Endocrinology and diabetes : a problem oriented approach

Preface to Second Edition
Contents
Contributors
Part I: Endocrinology
	1: Hyperthyroidism and Thyrotoxicosis
		Introduction
		Presentation of Thyrotoxicosis State
		Clinical Presentations of Thyrotoxicosis Mimicking Other Conditions
		Thyrotoxicosis Syndromes (Table 1.1)
			Hyperthyroidism Associated with High Thyroid RAIU [5]
			Hyperthyroidism Associated with Normal RAIU
			Thyrotoxicosis Associated with Very Low or Near-Zero (Table 1.2) Neck RAIU [2, 5]
			Thyrotoxicosis with Low Thyroid RAIU and Low Serum Thyroglobulin
			Thyrotoxicosis Presenting with Neck Pain
			Drug-Induced Thyrotoxicosis and Hyperthyroidism
			Amiodarone-Induced Thyrotoxicosis
		Subclinical Hyperthyroidism
			Hyperthyroidism Associated with Pregnancy
			Fetal and Neonatal Hyperthyroidism
			Hyperthyroidism in Pediatric Age Group
			Hyperthyroidism in Trophoblastic Disease
			Hyperthyroidism with Inappropriately Normal Serum TSH in TSH-Producing Pituitary Adenoma
			Hyperthyroidism in Thyroid Hormone Resistance
			Thyrotoxicosis Associated with “Café au Lait” Pigmentation and Fibrous Dysplasia (McCune–Albright Syndrome)
			Non-autoimmune Hyperthyroidism Caused by Genetic Mutation of TSH Receptor
			Metastatic Follicular Cancer and Hyperthyroidism
			Hyperthyroidism Associated with Normal T4 but Elevated T3 (T3 Toxicosis)
		Laboratory Investigation of Thyrotoxicosis and Hyperthyroidism
		Management of Thyrotoxicosis and Hyperthyroidism
		Management of Graves’ Hyperthyroidism
		Pros and Cons of Antithyroid Therapy
		How to Manage Recurrence of Hyperthyroidism After 18 Months of Antithyroid Therapy?
		Radioactive Iodine Therapy (RAI) for Graves’ Hyperthyroidism
		Management Before and Immediately After RAI Therapy
		Surgical Management of Graves’ Hyperthyroidism
		Preparing Patients with Graves’ Hyperthyroidism for Surgery
		Management of Severe Hyperthyroidism and Thyroid Storm
		Management of Toxic Adenoma and Toxic Multinodular Goiter
		Management of Hyperthyroidism Associated with Ophthalmopathy and Thyroid Dermopathy
		Conclusions
		References
	2: Hypothyroidism
		Introduction
		Epidemiology
		Clinical Presentation and Physical Examination
		Etiology
			Primary Hypothyroidism
			Medication-Induced Thyroid Dysfunction
			Central (Secondary and Tertiary) Hypothyroidism
			Generalized Thyroid Hormone Resistance
		Evaluation
		Treatment
			Therapeutic Target
			Persistent Complaints Despite Normal TSH
			Combination Therapy
		Special Populations
			Subclinical Hypothyroidism (SCH)
			Hypothyroidism and Pregnancy
			Myxedema Coma
		References
	3: Thyroid Nodules and Cancer
		Introduction and Clinical Importance
		History and Physical Examination
		Diagnostic Evaluation
			Serum Markers
			Thyroid Ultrasound and Indication for Fine-Needle Aspiration (FNA)
			Other Imaging
		Cytology
		Management, Therapy, and Follow-Up
			Benign Thyroid Nodule
			Malignant Thyroid Nodule
			Suspicious for Malignancy
			Indeterminate Thyroid Nodule (AUS/FLUS and FN/SFN)
				Non-diagnostic
		Special Situations
			Thyroid Nodule During Pregnancy
			Thyroid Nodules in Children
		Thyroid Cancer
			American Thyroid Association Risk Stratification System
				ATA Low Risk
				ATA Intermediate Risk
				ATA High Risk
		Summary
		Appendix
		References
	4: Evaluation of Sellar Masses
		Introduction
		Key Points to the Diagnosis
			Radiologic Findings
			History, Physical Examination, and Laboratory Findings
			Evaluation of the Incidentally Found Pituitary Mass
			Differential Diagnosis
		Present and Future Therapies
			Transsphenoidal Surgery
			Radiation
			Medical Therapy
		References
	5: Hyperprolactinemia
		Pathophysiology
		Key Points for Diagnosis
			Differential Diagnosis
