By Anil Bhansali, Yashpal Gogate
This ebook covers attention-grabbing and but frequently difficult situations between grownup sufferers in a distinct Question-Answer layout. Simulating the bed-side case discussions in the course of the ward rounds, one query logically results in one other query thereby producing interest and selling evidence-based medication. Taking the readers during the complete spectrum ranging from etiology and pathophysiology to medical presentation to administration ideas, each one query addresses one key element of the affliction. defined in a very easy and lucid narrative, this booklet guarantees sound conceptual figuring out whereas protecting each one subject comprehensively. This quantity covers vital themes resembling acromegaly, Cushing syndrome, osteoporosis, hypercalcemia, pheochromocytoma, hyperaldosteronism, thyroid problems and diabetes in grownup sufferers. those circumstances aren't in simple terms noticeable through endocrinologists, yet also are controlled by way of internists, orthopedic surgeons, obstetricians and gynecologists. much less universal problems equivalent to adrenal issues and androgen extra have additionally been coated.
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Extra resources for Clinical Rounds in Endocrinology: Volume I - Adult Endocrinology
It is difficult to make a diagnosis of acromegaly during pregnancy. Biochemical abnormalities like non-suppressible GH after glucose load and mildly elevated IGF1 occur in normal pregnancy due to placental production of GH. However, 2 Acromegaly: Diagnosis and Treatment 37 in patients of acromegaly with pregnancy, serum IGF1 is highly elevated and can help in establishing the diagnosis. Despite of active disease during pregnancy, signs and symptoms of acromegaly usually do not worsen because of a relative GH-resistant state due to rising estrogen levels during pregnancy.
Suggested Reading 1. Jameson JL, De Groot LJ. Endocrinology: adult and pediatric. Philadelphia: Elsevier Health Sciences; 2010. 2. Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly-2011 update. Endocr Pract. 2011;17:1–44. 3. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. New York: McGraw Hill Professional; 2012.
In macroadenomas, headache is caused by stretching of the dura (supplied by ophthalmic division of the trigeminal nerve) due to suprasellar extension of tumor or direct involvement of the trigeminal nerve due to cavernous sinus invasion. Other causes of headache related to acromegaly per se, irrespective of tumor size, include calvarial thickening leading to periosteal stretch, osteomas, recurrent sinusitis, and secretion of putative algesic peptides by the tumor tissue. Causes of acute-onset severe headache in a patient with acromegaly include pituitary apoplexy, aneurysmal rupture, or rarely, raised intracranial tension due to hydrocephalus.