117-Draznin-Chap117.indd 691 3/31/2011 5:40:55 PM CHAPTER 117 Pitfalls in laboratory endocrinology 692 Box 117.4 Disastrous outcomes Assay interference A series of patients has been described in whom aggressive therapy for c horiocarcinoma was instituted for diagnoses based on assays affected by in vitro artifacts. Antibody speci \201 city A patient has been described who had prolactin measured by three different assays, giving three different answers. The solution awaited a clinical answer wh en the hyperprolactinemia resolved after the offend- ing medication was stopped. Interference by insulin autoantibodies A patient has been described with recurrent hypoglyc emia due to insulin autoantibodies caused by myeloma. This patient demonstrated in vivo int erference by endogenous antibodies as well as in vitro interference. Hook effect A patient presents with a large pituitary tumor that appears nonfunc- tioning; prolactin is normal and the patient is treated surgically. The next day, the blood sample i s reassayed after dilution, and high prolactin is uncovered when the antibody is no longer \202 ooded by excess prolactin. 117-Draznin-Chap117.indd 692 3/31/2011 5:40:55 PM THYROID FUNCTION 693 Reference intervals Introduction Box 118.1 De \201 nitions \200 Serum A serum sample is collected in a plain tube, left t o permit clotting, then centrifuged and separated. Plasma A plasma specimen is collected in a tube containing EDTA or lithium heparin, centrifuged immediately, and separated. All values are for serum unless speci \201 ed otherwise. Thyroid function Table 118.1 Thyroid Function Tests Traditional units Conversion factor Hormone SI Units TSH 0.35 \200\2234.50 mU/L 0.35 \200\2234.50 mU/L 1 Total T 4 Free T 4 Total T 3 Free T 3 Thyroglobulin 60 \200\223140 nmol/L 4.5 \200\22311.0 mcg/dL 12.9 10.3 \200\22322.7 pmol/L 0.8 \200\2231.8 ng/dL 12.9 1.2 \200\2232.8 nmol/L 80 \200\223180 ng/dL 0.0154 3.5 \200\2236.5 pmol/L 2.3 \200\2234.3 pg/mL 1.54 1.0 \200\22330 mcg/L 1.0 \200\22330 ng/mL 1 Acid-containing container (20 mL 6M HCl). 118-Draznin-Chap118.indd 693 3/31/2011 5:41:54 PM CHAPTER 118 Reference intervals 694 Adrenal and gonadal function Table 118.2 Adrenal and gonadal function tests Traditional units Conversion factor Hormone SI units Cortisol (9 A.M.) 140 \200\223635 nmol/L 5 \200\22323 mcg/dL 27.6 Aldosterone Supine Erect 0.8 \200\2233.0 nmol/L 1.4 \200\2238.0 nmol/L 3 \200\22310 ng/dL 5 \200\22330 ng/dL 0.0277 0.0277 Plasma renin activity Supine Erect 0.6 \200\2233 mcg/L/hr 3 \200\22310.8 mcg/L/hr DHEAS Women Men 6 \200\22310 micromol/L 6 \200\22317 micromol/L 22 \200\223380 mcg/dL 22 \200\223640 mcg/dL 0.0027 0.0027 Androstene- dione Women Men 0.3 \200\2237.4 nmol/L 1.0 \200\2234.6 nmol/L 0.1 \200\2232.1 ng/mL 0.3 \200\2231.3 ng/mL 3.49 3.49 17 \200\223hydroxy- progesterone Women Men 0.3 \200\22310 nmol/L 0.3 \200\2234.6 nmol/L 0.1 \200\2232.9 ng/mL 0.1 \200\2231.4 ng/mL 3.3 3.3 Estradiol Women Pre-M Post-M Men 110 \200\2231468 pmol/L 0 \200\223110 pmol/L 36 \200\223185 pmol/L 30 \200\223400 pg/mL 0 \200\22330 pg/mL 10 \200\22350 pg/mL 3.6 3.6 3.6 Progesterone Follicular Luteal Men <3 nmol/L 6.5 \200\22380 nmol/L <3 nmol/L <1.0 ng/mL 2.0 \200\22325 ng/mL <1.0 ng/mL 3.2 3.2 3.2 Testosterone Men Women 6.9 \200\22338 nmol/L 0.35 \200\2232.45 nmol/L 200 \200\2231080 ng/dL 10 \200\22370 ng/dL 0.035 0.035 Dihydro- testosterone Men Women 1 \200\2232.6 nmol/L 0.3 \200\2230.8 nmol/L 29 \200\22376 ng/dL 8.7 \200\22323 ng/dL 0.034 0.034 Sex hormone binding globulin Women Men 18 \200\223114 nmol/L 13 \200\22371 nmol/L 18 \200\223114 nmol/L 13 \200\22371 nmol/L 1 1 A variety of different units are used by non-UN labs. 118-Draznin-Chap118.indd 694 3/31/2011 5:41:55 PM PITUITARY HORMONES 695 Pituitary hormones Table 118.3 Pituitary hormones Traditional units Conversion factor Hormone SI units FSH Follicular Mid-cycle Luteal Post- menopausal Men 0.5 \200\2235 IU/L 8 \200\22333 IU/L 2 \200\2238 IU/L >30 IU/L 0.5 \200\2235 mU/mL 8 \200\22333 mU/mL 2 \200\2238 mU/mL >30 mU/mL 1 1 1 1 1.0 \200\22318 IU/L 1.0 \200\22318 mU/mL 1 LH Follicular Mid-cycle Luteal Post- menopausal Men 1 \200\22310 IU/L 20 \200\22380 IU/L 3 \200\22316 IU/L >30 IU/L 1 \200\22310 mU/mL 20 \200\22380 mU/mL 3 \200\22316 mU/mL >30 mU/mL 1 1 1 1 3 \200\2238 IU/L 3 \200\2238 mU/mL 1 Prolactin Women Men 0 \200\22325 mcg/L 0 \200\22320 mcg/L 0 \200\22325 ng/mL 0 \200\22320 ng/mL 1 1 Growth Hormone 0 \200\22320 mU/L 0 \200\22310 ng/mL 3 IGF-1 20 years 40 years 60 years >60 years 16 \200\223115 nmol/L 14 \200\22346 nmol/L 10 \200\22335 nmol/L 7 \200\22328 nmol/L 120 \200\223885 ng/mL 105 \200\223353 ng/mL 79 \200\223263 ng/mL 52 \200\223210 ng/mL 0.13 ACTH* 2 \200\22318 pmol/L 10 \200\22380 pg/mL 0.22 Antidiuretic hormone 0 \200\2234.7 pg/mL Lithium heparin tube is cold spun immediately. 