		Current Therapies and Future Perspectives
			Medical Treatment
			Surgical Treatment
			Radiotherapy
			Fertility and Pregnancy
			Addressing Prolactinomas Resistant and/or Aggressive
		Summary: Diagnosis and Treatment
		References
	6: Acromegaly
		Epidemiology
		Etiology
		Pathophysiology
		Clinical Features
			Cardiovascular System
			Endocrine and Metabolic Features
			Musculoskeletal Features
			Neoplastic Features
		Respiratory System
		Diagnosis
		Treatment
			Transsphenoidal Surgery
			Medical Treatment
				Somatostatin Analogues
				Dopaminergic Agonists
				GH Receptor Antagonists
				Combination Therapy
		Radiotherapy
		Treatment in Pregnancy
		Pasireotide LAR
			Somatoprim
			Subcutaneous Octreotide
			Oral Octreotide
			Temozolomide
		References
	7: Hypopituitarism
		Causes
		Diagnosis
			Clinical Presentation
		Somatotropin Deficiency
			Children
			Adults
		Gonadotropin Deficiency
		Thyrotropin Deficiency
		Corticotropin Deficiency
		Antidiuretic Hormone (ADH) Deficiency
			Diagnostic Testing
		Somatotropin Deficiency
			Children
				GH Stimulation Testing in Children
			Adults
				GH Stimulation Testing in Adults
		Transitional Period
		Gonadotropin Deficiency
		Thyrotropin Deficiency
		Corticotropin Deficiency
		ADH Deficiency
			Imaging
			Neuro-ophthalmic Exam
			Management
		Hormone Replacement Therapy
			Hyposomatotropism
				Children
				Adults
		Transitional Period
		Hypogonadism (in the Adult Female)
			Pubertal Development
			Fertility Treatment
		Hypogonadism (in the Adult Male)
			Oral Testosterone
			Intramuscular Depot
			Transdermal Systems
			Buccal Tablet
			Pellets
			Other
		Monitoring During Androgen Therapy
			Infants/Pubertal Development
			Fertility Treatment
		Thyrotropin Deficiency
		ACTH Deficiency
		ADH Deficiency
		Hormone Replacement Therapy Interactions
		Long-Term Management
		Potential Future Therapy
		References
	8: Cushing’s Syndrome
		Introduction
			Aetiology
			Epidemiology
			Key Points to the Diagnosis and to the Differential Diagnosis (Fig. 8.1)
		Present and Future Therapies (Fig. 8.2)
		Conclusions
		References
	9: Adrenal Failure
		Introduction
		Presentation of Adrenal Insufficiency
		Biochemical Findings in Adrenal Insufficiency
		Pathophysiology
		Diagnostic Tests (Tables 9.2 and 9.3) [12]
		Investigations to Establish the Underlying Cause of Adrenal Insufficiency
		Other Investigations
		Differential Diagnosis
		Treatment
			Management of Adrenal Crisis
			Management of Chronic or Insidious Onset of Adrenal Insufficiency
				Glucocorticoid Replacements
				Mineralocorticoid Replacement
				DHEA Replacement [17]
		Modified Release Hydrocortisone
		Follow-Up
		Assess Glucocorticoid Replacement
		Assess Mineralocorticoid Replacement
		Patient Education
		References
	10: Adrenal Incidentalomas
		Epidemiology
		Imaging Procedures
		Fine Needle Aspiration (FNA)
		Hormonal Evaluation
		Patient Follow-Up
		Treatment
		References
	11: Endocrine Hypertension
		Introduction
		Primary Aldosteronism
		Etiology
		Clinical Presentation
		Diagnosis
			Screening
			Confirmatory Tests
			Imaging Tests
			Adrenal Vein Sampling
			Postural Test
			Genetic Tests
		Treatment
		Pheochromocytoma and Paraganglioma
		Epidemiology and Pathophysiology
		Clinical Presentation
			Laboratory Tests
			Imaging Tests
			Genetic Tests
		Treatment
			Preoperative Clinical Management
			Perioperative Management
			Follow-Up
			Treatment of Malignant Pheochromocytoma
		References
	12: Hirsutism and Virilization
		Epidemiology of Hirsutism and Virilization
		Etiology of Hirsutism and Virilization
		Pathophysiology of Hirsutism and Virilization
		Key Points to the Diagnosis of Hirsutism and Virilization
		Physical Examination
		Hormone Profile
		Genetic Analysis
