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# EndoText

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- [Webinar Case Studies](https://www.endotext.org/case-studies/) - Webinar Case Studies Home » Webinar Case Studies Webinars On Endocrine Topics Built Around Case Studies Please Note: Webinars may take a longer time to load Pediatric Bone Diseases September 15, 2021 Tropical Endocrinology August 25, 2021 Neuroendocrine Tumors July 20, 2021 Diabetes Mellitus June 22, 2021 Obesity May 26, 2021 Pediatric Lipidology May 4,
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- [Country Associates](https://www.endotext.org/country-associates/) - Country Associates Home » Country Associates We are fortunate to have the collaboration of a group of physicians from around the world who are helping to bring www.endotext.org to the attention of endocrinologists in their home country. We are deeply grateful for their efforts, and hope that in time ENDOTEXT will be available and used
- [Clinical Guidelines](https://www.endotext.org/clinical-guidelines/) - Clinical Guidelines Home » Clinical Guidelines Clinical Guidelines in Endocrinology Dace Trence, MD, FACE, Professor of Medicine-Emeritus, Division of Metabolism, Endocrinology, and Nutrition, University of Washington Medical Center UPDATED: February 13, 2025 Topics are listed in categories in the following arbitrary order: AllAdrenalBone and Mineral DiseaseDiabetesFemale EndocrinologyLipidsMale EndocrinologyMiscellaneousObesity/NutritionPituitaryThyroidAdrenalDiagnosis and Therapy of Glucocorticoid-Induced Adrenal InsufficiencyPublished: JCEM
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## Country Associates

- [Ibrahim Salti](https://www.endotext.org/country_associate/ibrahim-salti/)
- [Murat Erdogan](https://www.endotext.org/country_associate/murat-erdogan/)
- [Valerio Renzelli](https://www.endotext.org/country_associate/valerio-renzelli/)
- [Enrico Papini](https://www.endotext.org/country_associate/enrico-papini/)
- [Francisco Bandeira](https://www.endotext.org/country_associate/francisco-bandeira/)
- [Mia Fojas](https://www.endotext.org/country_associate/mia-fojas/)
- [Dario Giuffrida…](https://www.endotext.org/country_associate/dario-giuffrida/)
- [Gerry Tan](https://www.endotext.org/country_associate/gerry-tan/)
- [Mahir Jallo](https://www.endotext.org/country_associate/mahir-jallo/)
- [Juan Francisco Fierro-Renoy, M.D.](https://www.endotext.org/country_associate/juan-francisco-fierro-renoy-m-d/)
- [Rue-Tsuan Liu, M.D.](https://www.endotext.org/country_associate/rue-tsuan-liu-m-d/)
- [Valeria Guimaraes, M.D.](https://www.endotext.org/country_associate/valeria-guimaraes-m-d/)
- [Metin Ozata, M.D.](https://www.endotext.org/country_associate/metin-ozata-m-d/)
- [Edward Limbert, M.D.](https://www.endotext.org/country_associate/edward-limbert-m-d/)
- [M. Helena Cardoso, MD, PhD](https://www.endotext.org/country_associate/m-helena-cardoso-md-phd/)
- [Jan Erik Varhaug, MD](https://www.endotext.org/country_associate/jan-erik-varhaug-md/)
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- [Abdel Kader Traore, MD](https://www.endotext.org/country_associate/abdel-kader-traore-md/)
- [Feredoun Azizi, MD](https://www.endotext.org/country_associate/feredoun-azizi-md/)
- [Dr. Daphne Khoo MBBS, MMed (Int Med) FAMS, FRCP (Ed)](https://www.endotext.org/country_associate/dr-daphne-khoo-mbbs-mmed-int-med-fams-frcp-ed/)
- [Bingyin Shi, MD](https://www.endotext.org/country_associate/bingyin-shi-md/)
- [Ampica Manglabruks](https://www.endotext.org/country_associate/ampica-manglabruks/)