118-Draznin-Chap118.indd 695 3/31/2011 5:41:55 PM CHAPTER 118 Reference intervals 696 Bone biochemistry Table 118.4 Bone biochemistry tests Traditional units Conversion factor Hormone SI units Parathyroid hormone* 1.0 \200\2236.0 pmol/L 10 \200\22360 pg/mL 0.1 Total 25-hydroxy- cholecalciferol* 75 \200\223200 nmol/L 30 \200\22380 ng/mL 2.5 1, 25-dihydroxy- cholecalciferol* 35 \200\223180 pmol/L 15 \200\22375 pg/mL 2.4 Calcitonin \200 0 \200\2237.5 pg/mL Serum, cold spun, \202 ash frozen. \200 Lithium heparin tube is cold spun immediately. Plasma gastrointestinal and pancreatic hormones Table 118.5 Plasma GI and pancreatic hormones Traditional units Conversion factor Hormone SI units Insulin (fasting)* 21 \200\223133 pmol/L 3 \200\22319 mU/L 6.9 C-peptide (fasting) 0.25 \200\2231.2 nmol/L 0.8 \200\2233.5 ng/mL 0.33 Gastrin* 0 \200\22345 pmol/L 0 \200\223100 pg/mL 0.45 Glucagon* 11 \200\22336 pmol/L 40 \200\223130 pg/mL 0.28 Vasoactive intestinal polypeptide (VIP)* 0 \200\22325 pmol/L 0 \200\22360 pg/mL 0.42 Pancreatic polypeptide* 0 \200\223104 pmol/L 0 \200\223435 pg/mL 0.24 Somatostatin* 0 \200\223150 pmol/L Chromogranin A* 0 \200\22350 pmol/L Vasopressin 0 \200\2234.7 pg/ml Fasting, Trasylol tube, lithium heparin, cold spun and \202 ash frozen. 118-Draznin-Chap118.indd 696 3/31/2011 5:41:55 PM URINARY COLLECTIONS 697 Tumor markers Table 118.6 Tumor markers Tumor marker Traditional units BhCG 0 Carcinoembryonic antigen (CEA) 0 \200\2233.0 ng/mL Prostate-speci \201 c antigen (PSA) A-Fetoprotein Thyroglobulin 0 \200\2234 ng/mL 0 \200\22315 ng/mL 0-30 ng/ml Urinary collections Table 118.7 Urinary collections: hormones Urine hormone Traditional units (mcg/24 hours) Norepinephrine 0 \200\223100 mcg/24 hours Epinephrine 0 \200\22325 mcg/24 hours Dopamine 60 \200\223440 mcg/24 hours Cortisol, free 0 \200\22360 mcg/24 hours 5-hydroxyindoleacetic acid 2 \200\2238 mg/24 hours Table 118.8 Urinary collections: analytes Urinary analyte Traditional units (mg or mmol/24 hours) Calcium 100 \200\223250 mg/24 hours Phosphate 400 \200\2231300 mg/24 hours Potassium 25 \200\223125 mmol/24 hours Sodium 50 \200\223285 mmol/24 hours 118-Draznin-Chap118.indd 697 3/31/2011 5:41:55 PM This page intentionally left blank 699 Index pheochromocytoma, 364 management of, 364 autoimmune adrenalitis associated with, 197 Abetalipoproteinemia, 673 Abnormal thyroid function Adrenalectomy, 188 clinical features of associated conditions, 198 chronic, 198 laboratory investigations, tests, 542 bilateral, for congenital adrenal hyperplasia, 244 Acanthosis nigricans, 650 Acarbose, 657 \200\2238 ACE inhibitors for Cushing \200\231s disease, 122 laparoscopic bilateral, 198 for hyporeninemic in pregnancy, 362 primary adrenal insuf \201 ciency causes of, 196 \200\2237 investigation of, 200 \200\2231 screening hypoaldosteronism, 192 180, 188 for pheochromocytoma, perioperative management of patients, 188, 189 preoperative preparation 214 for primary hyperaldosteronism, 174, 180 of patients, 188 unilateral, 186 Adrenal glands recommendations for, 199 treatment for drug interactions, 204 education of the patient, Achilles tendonitis, 670 Acne, 237 anatomy of, 164 computed tomography scanning for, 168 mild to moderate, 237 moderate to severe, 237 oral contraceptive pills for, function, in elderly people, 205 244 \200\2235, 276 541 intercurrent illness, 204 maintenance therapy severe, 237 123Iodine-metaiodo benzyl- guanidine imaging for, 169 Acromegaly, 110, 357 for, 203 clinical features of, 110 \200\2231 complications, 111 mass effects of tumor, 111 signs, 11 1 symptoms, 110 \200\2231 de \201 ned, 110 epidemiology of, 110 etiologies of, 110 managem ent of, 114 \200\22315 algorithm of, 112 criteria for cure, 114 medical therapies, 114 \200 \22315 radiotherapy, 115 transsphenoidal surgery, monitoring of therapy, 203 Adjunctive therapy, for androgen-secreting tumors, 251 Adjuvant therapy magnetic resonance imaging for, 168 physiology of, 165, 166 75Se 6B-selenomethyl- 19-norcho lesterol imaging for for medullary thyroid carcinoma, 78 for papillary ultrasound imaging for, microcarcinoma of the thyroid, 67 \200\2238 Adrenal cortex steroid production, 166 Adrenal Cushing \200\231s 168 venous sampling of, 169 Adrenal hormones, 555 Adrenal hyperplasia, 172 bilateral, 173, 186 bilateral macronodular, syndrome, 184. See also Cushing \200\231s syndrome clinical features of, 185 clinical inves tigations 114 mortality data, 115 pathophysiology of, 110 screening of, 112 \200\22313 suppression test f or, 93 Active ophthalmopathy threatening sight, 41 Acute myocardial infarction, management of, 634 \200\2235 184, 185 congenital, 192 Adrenal hypoplasia, 192 Adrenal incidentalomas, 208 of, 185 de \201 ned, 184 epidemiology of, 184 pathophysiology of, 184 prognosis of, 186 tr eatment for, 186 adrenal mass, determination of, 208 clinical investigations for, 