		Differential Diagnosis
		Management of Hirsutism and of Virilization
		References
	13: Menopause
		Epidemiology
		Clinical Manifestations
		Diagnosis
		Hormone Therapy
		Vasomotor Symptoms
		Genitourinary Tract
		Sexual Function
		Quality of Life
		Osteoporosis
		Cardiovascular Effect
		Diabetes Mellitus
		Endometrial Cancer
		Breast Cancer
		Ovarian Cancer
		Cognition and Dementia
		Principles of Treatment
			Patient Selection
		Preparations
		Dose and Route of Administration
		Duration of Treatment
		Discontinuation of Treatment
		Complementary and Alternative Therapies
			Nonhormonal Therapy for Vasomotor Symptoms
		Other Hormone Therapies
		Phytohormones
		Botanicals
		Tibolone
		Ospemifene
		Others
		The Future
		References
	14: Male Hypogonadism
		Pathophysiology
		Causes of Hypogonadism
			Primary Hypogonadism (Hypergonadotropic)
				Congenital Causes
					Klinefelter Syndrome
					Other Chromosomal Abnormalities
					Disorders of Androgen Synthesis
					Mutation in FSH and LH Genes
					Cryptorchidism
					Congenital Anorchia
				Acquired Causes
					Varicocele
					Orchitis
					Chronic Diseases
					HIV Infection
					Irradiation
					Gonadal Toxicity of Cancer Chemotherapy
					Trauma and Torsion of Testes
					Medications
					Autoimmune Testicular Failure
			Secondary Hypogonadism (Hypogonadotropic)
				Congenital Causes
					Isolated Hypogonadotropic Hypogonadism
					Kallmann Syndrome
					Laurence–Moon and Bardet–Biedl Syndrome
					Deficiencies of Transcription Factors
				Acquired Causes
				Disorders of Gonadotropin Secretion
					Hyperprolactinemia
					Drugs
					Chronic Diseases
					Critical Conditions
					Anorexia Nervosa
					Diabetes Mellitus
					Obesity
				Disorders of Direct Gonadotroph
					Benign Tumors and Cysts
					Neoplasms
					Infiltrative Diseases
					Infections
					Traumatic Brain Injury
					Endocrine Disruptors and the Gonadotropic Axis
					Quality of Semen
					Testes Dysgenesis Syndrome
					Male Urogenital Tract Malformation
					Testicular Germ Cell Cancer
					Gynecomastia
		Diagnosis
		Treatment
			Oral Androgens
			Transdermal Androgens
			Testosterone Gel (1%)
			Testosterone Topical Solution (2%) Applied to the Axillae
			Transdermal Patches
			Injectable Androgens
			Subcutaneous Implants
			Other forms of treatment
			Male Hypogonadism Associated with T2DM and Obesity: To Treat or Not to Treat?
			Testosterone and Cardiovascular Disease
		Monitoring and Follow-Up
		References
	15: Hormone Therapy in the Transgender Patient
		Introduction and Terminology
		Diagnosis and Guidelines
		Gender-Affirming Hormone Therapy in Children
		Transfeminine Hormone Therapy and Long-Term Monitoring
		Transmasculine Hormone Therapy and Long-Term Monitoring
		Surgical Considerations
		Conclusions
		References
	16: Idiopathic Short Stature: Diagnostic and Therapeutic Approach
		Case Report
		Introduction
		Short Stature Diagnosis
			Criteria for Investigation of Short Stature
			Diagnostic Approach
		Case Report Evolution and the Diagnosis of Idiopathic Short Stature (ISS)
		Present Therapies for Short Stature
		References
	17: Delayed Puberty
		Introduction
		Key Points to the Diagnosis
		Hypogonadotropic Hypogonadism (HH)
			Constitutional Delay of Growth and Puberty (CDGP)
			Functional Hypogonadotropic Hypogonadism (FHH)
			Isolated Gonadotropin Deficiency
			Multiple Pituitary Hormone Deficiencies
				Genetic Syndromes
		Hypergonadotropic Hypogonadism (HHG)
			Gonadal Dysgenesis
			Disorders of Sex Development
			Gonadal Injury or Loss
		Eugonadotropic Hypogonadism (EH)
		Diagnostic Tests
		Present and Future Therapies
		Future Therapies
		References
	18: Precocious Puberty
		Introduction
		Hypothalamic–Pituitary–Gonadal Axis
		Normal Puberty
			Girls
