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