209 de \201 ned, 208 differential diagnosis Acute symptomatic Adrenal disorders during hypocalcemia, 394 Addison \200\231s disease, 196 pregnancy, 361 of, 208 Addison \200\231s disease, 362 congenital adrenal hyperplasia, 363 fetoplacental unit, 361 fetal adrenal gland, 361 placenta, 361 management of, 362 maternal adrenocortical acute adrenal insuf \201 ciency, epidemiology of, 208 management of, 209 201 cause of, 201 clinical features of, 201 clinical investigations Adrenaline, 653 Adrenal insuf \201 ciency, 193 acute, 201 cause of, 201 clinical features of, 201 clinical investigations for, 201 emergency management of, 202 function, changes in, 361 antibody screening for, 10 for, 201 119-Draznin-Index.indd 699 4/2/2011 8:17:19 PM INDEX 700 side effects and wasting syndrome, 544 \200\2235 Adrenal insuf \201 ciency (Cont.) emergency management Albright \200\231s hereditary complications of, 64 osteodystrophy, 392 thyroid function tests of, 202 Albumin, 4 Albuminuria, 612 Alcoholism and sex hormones, 554 \200\2235 Aldosterone, 535 \200\2236 for, 62 clinical investigations induced hypothyroidism, for, 195 de \201 ned, 193 epidemiology of, 194 isolated ACTH 62 diagnosis of, 64 pathogenesis for, 63 treatment for, 64, 64 -induced thyroiditis, 52 -induc ed thyrotoxicosis, 62 pathogenesis for, 63 in \202 uence on thyroid physiological mechanisms de \201 ciency, 194 of, 166, 166 Aldosterone-producing carcinoma, 173 Aldosteronoma, 172 Alendronate, 426 Alend ronic acid, for osteoporosis, 268 Alfalfa (Medicago sativa), primary causes of, 196 \200\2237 investigation of, 200 \200\2231 pathophysiology of, 195 in pregnancy, 204 secondary causes of, 194 features of, 194 pathophysiology of, 195 B-Adrener gic antagonists, for hyperthyroidism, 22 function tests, 8, 9, 11 Amitriptyline, 623 Amlodipin, for primary hyperaldosteronism, 174 Amoxicillin, in diabetic feet infection control, 639 with estrogenic activity, 580 Amphetamine, for Alkaline phosphatase, pheochromocytoma, 214 Ampicillin, in diabetic feet infection control, 639 15, 423 Allostasis, 575 Alpha2b-interferon 470 Alprostadil, 311 \200\22312, 625 \200\2236 A ltered coagulability, as Adrenocorticotropic hormone (ACTH), 83, 84 Anabolic steroids, associated with secondary hypogonadism, 287. See also Steroids adenoma, 102 and cortisol, in critical diabetic risk factor, 628 illness, 558 \200\2239 Alternative therapy, and endocrinology, 577 in patients with diabetes de \201 ciency associated with Analphalipoproteinemia. See Tangier disease congenital adrenal hyperplasia, 242 associated with primary adrenal insuf \201 ciency, 200 mellitus, 578 \200\2239 Anaplastic Alzheimer disease, effect of hormone replacement therapy on, 271 Ambiguous genitalia assess ment of, 456 management of, 458 Amenorrhea, 230 \200\2231, 236 (undifferentiated) thyroid carcinoma, 79, 66. See also Thyroid cancer glucocorticoid replacement for, 98 -dependent Cushing \200\231s syndrome, 117, 118, 122 resistance, 570 st imulation test, for Anastrozole, 305 Androgen de \201 ciency, symptoms of, 321 Androgen insensitivity syndrome , 335 causes of, 254 osteoporosis and, 407 \200\2238 premature ovarian clinical features of, 335 hormonal evaluation insuf \201 ciency and, 260 congenital adrenal hyperplasia, 242 test for corticotrope de \201 ciency, 92 primary, 252 secondary, 252 treatment for, 236, 244 \200\2235 for, 335 management of, 335 pathogenesis of, 335 Androgen oversecretion, American ginseng (Panax quinquefolius), 579 Adrenoleukodystrophy, 192 associated with primary adrenal insuf \201 ciency, 196 \200\2237 Adriamycin, for 457 Amiloride Androgen production, regulation of, 281 for Liddle \200\231s syndrome, 190 for nephrogenic diabetes in women, 223 Androgen receptor insipidus, 154 pheochromocytomas/ paragangliomas, 219 for primary blockers, for polycystic ovary syndrome, 235 hyperaldosteronism, 180 Agranulocytosis, 22 \200\2233 AIDS, endocrinology of, Androgen receptor Aminoglutethamide, 544 \200\2238 insensitivity syndrome, 457 associated with primary adrenal insuf \201 ciency, 196 \200\2237 Amiodarone adrenal, 545 \200\2236 electrolyte disturbance due to endocrine perturbation, 547 Androgen replacement therapy, for Kallmann syndrome, 287 Androgen-secreting tumors, 249 characteristics of, 63 diagnosis of, 64 treatment for, 64, 65 for hyperthyroidism, 25 gonads, 546 \200\2237 lipodystrophy, 545 pituitary, 548 thyroid dysfunction, 547 \200\2238 adrenal tumors, 249 119-Draznin-Index.indd 700 4/2/2011 8:17:19 PM INDEX 701 for subclinical Antiarrhythmic drugs, for clinical features of, 250 de \201 ned, 249 epidemiology of, 249 laboratory evaluation hyperthyroidism, 29 \200\22330 thyroid crisis, 28 Antibiotic therapy, for At-risk feet with no pyogenic thyroiditis, 51 current ulceration, 638 Antibody screening, for thyroid disease, 10 Anticonvulsants, in \202 