			Boys
		Precocious Puberty
			Definition
			Normal Variants
			Differential Diagnosis
			Gonadotropin-Dependent Precocious Puberty
			Gonadotropin-Independent Precocious Puberty
		Key Points to the Diagnosis
		Evaluation
			Medical History
			Physical Examination
			Imaging Studies
			Biochemical Studies
		Present and Future Therapies
			Treatment of Gonadotropin-Dependent Precocious Puberty
			GnRHa Dosing and Monitoring
			Safety
			Treatment of Gonadotropin-Independent Precocious Puberty
		Conclusions
		References
	19: Ambiguous Genitalia
		Epidemiology and Classification
		Differentiation of Genitalia and Hormonal Control
		Genetics
		Causes of Ambiguous Genitalia
			Sex Chromosome DSD
			Ovotesticular DSD
		46,XX DSD
			21-Hydroxylase (21-OH) Deficiency
			11β-Hydroxylase (11-OH) Deficiency
			P450 Oxidoreductase (POR) Deficiency
			P450 Aromatase Deficiency
			Androgens and Progestogens of Maternal Origin
		46,XY DSD
			Androgen Insensitivity Syndrome (CAIS and PAIS)
			46,XY Partial or Total Gonadal Dysgenesis
			17-OH Deficiency
			3βHSD2 Deficiency
			StAR Deficiency (Lipoid CAH)
			SCC Deficiency
			Smith-Lemli-Opitz Syndrome
			5α-Reductase Deficiency
			17β-Hydroxysteroid-Dehydrogenase Type 3 Deficiency
		Initial Approach of Newborns with Ambiguous Genitalia
			Physical Exam
			Diagnostic Tests
		Hormonal Treatment
		Monitoring
		Surgical Treatment
		Affirmation of Gender
		References
	20: Non-parathyroid Hypercalcemia
		Non-parathyroid Hypercalcemia
		Etiology
		Bone Resorption
			Primary Hyperparathyroidism
			Secondary and Tertiary Hyperparathyroidism
			Malignant Neoplasms
			Thyrotoxicosis
		Increase in Intestinal Calcium Absorption
			Alkaline Milk Syndrome
			Hypervitaminosis D
			Granulomatous Diseases
		Decrease of Calcium Excretion
			Chronic Renal Insufficiency
			Rhabdomyolysis and Acute Renal Failure
			Thiazide Diuretics
		Downregulation of Calcium-Sensing Receptor
			Familial Hypocalciuric Hypercalcemia (FHH)
		Medicines
			Lithium
			Hypervitaminosis A
		Other Endocrinopathies
			Pheochromocytoma
			Adrenal Insufficiency
		Uncommon Causes of Hypercalcemia
			Hypercalcemia Mediated by Elevated Levels of Calcitriol
			Hypercalcemia Caused by PTHrp
			Hypercalcemia of Unknown Mechanism
		Clinical Manifestations
			Gastrointestinal
			Renal
			Cardiovascular
			Neuropsychiatric
			Physical Findings
		Diagnostic Evaluation/Laboratory Diagnosis
		Treatment
			Increase in Calcium Urinary Excretion
			Decrease in Intestinal Calcium Absorption
			Inhibition of Bone Resorption
			Denosumab
		Other Therapies
			Calcimimetics
			Dialysis
		References
	21: Hypocalcemia
		Key Points to the Diagnosis
		Signs and Symptoms
		Differential Diagnosis
		PTH-Mediated Hypocalcemia
			Hypoparathyroidism
			Illustration: Case 1
			Illustration: Case 2
			PTH Resistance
		Vitamin D-Related Hypocalcemia
			Vitamin D Deficiency
			Illustration: Case 3
			Vitamin D-Resistant Rickets
		Other Causes of Hypocalcemia
		Laboratory Tests and Interpretation
		Management
		References
	22: Primary Hyperparathyroidism
		Epidemiology
		Etiology
		Diagnosis
		Differential Diagnosis
		Normocalcemic Primary Hyperparathyroidism
		Skeletal Manifestations
		Extraskeletal Manifestations
			Neuropsychiatric Symptoms
			Cardiovascular Symptoms
		Renal Manifestations
			Localization of Parathyroid Lesions
		Indications for Parathyroidectomy in PHPT
		Surgical Techniques
			Intraoperative PTH Monitoring
			Medical Therapy
			Calcimimetic Agents
			Hormone Replacement Therapy
			Selective Modulators of Estrogen Receptors (SERMs)
			Bisphosphonates
		References
	23: Vitamin D Deficiency
		Introduction
		Key Points
			Definition of Vitamin D Deficiency (Fig. 23.1)
			Measuring 25OHD