- [Marie Yvette Amante, MD](https://www.endotext.org/country_associate/marie-yvette-amante-md/)
- [Rosane Abramof.Ness, MD](https://www.endotext.org/country_associate/rosane-abramof-ness-md/)
- [Dr Ayoade Adedokun](https://www.endotext.org/country_associate/dr-ayoade-adedokun/)
- [Dr Goran Wallin](https://www.endotext.org/country_associate/dr-goran-wallin/)
- [Dr Corin Badiu](https://www.endotext.org/country_associate/dr-corin-badiu/)
- [Dr Luis E Mendez Abvalos](https://www.endotext.org/country_associate/dr-luis-e-mendez-abvalos/)
- [Mary Vinocour, MD](https://www.endotext.org/country_associate/mary-vinocour-md/)
- [Mihail Coculescu, MD](https://www.endotext.org/country_associate/mihail-coculescu-md/)
- [Dr Rene Miguel Baez Robiou](https://www.endotext.org/country_associate/dr-rene-miguel-baez-robiou/)
- [Dr Maria Alejandra Aponte Farias](https://www.endotext.org/country_associate/dr-maria-alejandra-aponte-farias/)
- [Dr Martha Gomez Cuellar](https://www.endotext.org/country_associate/dr-martha-gomez-cuellar/)
- [Bojan S. Lozanov, MD PhD](https://www.endotext.org/country_associate/bojan-s-lozanov-md-phd/)
- [Dr. ibrahim Mokhtar](https://www.endotext.org/country_associate/dr-ibrahim-mokhtar/)
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- [Dra Martha Gomez Cuellar](https://www.endotext.org/country_associate/dra-martha-gomez-cuellar/)
- [Dr Douglas Villarroel](https://www.endotext.org/country_associate/dr-douglas-villarroel/)
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- [Katherine Araque, MD](https://www.endotext.org/country_associate/katherine-araque-md/)
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- [Daniel Bulzico, MD](https://www.endotext.org/country_associate/daniel-bulzico-md/)
- [Dr. Carlos R. Arguello, M.D., F.A.C.E.](https://www.endotext.org/country_associate/dr-carlos-r-arguello-m-d-f-a-c-e/)
- [Daniela Voicu, MD](https://www.endotext.org/country_associate/daniela-voicu-md/)
- [Sriharsha tella, MD](https://www.endotext.org/country_associate/sriharsha-tella-md/)
- [Salem Beshyah](https://www.endotext.org/country_associate/salem-beshyah/)
- [Ana Gonçalves](https://www.endotext.org/country_associate/ana-goncalves/)
- [Nasrin Goolam Mahyoodeen](https://www.endotext.org/country_associate/nasrin-goolam-mahyoodeen/)
- [Ritu Madan](https://www.endotext.org/country_associate/ritu-madan/)
- [Saxon, David](https://www.endotext.org/country_associate/saxon-david/)
- [Shivaswamy, Vijay](https://www.endotext.org/country_associate/shivaswamy-vijay/)
- [Farid Fawzy, MD, PhD](https://www.endotext.org/country_associate/farid-fawzy-md-phd/)
- [Sam Lockhart](https://www.endotext.org/country_associate/sam-lockhart/)
- [Daniel Zuniga](https://www.endotext.org/country_associate/daniel-zuniga/)
- [Sajjad Ali Khan](https://www.endotext.org/country_associate/sajjad-ali-khan/)
- [Niyoti Khilare](https://www.endotext.org/country_associate/niyoti-khilare/)
- [Paul Namrata](https://www.endotext.org/country_associate/paul-namrata/)
- [Sanjay Kalra](https://www.endotext.org/country_associate/sanjay-kalra/)
- [Dr RUKUNDO Jean Damascene](https://www.endotext.org/country_associate/dr-rukundo-jean-damascene/)
- [Sakthivel Sivasubramainan, MD, DM](https://www.endotext.org/country_associate/sakthivel-sivasubramainan-md-dm/)
- [A.B.M. Kamrul Hasan](https://www.endotext.org/country_associate/a-b-m-kamrul-hasan/)
- [Rebecca C. Pierson, MD, FACOG](https://www.endotext.org/country_associate/rebecca-c-pierson-md-facog/)
- [Andrew Jamieson MB ChB(Hons) BSc(Hons) PhD MRCP(UK) FRCPGlasg AFHEA](https://www.endotext.org/country_associate/andrew-jamieson-mb-chbhons-bschons-phd-mrcpuk-frcpglasg-afhea/)