uence on thyroid func tion tests, 8 of, 250 Atrophic thyroiditis, 50. See also Thyroiditis Autoimmune adrenalitis, management of, 251 ovarian tumors, 249 pathology of, 249 prognosis of, 251 Androgen synthes is, 197 Autoimmune diseases and premature ovarian insuf \201 ciency, 260, 261 Antidepressants, for 165, 166 hyperprolactinemia, 106 biochemical defects Antidiuretic hormone (ADH), 15, 85 Autoimmune of, 457 hypothyroidism, antibody screening for, 10. See also Hypothyroidism Androgen therapy, 296 Anti-M llerian hormone contraindications to, 297 goals of, 296 indications for, 297 monitoring of, 297 pretreatmen t evaluation de \201ciency/insensitivity, 458 Antipsychotics, for Autoimmune hyperprolactinemia, 106 polyendocrinopthy, candidiasis, and epidermal dystrophy (APECED). See Autoimmune polyglandu lar syndrome type 1 for, 297 Antithyroid drugs (ATDs), risks and side effects 347 \200\2238 Apo C-II, 671 Apolipoprotein A1-CIII de \201 ciency, 673 of, 298 testosterone preparations for, 299 for wasting syndrome, 544 Apoplexy, 95 Autoimmune polyglandular Anemia treatment for, 95 syndrome (APS) microcytic, 15 normochromic, 15 pernicious, 10 Apparent type 1, 98 types 2 \200\2234, 199 mineralocorticoid excess, 182. See also Mineralocorticoid excess Autonomic neuropathy, Angiotensin-converting enzyme (ACE) inhibitors, for renal disease, 609 \200\22310 Angiotens in II receptor antagonists, 616 624 \200\2236 assessment of, 624 \200\2235 clinical features of, 624 as diabetic foot risk biochemistry of, 182 treatment for, 183 Appetite-suppressant factor, 637 treatment of, 625 \200\2236 drugs, 532 Anhidrosis, 626 Anion exchange resins, Arginine test protocol, Autonomic symptoms, of hypoglycemia, 657 Autosomal dominant hypocalcemic hypercalciuria (AD HH), 510 \200\2231 Azathioprine for growth hormone de \201 ciency, 93 Arginine vasopressin 681 indications of, 681 interactions, 681 mechanism of action, 681 side effects of, 681 (AVP), 575. See also Vasopressin for neurogenic diabetes Anorexia nervosa, in secondary hyperlipidemias, 675 insipidus, 154 Arterial thrombosis, oral contraceptive pill for, 277 \200\2238 Artifactual/ for lymphocytic hypophysitis, 137 for sarcoidosis, 138 Anovulation, 317, 324 hypergonadotropic, 324 hypogonadotropic, 324 normogonadotropic, 324 Anterir pituitary hormo ne Background retinopathy, pseudohyponatremia, treatment for, 158. See also Hyponatremia Aspirin, and macrovascular 605 \200\2236 Banaba (Lagerstroemia speciosa), 578 replacement, 98 Bartter \200\231s syndrome, 190, glucocorticoid disease, 627 191 replacement, 98 Assisted reproduction causes of, 191 clinical features of, 191 clinical investigations regimens, 99 safety and stress-dose steroids for, 98 growth hormone techniques (ART), 326 Atenolol, for primary hyperaldosteronism, 174 for, 191 treatment for, 191 Benzoyl peroxide, for replacement, 99 Atherosclerosis, 662 risk factors of, 662 sex hormone acne, 237 replacement, 100 Atorvastatin, 687 Atrial \201 brillation (AF) Bevacizumab, for diabetic thyroid hormone eye disease, 610 replacement, 100 for hyperthyroidism, 22 119-Draznin-Index.indd 701 4/2/2011 8:17:20 PM INDEX 702 Bromocriptine (Parlodel) on fetus, effect of, 354 for hyperprolactinemia, Blood concentration of calcium, 373 of phosphate and magnesium, 373 Biguanides, 595, 596 \200\2237. See also Metformin mode of action, 596 side effects and 107 for macroprolactinoma, BMP-4 mutations, associated with pituitary adenomas, 102 contraindications, 596 \200\2237 354 \200\2235 for pheochromocytoma, Bilateral adrenalectomy, for congenital adrenal hyperplasia, 244. See also Adrenalectomy 214 Body mass index (BMI), for prolactinomas, 108, 522 144 Bone Butyrophenones, for age, 432 \200\2233 biochemistry tests, 696 biopsy, 372 densitometry, 410 disease, 537 inher ited disorders, 427 osteogenesis imperfecta, Bilateral adrenal hyperprolactinemia, 105 hyperplasia, 173. See also Adrenal carcinoma Ca antagonists, for primary hyperaldosteronism, 174 treatment for, 186 Bilateral idiopathic hyperaldosteronism, 173 Cabergoline (Dostinex) on fetus, effect of, 354 for hyperprolactinemia, 427 Bilateral macronodular osteoporosis, 537 Paget \200\231s disease. See Paget \200\231s disease adrenal hyperplasia. See also Adrenal carcinoma 107 clinical features of, 185 pathophysiology of, 184 Bile acid sequestrants. See Anion exchang e resins for macroprolactinoma, primary 354 \200\2235 hyperparathyroidism, 537 for prolactinomas, 108, 144 vitamin D de \201ciency and osteomalacia, 537 Biochemical tests, for thyroid disease, 15 Biphasic/mixed insulins, 601 Bisphosphonates Caf -au-lait pigmentation, 487 Caffeine, for imaging, 370 isotope bone scanning, pheochromocytoma, 214 Calcitriol 370 for hypercalcemia, 382 for osteoporosis, 268, 417 skeletal radiology, 370 mass during life, 367 measurements, 371 Bone mineral density