			Defining Vitamin D Status and Intake Requirements (Fig. 23.1)
			Secondary Indices of Vitamin D Deficiency (Fig. 23.3)
		Differential Diagnosis (Table 23.2)
			Intestinal, Hepatic, and Renal Diseases
			Hypophosphatemic Bone Disease (Table 23.2)
			Rare Conditions
		Present and Future Therapies
			Vitamin D and Calcium Supplementation
			High-Dose Vitamin D Therapy: 25OHD Dose Response and Outcome Response
			Future Therapies
		Conclusion
		References
	24: Postmenopausal Osteoporosis
		Epidemiology
		Risk Factors
		FRAX
		Diagnosis
			Clinical History and Physical Examination
			Laboratory Evaluation
			Bone Markers
		Imaging
			Plain Radiography
			Bone Densitometry
			Quantitative Computerized Tomography
			Ultrasonography
			Bone Quality
		Treatment
			Indication
			Non-pharmacological Treatment
			Calcium/Vitamin D
			Physical Exercise
			Pharmacological Treatment
			Estrogens
			Tibolone
			Calcitonin
			SERMs (Selective Modulators of Estrogen Receptors)
			Bisphosphonates
			Denosumab
			Parathyroid Hormone
			Strontium
		Romosozumab
			Transdermal Abaloparatide
			Oral Calcitonin
		References
	25: Osteoporosis in Men
		Introduction
		Clinical Case
		Key Points to the Diagnosis of Bone Loss in Men
			Medical History and Physical Examination
			Laboratory Tests
			Bone Mineral Density (BMD)
			Fracture Risk Algorithms
		Differential Diagnosis of Bone Loss in Men
		Selection of Men for Pharmacological Treatment
		Approved Treatments for Male Osteoporosis
			Antiresorptive Agents
				Bisphosphonates
				Denosumab
			Osteoanabolic Agents
			Testosterone Replacement
		Future Therapeutic Approaches
			Selective Estrogen Receptor Modulators (SERMs)
			Selective Androgen Receptor Modulators (SARMs)
			Abaloparatide
			Sclerostin Antibody
		Monitoring Therapy
		References
	26: Glucocorticoid-Induced Osteoporosis
		Introduction
		Patient Case Report
		Epidemiology
		Pathophysiology
		Assessment of Fracture Risk
		Management
		Guidelines
		Lessons from the Patient Case Report
		Summary
		References
	27: Metabolic Bone Diseases Other Than Osteoporosis
		Osteogenesis Imperfecta
			Pathophysiology
			Clinical Manifestations
			Diagnosis
			Differential Diagnosis
			Treatment
		Osteomalacia
			Clinical Manifestations
			Diagnosis
			Treatment
		Paget’s Disease of Bone
			Pathogenesis
			Histopathology
			Epidemiology
			Clinical Manifestations
			Diagnosis
			Treatment
		References
Part II: Diabetes Mellitus
	28: Classification and Laboratory Diagnosis of Diabetes Mellitus
		Introduction
		Part II: Classification of Diabetes Mellitus
			Historical Perspective on Diabetes Nomenclature
			Case Examples Illustrating Different Classifications of Diabetes
				Case 1
				Case 2
				Case 3
				Case 4
				Case 5
		Part II: Clinical Stages of Diabetes
		Part III: Laboratory Diagnosis of Diabetes Mellitus
			Determining Diagnostic Thresholds
			Tests of Glycemia for Diabetes Diagnosis
			Serum Glucose and OGTT
			Glycated Hemoglobin (HbA1c)
				Case 6
				Case 7
			Tests to Aid Determination of Diabetes Type
				C-Peptide
				Autoantibodies
		Conclusion
		References
	29: Gestational Diabetes
		Diagnosis of Gestational Diabetes
		Differential Diagnosis/Other Considerations
		Current and Future Therapies
		Summary and Conclusions
		References
	30: Oral Therapies for Type 2 Diabetes
		Introduction
		Present and Future Therapies
		Metformin
		Sulfonylureas
		Thiazolidinediones (TZD)
		DPP-4 Inhibitors
		α-Glucosidase Inhibitors
		Glinides
		Bromocriptine
		Gliflozins
		Conclusion
		References
	31: GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes
		The Incretin Effect
		Biological Effects of GLP-1
			Pancreatic Effects
			Extra-Pancreatic Effects
			The Incretin Effect on Type 2 Diabetes
			Exenatide
			Side Effects