- [Dr. S.M. Hue, Raymond](https://www.endotext.org/country_associate/dr-s-m-hue-raymond/)
- [Nauman Arif Jadoon, MRCP, MAcadMed, FHEA, FRSPH](https://www.endotext.org/country_associate/nauman-arif-jadoon-mrcp-macadmed-fhea-frsph/)
- [Dr. Muhammad Zubair](https://www.endotext.org/country_associate/dr-muhammad-zubair/)
- [Dr. Thiago Artioli](https://www.endotext.org/country_associate/dr-thiago-artioli/)
- [Nadjib Kaouache, PhD](https://www.endotext.org/country_associate/nadjib-kaouache-phd/)
- [Federico Hawkins Carranza](https://www.endotext.org/country_associate/federico-hawkins-carranza/)
- [Mohammed Jawad](https://www.endotext.org/country_associate/mohammed-jawad/)

## Chapters

- [Combined Dyslipidemia in Children and Adolescents](https://www.endotext.org/chapter/combined-dyslipidemia-in-children-and-adolescents/) - ABSTRACT Combined dyslipidemia (CD) is now the predominant hyperlipidemic pattern in childhood, characterized by moderate to severe elevation in triglycerides (TG) and non-high-density lipoprotein cholesterol (non-HDL-C) with reduced high-density lipoprotein cholesterol (HDL-C). In youth, CD occurs almost exclusively with obesity and is highly prevalent, seen in 30-60% of obese adolescents. With nuclear magnetic resonance spectroscopy,
- [Emergencies Related To Pheochromocytoma/ Paraganglioma Syndrome](https://www.endotext.org/chapter/emergencies-related-to-pheochromocytoma-paraganglioma-syndrome/) - INTRODUCTION Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare chromaffin cells tumors (PPGLs) characterized by the production, storage, metabolism, and secretion of catecholamines and their metabolites, metanephrines and methoxytyramine. These tumors can raise significant challenges in clinical recognition, diagnosis, and therapy and when undiagnosed can result in severe morbidity as well as mortality, especially due to
- [Dyslipidemia in Patients With Diabetes](https://www.endotext.org/chapter/dyslipidemia-in-patients-with-diabetes/) - ABSTRACT Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality in both men and women with T1D and T2D. Many cardiovascular risk factors increase the risk of ASCVD and this chapter focuses on the important role of lipids/lipoproteins. It is widely accepted that LDL-C and non-HDL-C are causative factors for ASCVD
- [Role Of Glucose And Lipids In Atherosclerotic Cardiovascular Disease In Patients With Diabetes](https://www.endotext.org/chapter/role-of-glucose-and-lipids-in-atherosclerotic-cardiovascular-disease-in-patients-with-diabetes/) - ABSTRACT Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality in both men and women with T1D and T2D. In this chapter we review studies that determined the effect of improving glycemic control on ASCVD in both T1D and T2D. In patients with T1D, intensive glycemic control results in a reduction in
- [Pharmacologic Treatment of Overweight and Obesity in Adults](https://www.endotext.org/chapter/pharmacologic-treatment-of-overweight-and-obesity-in-adults/) - ABSTRACT Obesity pharmacotherapy has evolved significantly over the past 60 years. Today, six obesity medications (OMs) are approved by the Federal Drug Administration (FDA) for the long-term treatment of obesity. Similar in approach to other chronic diseases, OMs are indicated in combination with lifestyle modification for the management of overweight and obesity. Current guidelines
- [Thyroid Regulation and Dysfunction in the Pregnant Patient](https://www.endotext.org/chapter/thyroid-regulation-and-dysfunction-in-the-pregnant-patient-lazurus/) - ABSTRACT Thyroid disease in pregnancy is a common clinical problem. During the past 2 years significant clinical and scientific advances have occurred in the field. This chapter reviews the physiology of thyroid and pregnancy focusing on iodine requirements and advances in placental function. There follows discussion on thyroid function tests in pregnancy and their interpretation