Bitter melon (Momordica for osteoporosis, 418 for renal disease, 556 charantia), 578 Black cohosh (Actaea racemosa), 581 Calcium, 418, 582 A-Blockers in acute hypocalcemia, (BMD), 410 Bone-speci \201 c alkaline 566 for pheochromocytoma, blood concentration phosphatase, 369 \200\22370 214, 218, 364 of, 373 Bone turnover, 366 for primary and bone physiology, 366 bone mass during life, biochemical markers of, hyperaldosteronism, 174 B-Blockers 369 \200\22370, 410 formation markers, 367 bone turnover, 366 circulation, calcium 369 \200\22370 for primary resorption markers, 369 during remodeling cycle, hyperaldosteronism, 174 for maternal in, 368 roles of calcium, 368 -creatinine excretion ratio, calculation of, 374 366 Brain tumors and cranial hyperthyroidism, 347 \200\2238 irradiation, 437 Breast cancer. See also for Graves \200\231 disease, 27 for pheochromocytoma, regulating hormones, Cancer 364 375 effect of hormone for thyroid crisis, 28 \200\2239 for thyrotropinomas, 129 for macrovascular disease, 627 calcitonin, 375 parathyroid hormone, 375 parathyroid hormone \200\223 related peptide (PTHr P), 375 vitamin D and its replacement therapy in, 269 \200\22371 family history of, 270 no personal or family history of, 269 \200\22370 oral contraceptive pill for thyrotoxic periodic paralysis, 30 for management of metabolites, 375 for, 278 Graves \200\231 disease in mother, 32 sensing receptor agonists, 382 overactivity of, 395 urine excretion of, 374 Calcium channel blockers past history of, 270 Breast tenderness, associated with hormone replacement therapy, 272 for pheochromocytoma, 214, 218 Blond psyllium seed (Plantago ovata), 579 119-Draznin-Index.indd 702 4/2/2011 8:17:20 PM INDEX 703 indications of, 682 interactions, 683 mechanism of action, 682 Cardiac valvulopathy, effect on prolactinomas, 108 for primary hyperaldosteronism, 180 Cardiovascular disease Chordomas/ (CVD) for thyroid crisis, 28 \200\2239 Calcium channel inhibitors, for pheochromocytoma, 214 Canc er condrosarcomas, 135 androgen therapy for, 298 associated with polycystic ovary syndrome, 231 Choriocarcinoma, 16 Chromium, 578 Chromosomal disorders, effect of hormone 290, 460 replacement therapy in, 271 breast, 269 \200\22371, 278 cervical, 278 colon, 269 endocrinology of, 549 anticancer chemo therapy, Chronic autoimmune thyroiditis, clinical presentation of, 50. See also Thyroiditis CARE (Cholesterol and Recurrent Events Trial), 629 \200\22333 atrophic thyroiditis, 50 clinical studies of, 50 Hashimoto \200\231s thyroiditis, Carney complex syndrome, 549 110, 184, 496 radiotherapy, 549 endometrial, 270 ovarian, 271 renal, 494 risk after radioiodine clinical presentation 50, 64 of, 496 de \201ned, 496 endocrine tumors prognosis of, 50 Chronic \201 brosing (Riedel \200\231s) thyroiditis. See also Thyroiditis associated with, 496 genetic factors associated therapy, 25 thyroid. See Thyroid causes and characteristics with, 496 cancer of, 49 Carpenter syndrome, 199 Cassia cinnamon Capecitabine, for carcinoid clinical presentation tumors, 470 of, 50 (Cinnamomum aromaticum), 578 Captopril Chronic kidney disease for diabetic renal disease, (CKD), 557 Catecholamine 616 Chronic lymphocytic hypersecretion, for pheochromocytoma, 214 \200\22315 suppression test, for primary aldosteronism, 177 thyroiditis, causes and characteristics of, 49. See also Thyroiditis Chronic renal disease, Celiac disease, 441 Cerebrovascular disease, effect of hormone replacement therapy in, 270 Carbamazepine in \202 uence on thyroid function tests, 8 in secondary hyperlipidemias, 685 Chvostek \200\231s sign, 391 \200\2232 Chylomicrons, 660 Ciclosporin, impact on mineralocorticoid de \201 ciency, 192 for peripheral sensorimotor neuropathy, 623 for neurogenic diabetes Cervical cancer, oral contraceptive pill for, 278. See also Cancer insipidus, 154 Carbimazole, for Charcot foot, 640 Chemical injury, as diabetic foot risk factor, 642 Cimicifuga racemosa. See Black cohosh (Actaea racemosa) Cinacalcet, 556 Cipro \202 oxacin, in diabetic feet infection control, 639 hyperthyroidism, 21, 23 dose and effectiveness Chemotherapy, 549 of, 21 \200\2232 for maternal for pheochromocytomas/ paragangliomas, 219 hyperthyroidism, 347 \200\2238 for primary hypogonadism, 291 Carbohydrate absorption Clavulanic acid, in diabetic feet infection control, 639 Chernobyl nuclear explosion, 67 inhibitors, 579 Carcinoid heart disease, Children 466 Clindamycin, in diabetic feet infection control, 639 growth regulation in, 430 hyperthyroidism in clinical features of, 35 epidemiology of, 35 i nvestigations for, 35 treatment for, 35 thyroid cancer in, 77 Chlorpropamide, for Carcinoid tumors, 464, 465, 466 Clo \201 brate classi \201cation of, 465 de \201ned, 465 diagnostic investigations in \202 uence on thyroid function tests, 8 for neurogenic diabetes for, 467 incidence of, 