		Exenatide Twice Daily and Extended Release
		Liraglutide
		Dulaglutide
		Semaglutide
		The Role of GLP1 RA in the Modern Treatment of T2DM
		GLP-1 RA in the Treatment of Obesity
		Lixisenatide
		References
	32: Insulin Therapy
		Insulin Therapy in Type 1 Diabetes and Type 2 Diabetes Inpatient
		Insulin Therapy in Type 1 Diabetes
		Insulin Therapy in Type 2 Diabetes
		Insulin Therapy Inpatient
		Protocol for Insulin Therapy in Critically Ill Patients
		Protocol for Insulin Therapy in Non-critically Ill Patients
		References
	33: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
		Introduction
		Pathophysiology
		Diabetic Ketoacidosis
		Hyperosmolar Hyperglycemic State
		Diagnosis
		Differential Diagnosis
		Treatment
		References
	34: Hypoglycemia in the Non-diabetic Patient
		Clinical Presentation
		Pathophysiology
		Differential Diagnosis
			The Healthy Patient: Hyperinsulinemic Hypoglycemia
				Insulinoma
				Non-insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS)
				Post-Bariatric Surgery Hypoglycemia
				Insulin Antibody-Mediated Hypoglycemia
			The Ill Patient
			Genetic Causation and Predisposition to Hypoglycemia
			Drug-Induced Hypoglycemia
			Non-insulin-Mediated Hypoglycemia
		Hypoglycemia Evaluation
			Establishing a Diagnosis of Hypoglycemia
				Seventy-Two-Hour Fast
					Criteria for Hyperinsulinemia
				Mixed Meal Test
			Localizing Studies
				Noninvasive Radiologic Studies
				Invasive Techniques
				Selective Arterial Calcium Stimulation
		Treatment
			Insulinomas
			NIPHS and Post-Bariatric Surgery Hypoglycemia
			Non-islet Cell Tumor Hypoglycemia
			Iatrogenic
		Future Therapies
		Conclusion
		References
	35: Hypoglycaemia in Diabetes
		Introduction
		Definition
		Morbidity and Mortality Associated with Hypoglycaemia
			Acute Effects of Hypoglycaemia
		Long-Term Effects of Hypoglycaemia
		Presentation
		Causes of Hypoglycaemia
		Nocturnal Hypoglycaemia
		Alcohol
		Exercise
		Risk Factors for Hypoglycaemia
		Long Duration of Diabetes
		Hypoglycaemia Unawareness
		Renal Failure
		Treatment Factors
		Psychosocial Factors
		Clinical Assessment
		Management
			Treatment of Acute Hypoglycaemia
		Prevention of Hypoglycaemia
		Education
		Individualised Glycaemic Targets
		Glucose-Lowering Agents with Lower Hypoglycaemic Potential
		Continuous Subcutaneous Insulin Therapy
		Continuous Glucose Monitoring
		Sensor-Augmented Pumps and Closed-Loop Systems
		Islet Cell and Pancreatic Transplant
		Lifestyle Implications
		Conclusion
		References
	36: The Diabetic Neuropathies
		Introduction
		Distal Symmetric Polyneuropathy
		When to Suspect and Main Characteristics of Diabetic Polyneuropathy
			Screening Tests
		Differential Diagnosis
		Acute Sensory Neuropathy and How to Distinguish from Chronic Sensorimotor Diabetic Polyneuropathy
		Treatment
			The Role of Glycemic Control
			Lifestyle Modifications
			Foot Care
		Pathogenetic Therapies
			Painful Diabetic Neuropathy
				Antidepressants
				Anticonvulsants
				Other Agents
		Nonpharmacological Therapy
			Autonomic Neuropathy
			Cardiovascular Autonomic Neuropathy
			Gastrointestinal Autonomic Neuropathy
			Genitourinary Autonomic Neuropathy
		The Effect on Diabetes Control
		Focal and Multifocal Neuropathies
			General Recommendations
		References
	37: Diabetic Nephropathy
		Introduction
		Diagnosis
		Differential Diagnosis
		Treatment (Table 37.2)
		Novel Therapies
		References
	38: The Diabetic Foot
		Introduction
		Diabetic Foot Ulcerations and Infections
		Diabetic Foot Osteomyelitis and Amputations
		Diabetic Charcot Neuroarthropathy
		Conclusion
		References
	39: Diabetic Retinopathy
		Introduction
		Classification
		Maculopathy
		Treatment
		References
	40: Carbohydrate Counting
		What Is Carbohydrate Counting?
