretion, hyperan
drogenism, acyclic estrogen production, decreased sex hormone
binding globulin (SHBG) capacity, and hyperinsulinemia from
insulin resistance, all of which contribute to increased ovarian
androgen production. The hyperinsulinemia found in PCOS
women accompanies upper body obesity, occurs independently
of obesity alone, and potentiates ovarian hyperandrogenism by
enhancing LH secretion, potentiating 17 hydroxylase and, to a
lesser extent, 17,20 lyase activity, and suppressing SHBG capacity.
All women with suspected hyperandrogenic anovulation should
undergo an evaluation to rule out other endocrinopathies, such
as virilizing tumors, adult onset congenital adrenal hyperplasia,
CONTENTS vii
hyperprolactinemia, and Cushing s syndrome. The aims of ther¬
apy for such women are to normalize the endometrium, antago¬
nize androgen action at target tissues, reduce insulin resistance,
and correct anovulation if necessary.
Osteoporosis 913
Patrick Garnero and Pierre D. Delmas
Osteoporosis, one of the most prevalent diseases associated with
aging, is characterized by a low bone mass and microarchitectural
deterioration of bone tissue leading to increased susceptibility of
fracture. The management of osteoporotic patients relies espe¬
cially on the static measurement of bone mass as bone mineral
and dynamic changes of bone turn over. New developments of
bone mineral density measurement techniques and biochemical
markers of bone turnover are reviewed. Their clinical uses for the
management of patients with osteoporosis are discussed.
Hypoglycemia 937
F. John Service
The diagnosis of a hypoglycemic disorder requires a high level
of suspicion, careful assessment of the patient for the presence of
mediating drugs or predisposing illness, and, when indicated,
methodic evaluation of the basis of well defined diagnostic crite¬
ria. The diagnostic burden is heaviest for healthy appearing per¬
sons with episodes of confirmed neuroglycopenia. The author s
criteria for insulin mediation of hypoglycemia are plasma insulin
of 6 |a.U/mL or higher (radioimmunoassay), C peptide of 200
pmol/L or higher (ICMA), proinsulin of 5 pmol/L or higher
(ICMA), (3OH butyrate of 2.7 mmol/L or lower, and generous
(s25 mg/dL) response of plasma glucose to intravenous gluca
gon administered when the patient is hypoglycemic. Sulfonylurea
should be sought in the plasma of any hypoglycemic patient,
especially by an assay which can detect the second generation of
these drugs.
Dynamic Endocrine Testing: The Mayo Clinic Model 957
Sheryl M. Ness and William F. Young, Jr
An endocrine testing center (ETC) is a universal requirement for
the practice of endocrinology. Modifications of the Mayo Clinic
model for an ETC should be applicable to most endocrine prac¬
tices. Key components of an ETC include a centralized testing
area, registered nurse physician team, detailed testing protocols,
and patient education programs.
Problems in Endocrinologic Imaging 973
John L. Doppman
Imaging, particularly cross sectional computer assisted tech¬
niques such as CT and MR imaging, has become so refined
viii CONTENTS
and even breathtaking that the display of anatomy is beguiling
endocrinologists into an unhealthy reliance on visual data. The
demonstration of a focal abnormality in an endocrine gland tells
us nothing about its function. Overreliance on such displays of
anatomy leads to problems in diagnosis and treatment. This arti¬
cle points out some instances in which imaging is deceptive.
Cumulative Index 993
Subscription Information Inside back cover
ERRATUM
A dosage error appeared in the article Management of Individual
Tumor Syndromes by Drs Kenneth J. Snow and Aubrey E. Boyd III
published in the March 1994 issue of the Endocrinology and Metabolism
Clinics of North America. On page 159, in the second sentence of the
second paragraph, the correct unit of measurement should have been
micrograms (|xg), not milligrams (mg). Below are the two sentences of
the paragraph as they should have appeared:
For screening purposes we now prefer the pentagastrin stimulation
test. The test is performed by giving 0.5 |xg/kg of this peptide by
intravenous bolus and measuring serum calcitonin levels at 0, 1, 2, and
5 minutes.
contents *x
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| spelling | Diagnostic evaluation update William F. Young ... guest ed. Philadelphia [u.a.] Saunders 1997 IX S., S. 703 - 1012 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Endocrinology and metabolism clinics of North America 26,4 Stoffwechselkrankheit (DE-588)4057700-4 gnd rswk-swf Diagnose (DE-588)4012040-5 gnd rswk-swf Endokrinopathie (DE-588)4113435-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Endokrinopathie (DE-588)4113435-7 s Diagnose (DE-588)4012040-5 s DE-604 Stoffwechselkrankheit (DE-588)4057700-4 s Young, William F. 1951- Sonstige (DE-588)143800728 oth Endocrinology and metabolism clinics of North America 26,4 (DE-604)BV000625447 26,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007896448&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Diagnostic evaluation update Endocrinology and metabolism clinics of North America Stoffwechselkrankheit (DE-588)4057700-4 gnd Diagnose (DE-588)4012040-5 gnd Endokrinopathie (DE-588)4113435-7 gnd |
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| title | Diagnostic evaluation update |
| title_auth | Diagnostic evaluation update |
| title_exact_search | Diagnostic evaluation update |
| title_full | Diagnostic evaluation update William F. Young ... guest ed. |
| title_fullStr | Diagnostic evaluation update William F. Young ... guest ed. |
| title_full_unstemmed | Diagnostic evaluation update William F. Young ... guest ed. |
| title_short | Diagnostic evaluation update |
| title_sort | diagnostic evaluation update |
| topic | Stoffwechselkrankheit (DE-588)4057700-4 gnd Diagnose (DE-588)4012040-5 gnd Endokrinopathie (DE-588)4113435-7 gnd |
| topic_facet | Stoffwechselkrankheit Diagnose Endokrinopathie Aufsatzsammlung |
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