465 perioperative insipidus, 154 Clomifene citrate for gynegomastia, 305 for infertility, 236, 328 \200\2239 neurogenic diabetes insipidus, 154 Cholecalcifero, 399 Cholesterol absorption blocker, 682 \200\2233 management of, 469 prognosis of, 469 \200\22371 treatment for, 469 \200\22371 tumor localization and staging o f, 468 Clomifene stimulation test, for male primary hypogonadism, 295 119-Draznin-Index.indd 703 4/2/2011 8:17:20 PM INDEX 704 intrauterine enzyme de \201 ciencies Clonidine contraceptive devices, 647 in, 243 for primary epidemiology of, 239 genetic advice, 459 hormonal therapy, hyperaldosteronism, 174 oral contraceptives, 645 \200\2236 suppression test, for Conventional external beam radiation, for pituitary tumors, 147. See also Radiotherapy monitoring of, 461 pheochromocytoma, 215, 216, 214 11B-hydroxylase de \201ciency ( 5%), 49 for vasomotor 17A-hydrolxylase de \201ciency, 460 symptoms, 268 Coronary heart disease Cocaine (CHD) 21-hydroxylase associated with secondary hypogonadism, 287 for hyperprolactinemia, lipid measurements, 663 lipid pro \201 le, 663 risk, assessment of, 663 risk factors of, 6 62 Corticosteroids, for chronic \201 brosing (Riedel \200\231s) thyroiditis, 51 de \201ciency, 459 3B-hydroxysteroid dehydrogenase de \201ciency, 460 laboratory evaluati on 105 Colchicines, for primary hypogonadism, 291 Colestyramine, for thyroid for, 242 ACTH levels, 242 androgen levels, 242 non-classic CAH \200\224 Corticotropes, 84 de \201 ciency, 91 \200\2232 basal testing for, 91 cosyntropin stimulati on crisis, 28 \200\2239 Colon cancer, effect of 17OHP measurement, diagnosis of, 242 hormone replacement therapy in, 269. See also Cancer test for, 91, 92 insulin tolerance test renin levels, 242 management of, 244 \200\2236, Complementary therapy, and endocrinology, 577 for, 91 460 \200\2231 classic, 244 nonclassic, 244 monitoring of treatment, metyrapone test for, 91 stimuation testing for, 91 Computed tomography (CT) Corticotropin-releasing hormone (CRH), 85, 575. See also Dexamethasone- corticotropin-relea sing hormone suppression test, for Cushing \200\231s syndrome abdominal, for Cushing \200\231s disease, 120, 121 for adrenal Cushing \200\231s syndrome, 185 of adrenal glands, 168 chest, for Cushing \200\231s disease, 121 246 pathogenesis of, 239 genetics, 239 during pregnancy, 245 \200\2236 prognosis of, 247 speci \201c investigations for, 459 for craniopharyngioma, test for Cushing \200\231s disease, 121 steroid acute regulatory 88, 131 for Graves \200\231 protein, 460 Cortisone acetate, Congenital adrenal ophthalmopathy, 40 for multinodular goiter, 46 for pheochromocytoma, for glucocorticoid de \201 ciencies, 206 Cortrosyn stimulation test (CST), 561 \200\2232 for glucocorticoid de \201 ciencies, 207 hypoplasia (CAH), 286 associated with primary adrenal insuf \201 ciency, 196 \200\2237 216 for primary Congenital hypothyroidism, hyperaldosteronism, 179 4, 60. See also Hypothyroidism clinical features of, 60 laboratory tests for, 60 Pendred \200\231s syndrome, 60 thyroid agenesis, 60 thyroid hormone dysgenesis, 60 treatment for, 6 1 for Rathke \200\231s cleft cysts, 88 for thyroid disease, 14 for perioperative management of patients undergoing adrenalectomy, 189 Congenital adrenal hyperplasia (CAH), 192, 363, 459. See also Adrenal hyperplasia for primary adrenal insuf \201 ciency, 200 Cosyntropin stimulation test, for corticotrope de \201 ciency, 91, 92 Cowden syndrome, 497 clinical presentation adrenal steroid biosynthesis pathway, 240 Conivaptan, for syndrome of inappropriate ADH, 160 in adults, 239 associated with primary adrenal insuf \201 ciency, 196 \200\2237 Conn \200\231s syndrome, 171 Connective tissue and joint of, 497 endocrine features disease, 650 biochemistry of, 240 clinical presentation, 241 classic, 241 nonclassic, 241 de \201 ned, 239 of, 497 Contraception, 645 \200\2237 genetic factors associated barrier methods, 646 \200\2237 hormone replacement with, 497 incidence of, 497 therapy, 647 Craniopharyngiomas, 130 119-Draznin-Index.indd 704 4/2/2011 8:17:20 PM INDEX 705 dexamethasone clinical features of, 130 clinical investigations renal disease, 556 \200\2237 adrenal, 557 calcitriol, 556 gonadal function, 557 growth horm one and suppression test, 121 diagnostic algorithm for, 131 for, 119 epidemiology of, 130 follow-up of, 131 magnetic resonance imaging for, 88 management of, 13 1 pathology of, 130 Craniotomy, 561 \200\2233 differential diagnosis of, 116 growth retardation, 557 due to ectopic ACTH production, 552 \200\2233 epidemiology of, 116 etiologies of, 116 follo w-up of, 124 inferior petrosal sinus sampling for, 120 management of, 356 \200\2237 medical therapies for, parathyroid hormone (PTH) and enal osteodystrophy, 556 prolactin, 557 thyroid, 557 TSH and thyroid hormones, 559 Cryopreservation, fertility, and cancer