		Who Should Do Carbohydrate Counting?
		Criteria for Prescribing the Counting of Carbohydrates
		Choice of Nutritional Therapy
		Action of Insulins
		Exercises
		What Is the Effect of Alcohol on Blood Glucose?
		How Is the Amount of Carbohydrates in a Meal to Be Assessed?
		Effects of Food on the Blood Sugar Level
		Concluding Remarks
		References
Part III: Obesity, Lipids and Nutrition
	41: Pharmacological Treatment of Obesity
		Introduction
		Pathophysiology
		Diagnosis
		Pharmacological Treatment
			Phentermine/Topiramate Association
			Naltrexone/Bupropiona Association
			Lorcaserin
			Orlistat
			Liraglutide
		Future Perspectives
			Cetilistat
			Bupropion/Zonisamide
			Beloranib
			Tesofensine
		Obesity and T2DM
			Additional Pharmacotherapy for Obesity in DM2 (Not Approved by the FDA)
			Metformin
			Pramlintide
			Semaglutide
			Phentermine and SGLT2 Inhibitor Association
		References
	42: Nonalcoholic Fatty Liver Disease
		Introduction
		Pathogenesis
		Screening
		Diagnosis
			Clinical Assessment
			Laboratory Assessment
			Imaging Exams
			Invasive and Noninvasive Methods for Assessment of Inflammation and Fibrosis
				Noninvasive Markers of NASH
				Noninvasive Markers for Fibrosis
		Treatment
			Who Should Be Treated?
			Nonpharmacological Treatment
			Pharmacological Treatment of Liver Disease
			Treatment of Dyslipidemia and Cardiovascular Risk Factors
			Surgical Treatment
		References
	43: Treatment of Obesity in the Patient with Type 2 Diabetes
		Introduction: Rising Prevalence of Obesity and Type 2 Diabetes Mellitus
		Key Points to Be Discussed
			Health Risks of Obesity
			Treating the Patient with Obesity and Type 2 Diabetes
			Lifestyle Modification
			Outcomes of Medical Nutrition Therapy
			Role of Medications in the Treatment of Obesity
				Orlistat
				Phentermine/Topiramate
				Bupropion/Naltrexone
				Liraglutide/Semaglutide
			Bariatric Surgery
			Impact of Bariatric Surgery on Type 2 Diabetes
			Mechanisms of Improvement in Diabetes
		Future Therapy Update
		Summary
		References
	44: Dyslipidemia
		Diagnosis
			Lipid Profile
			LDL-Cholesterol
			HDL Cholesterol
			Triglycerides
			Non-HDL Cholesterol
		Additional Tests
			Lipoprotein (a)
			C-Reactive Protein
			Homocysteine
			Apolipoproteins
			Carotid Intima-Media Thickness and Coronary Calcium Score
			In Whom Should Serum Lipids Be Measured?
			Cardiovascular Risk Assessment
		Treatment
			Treatment Goals
			Lifestyle Change (LSC)
			Statins
			Benefits in Secondary Prevention
			Beneficial Effects on Atheromatous Plaque
			Benefits of Primary Prevention
			Fibrates
			Niacin
			Ezetimibe
			Bile Acid Sequestrants
			Combination Therapy
			PCSK9 Inhibitors
		Future Therapies
		References
	45: Dietary Approach for Cardiometabolic Disorders
		Dietary Approach for Cardiometabolic Disorders
		Nutritional Factors and Targets of MD
			Mediterranean Diet
			DASH
			Low-Carb Diet
			Vegetarian Diet
			Quality of Fats
			Micronutrients and Cardiovascular Health
		Conclusion
		References
	46: Nutrition Supplements in Sports
		Carbohydrates
		Whey Protein
		Creatine
		Beta-Hydroxy-Beta-Methylbutyrate (HMB)
		Caffeine
		Buffering Agents
			Sodium Bicarbonate (NaHCO3)
			Beta Alanine
		References
Index