Hypoparathyroidism and Pseudohypoparathyroidism

ABSTRACT In primary hypoparathyroidism with hypocalcemia and hyperphosphatemia, deficient parathyroid hormone (PTH) secretion most commonly occurs from surgical excision of, or damage to, the parathyroid glands. The term idiopathic hypoparathyroidism describes isolated cases when a cause is not obvious and there is no family history. However, hypoparathyroidism is also a feature common to a variety […]

Atypical Forms of Diabetes

ABSTRACT   While most patients with diabetes have Type 1 or Type 2 diabetes there are other etiologies of diabetes that occur less frequently. In this chapter we will discuss a number of these less-common causes of diabetes. It is clinically very important to recognize these uncommon causes of diabetes as treatment directed towards the […]

Clinical Guidelines in Endocrinology

Dace Trence, MD, FACE, Division of Metabolism, Endocrinology, and Nutrition, Director, Endocrine Fellowship Program, Director, Diabetes Care Center, University of Washington Medical Center UPDATED: February 25, 2019 Topics are listed in categories in the following arbitrary order– Diabetes, Adrenal, Thyroid, Pituitary, Male Endocrinology, Female Endocrinology, Obesity, Bones and Mineral Disease Lipids, Miscellaneous DIABETES ADA Standards […]

Thyroid Nodules and Cancer in the Elderly

ABSTRACT   Thyroid nodules and cancer are common in elderly patients and demonstrate age-specific prevalence, malignancy risk, and clinical behavior. Improved risk stratification by ultrasound characteristics and molecular testing of thyroid nodules has reduced the need for diagnostic surgery. Surgery, radioactive iodine ablation, and thyroid hormone suppression remain the cornerstones of differentiated thyroid cancer treatment. […]

Calcium and Phosphate Metabolism and Related Disorders During Pregnancy and Lactation

ABSTRACT Pregnancy and lactation require women to provide calcium to the fetus and neonate in amounts that may exceed their normal daily intake. Specific adaptations are invoked within each time period to meet the fetal, neonatal, and maternal calcium requirements. During pregnancy, intestinal calcium absorption more than doubles, and this appears to be the main […]

Primary Disorders of Phosphate Metabolism

ABSTRACT   Phosphorus is critical to many functions in human biology. Deprivation of phosphorus may manifest as disorders of the musculoskeletal system, reflecting its important role in energy metabolism and skeletal mineralization. Phosphorus excess can promote heterotopic mineralization and is associated with mortality, particularly in the setting of chronic kidney disease. Inorganic phosphorus, primarily occurring […]

Adrenal Insufficiency

CLINICAL RECOGNITION   Adrenal insufficiency (AI) is a disorder characterized by the failure of adrenocortical function resulting mainly in impaired secretion of glucocorticoids (GCs) only or of GCs and mineralocorticoids (MCs), hormones crucial for energy, salt and fluid homeostasis. The disorder may be caused by an adrenocortical disease (primary AI, known as Addison’s disease), which […]

Hypocalcemia

CLINICAL RECOGNITION   Hypocalcemia can occur acutely over minutes to hours or chronically over weeks to months. Correspondingly, the signs and symptoms of hypocalcaemia can develop acutely or chronically and can be life-threatening. The clinical manifestations of hypocalcemia are due to the increased neuromuscular tingling in the extremities and around the mouth. Chvostek’s and Trousseau’s […]

Hyperparathyroidism in Chronic Kidney Disease

ABSTRACT   Chronic kidney disease (CKD) isassociatedwith amineraland bonedisorder(CKD-MBD)whichstarts early in the course of the disease and worsens with its progression. The main initial serum biochemistry abnormalities are increases in fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH) and decreases in 1,25 dihydroxy vitamin D (calcitriol) and soluble a-Klotho (Klotho), allowing serum calcium and […]

Osteoporosis: Clinical Evaluation

ABSTRACT   The identification of a patient at high risk of fracture should be followed by evaluation for factors contributing to low bone mass, skeletal fragility, falls, and fractures. Components of the evaluation include a bone density test, osteoporosis-directed medical history and physical exam, laboratory studies, and possibly skeletal imaging. A bone density test with […]