treatment, 331 postoperative assessment of, 562 \200\2233 postoperative glucocorticoid management for, 562 \200\2233 122, 123 pituitary imaging for, preoperative assessment 119 \200\22320 Cryptorchidism, 290 Cushing \200\231s disease (CD), of, 561 \200\2232 pituitary radiotherapy Creatinine excretion ratio, calculation of, 374 Creatinine kinase, 15 Critical illness, for, 122 in pregnancy, 116 abdominal CT for, 120, complications of, 356 121 screening tests for, 118 in secondary adrenalectomy for, 122 chest CT/MRI, 121 corticotropin-releasing hormone test, 121 endocrinology of, 544 ACTH and cortisol, hyperlipidemias, 675 558 \200\2239 AIDS, 544 \200\2238 adrenal, 545 \200\2236 electrolyte disturbance due to end ocrine perturbation, 547 serum potassium test for, 121 de \201 ned, 116 dexamethasone steroid replacement for, 207 subclinical, 184 suppression tests for, 92 transsphenoidal surgery suppression test, 121 differential diagnosis gonads, 546 \200\2237 lipodystrophy, 545 pituitary, 548 thyroid dysfunction, of, 116 for, 122 epidemiology of, 116 etiologies of, 116 follow-up of, 124 inferior petrosal sinus sampling for, 120 medical therapies for, Cyclin D/E mutations, associated with pituitary adenomas, 102 547 \200\2238 wasting syndrome, 544 \200\2235 cancer, 549 anticancer chemotherapy, Cyclophosphamide, for pheochromocytomas/ paragangliomas, 219 122, 123 549 Cyclosporine A, pituitary imaging for, radiotherapy, 549 ectopic hormone production, syndromes of, 550 \200\2233 Cushing \200\231s syndrome due to ectopic ACTH production, 552 \200\2233 for lymphocytic hypophysitis, 137 Cytokine modulators, 545 Cytotoxic T-lymphocyte antigen 4 (CTLA-4), associated with Graves \200\231 disease, 17 119 \200\22320 pituitary radiotherapy for, 122 serum potassium test for, 121 transsphenoidal surgery for, 122 de \201ned, 550 malignancy, humeral Cushing \200\231s syndrome (CS), Dacarbazine, for 356 \200\2237 hypercalcemia of, 552 pheochromocytomas/ paragangliomas, 219 Danazol, for gynecomastia, abdominal CT for, 120, SIADH due to ectopic 121 vasopressin production, 550 \200\2232 adrenal. See Adrenal 305 Cushing \200\231s syndrome adrenalectomy for, 122 causes of, 118 endogenous, 117 chest CT/M RI, 121 clinical features of, 117 corticotropin-releasing hormone test, 121 gonadotropins and Decongestants, for gonadal steroids, 559 pheochromocytoma, 214 growth hormone, 559 and hormone Dehydroepiandrosterone (DHEA), 541, 584 for Addison \200\231s disease, replacement, 559 liver disease, 554 \200\2235 adrenal hormones, 555 sex hormones, 554 \200\2235 thyroid, 555 metabolism, 559 203 for glucocorticoid de \201 ciencies, 207 CRH test for, 91 de \201 ned, 116 119-Draznin-Index.indd 705 4/2/2011 8:17:20 PM INDEX 706 type 1, 587 type 2, 587 suppression test, for Dehydroepiandrosterone sulfate (DHEAS), 361, 541 Cushing \200\231s syndrome, 92, 118, 121 Dexamethasone- Diabetic amyotrophy. See Proximal motor neuropathy Delayed puberty, 453. See corticotropin-releasing hormone (DEX-CRH) suppression test, for Cushing \200\231s syndrome, 92 also Puberty causes of, 453 clinical investigations for, Diabetic cheiroarthropathy, 650 Diabetic eye disease, 604 clinical and histological features of, 605 \200\2236 epidemiology of, 604 eye screening, 607 \200\2238 surgery for, 610 \200\22311 ca taract extraction, 611 laser treatment, 610 vitrectomy, 611 treatment for, 609 \200\22310 453 \200\2234 de \201ned, 453 management of, 453 Diabetes duration, as diabetic foot risk factor, 637 Dementia, associated with Diabetes insipidus (DI), menopause, 266 Denosumab (Prolia), 151 classi \201 cation of, 151 clinical features of, 152 de \201 ned, 151 diagnosis of, 153 e tiologies of, 152 treatment for, 154 adequate \202 uid input, 413 \200\22315 Dent \200\231s disease, 510 Deoxycorticosterone (DOC) excess, 183. See also Mineralocorticoid excess Diabetic foot, 636 clinical features of, 636 risk factors of, 637 treatment for, 638 \200\22340 Wagner \200 \231s classi \201 cation Deoxypyridinoline cross- maintenance of, 154 links, 369 drug therapy, 154 water deprivation test Depot octreotide, for Graves \200\231 ophthalmopathy, 41 de Quervain thyroiditis, 49, 51. S ee also Thyroiditis of, 636 Diabetic ketoacidosis, for, 153 caveats for, 155 651 \200\2234 additional therapies Diabetes mellitus, 586 background, 586 classi \201 cation of, 587, of, 653 interleukin 2-induced thyroiditis, 5 interferon-A-induced thyroiditis, 52 lithium-induced t hyroiditis, 52 scintiscanning for, 12 Desamino-D-arginine clinical features of, 651 diagnosis of, 651 \200\2232 epidemiology of, 652 initial treatmen t for, 654 management of, 652 monitoring of, 653 pathogenesis of, 652 precipitants of, 653 subsequent treatment 588 \200\2239 as coronary heart disease risk factor, 662 diagnosis of, 586 general management and treatment for, 593 background, 593 dietary advice, 595 insulin, 599, 600 newly diagnosed patients, assessment of, 594 \200\2235 oral hypoglycemic agents, vasopressin, 562. See also Vasopressin for, 654 Desmopressin Diabetic maculopathy, 606 Diabetic nephropathy, (1-deamino-8-D- arginine-vasopressin), for neurogenic diabetes insipidus, 54 Desogestrel, 2 75 612, 619 autonomic neuropathy, 595 \200\2239 624 \200\2236 suggested aims of, 600 genetic syndromes associated with, 587, 590 classi \201 cation of, 619 de \201 ned, 619 pathogenesis of, 620 pathology of, 619 periph eral sensorimotor neuropathy, 621 Diabetic patients, newly diagnosed, 594 \200\2235 examina tion of, 594 history of, 594 treatment for, 594 \200\2235 Diabetic renal disease, 612 for amenorrhea, 236 Dexamethasone for Addison \200\231s disease, 203 for anterior pituitary and hypertension, 632 epidemiology of, 632 management of, 632 \200\2233 pathogenesis of, 63 2 treatment for, 633 \200\2235 and lipid abnormalities in, hormone de \201 ciencies, 98, 99 for apparent mineralocorticoid excess, 183 629 \200\22331 for congenital adrenal hyperplasia, 245 investigations of, 631 lipid reduction studies, for diabetic ketoacidosis, background, 612 de \201 ned, 612 diagnosis of, 613 epidemiology of, 613 natural history of , 615 pathogenesis of, 614 \200\22315 pathology of, 614 treatment for, 616 \200\22318 630 653 management of, 629 \200\22333 treatment aims for, 631 during pregnancy, 641 background, 641 monitoring during pregnancy, 643 for glucocorticoid de \201 ciencies, 206 for primary aldosteronism, 176 for primary hyperaldosteronism, 180 risks, 641 119-Draznin-Index.indd 706 4/2/2011 8:17:20 PM INDEX 707 SIADH due to ectopic for diabetic ketoacidosis, blood pressure control, vasopressin production, 550 \200\2232 653 616 on fetus, effect of, 354 for gonadotropinomas, dietary protein Ectopic thyroid tissue, 18 E \202 ornithine, for polycystic ovary syndrome, 235 Ellsworth \200\223Howard test, restriction, 617 126 glycemic control, 616 \200\22317 lipid lowering, 617 Diabetic retinopathy, classi \201 cat ion and features of, 605 for hyperprolactinemia, 106, 107 modi \201 ed, 393 Empty sella syndrome in \202 uence on thyroid function tests, 8 for prolactinomas, 103, (ESS), 95 Diazoxide, for Enalapril, for diabetic renal 144 pheochromocytoma, 214 disease, 616 Endocrine disorders, formulations/doses, 144 mechanism of action, Diet and dietary advice for dyslipidemia, differential diagnosis of, 571 \202 ushing, 572 general malaise, tiredness, 572 palpitati ons, 571 \200\2232 sweating, 571 144 management of, 677 \200\2238 and obesity management, side effects of, 144 Down syndrome, antibody 530 \200\2231 for secondary screening for, 10 Doxazosin, for primary hyperlipidemias, 675 Dietary phytoestrogens, effect on menopausal women, 273 hyperaldosteronism, 174 Doxycycline, for acne, 237 Drug-induced thyroiditis. See also Thyro iditis Endocrine disorders and osteoporosis, 407 \200\2238 Endocrine tests, for thyroid Differentiated thyroid causes of, 49, 52 characteristics of, 49 cancer (DTC), TNM staging for, 69 Diffuse glomerular sclerosis, 614 Digoxin, for thyroid disease, 15 Endocrine tumors, Dual energy associated with carney complex syndrome, 496 absorptiometry (DXA), for bone density measurement, 371 Endocrinology and aging, crisis, 28 534 Dual-energy X-ray Dihydrotestosterone, 455 Dipeptidyl peptidase-4 (DPP-4), 598 \200\2239 Dipsogenic diabetes adrenal function, 541 aldosterone, 535 \200\2236 cortisol, 541 dehydroepiandrosterone absorptiometry (DXA), 410 Duloxetine, for peripheral sensorimotor neuropathy, 623 insipidus, 151. See also Diabetes insipidus clinical features of, 152 diagnosis of, 153 eti ologies of, 152 sulfate, 541 bone disease, 537 osteoporosis, 537 Paget \200\231s disease, see Paget \200 \231s disease Dyslipidemia associated with polycystic ovary syndrome, 230 management of, 685 aim of treatment, 684 background, 677 dietary advice, 677 \200\2238 drug therapy for, 678 \200\22383 physical activity, 678 primary and secondary prevention of, 67 7 \200\2238 Disorders of sex primary development (DSD), 457 \200\2238 hyperparathyroidism, 537 ambiguous genitalia, vitamin D de \201ciency and osteomalacia, 537 \202 uid and electrolyte management of, 458 46XX DSD, 457 46XY DSD, 457 \200\2238 homeostasis, 535 \200\2236 Diuretics hypernatremia and dehydration, 535 hyponatremia, 535 \200\2236 vasopressin and ADH, 535 gon adal function, 538 men, 539 \200\22340 women, 539 growth hormone and weight control, 678 potassium-sparing, for Bartter \200\231s syndrome, 191 for primary Ectopic ACTH production, 552 \200\2233 Ectopic ACTH syndrome, hyperaldosteronism, 174, 180 183. See also Mineralocorticoid excess Dobutamine, for diabetic ketoacidosis, 653 IGF-1, 538 Ectopic hormone Domperidone thyroid disease, 542 abnormal thyroid production, syndromes of, 550 \200\2233