- [Thyroid Regulation and Dysfunction in the Pregnant Patient](https://www.endotext.org/chapter/thyroid-regulation-and-dysfunction-in-the-pregnant-patient/) - ABSTRACT Thyroid dysfunction is common in pregnancy. This chapter reviews alterations in thyroid physiology during normal pregnancy. The interpretation of thyroid function tests in pregnancy is discussed. Preconception considerations for women with thyroid dysfunction and/or thyroid autoimmunity are described, including in the setting of infertility and with use of assisted reproductive technology. Subsequent sections describe
- [Neonatal Hyperthyroidism](https://www.endotext.org/chapter/neonatal-hyperthyroidism-3/) - ABSTRACT Neonatal hyperthyroidism is most commonly caused by neonatal Graves’ disease (NGD). NGD is a transient disorder resulting from the transplacental passage of maternal stimulatory thyrotropin (TSH) receptor antibodies (TRAbs), leading to neonatal hyperthyroidism. Although NGD occurs in only 1-5% of neonates born to mothers with Graves’ Disease (GD), it carries high mortality if
- [Neonatal Hyperthyroidism](https://www.endotext.org/chapter/neonatal-hyperthyroidism-2/) - INTRODUCTION Neonatal Hyperthyroidism is a rare neonatal endocrine condition with an estimated prevalence of 1:50000 (1). The most common cause is maternal thyroid autoimmune disorders, mainly Graves' disease (GD), and is responsible for transient neonatal hyperthyroidism. The occurrence of thyrotoxicosis arising from excess iodine exposure (Jod–Basedow phenomenon) is extremely rare in newborns. Permanent neonatal hyperthyroidism
- [Management of Hospitalized Children with Severe Hypertriglyceridemia](https://www.endotext.org/chapter/management-of-hospitalized-children-with-severe-hypertriglyceridemia-2/) - ABSTRACT Severe hypertriglyceridemia (SHTG) is uncommon in children. Those with triglyceride (TG) levels greater than 1,000 mg/dL are likely to have a monogenic disorder affecting TG metabolism or a combination of polygenic and small-effect genetic variants that increase the risk of hypertriglyceridemia (HTG), in addition to other factors such as obesity and insulin resistance, poorly
- [Endocrine Hypertension](https://www.endotext.org/chapter/endocrine-hypertension/) - CLINICAL RECOGNITION Hypertension is defined differently by various societies with a blood pressure exceeding 139/89 mm Hg for adults aged 18 years or older generally considered being elevated, based on the mean of 2 or more properly measured seated BP readings on each of 2 or more office visits. Hypertension affects approximately 31% of
- [Management of Hospitalized Children with Severe Hypertriglyceridemia](https://www.endotext.org/chapter/management-of-hospitalized-children-with-severe-hypertriglyceridemia/) - ABSTRACT Severe hypertriglyceridemia (SHTG) is uncommon in children. Those with triglyceride (TG) levels greater than 1,000 mg/dL are likely to have a monogenic disorder affecting TG metabolism or a combination of polygenic and small-effect genetic variants that increase the risk of hypertriglyceridemia (HTG), in addition to other factors such as obesity and insulin resistance, poorly
- [PEDIATRIC EMERGENCIES](https://www.endotext.org/chapter/miscellaneous/)
- [Disorders of Sexual Differentiation in Newborns](https://www.endotext.org/chapter/ambiguous-genitalia-in-newborns/) - INTRODUCTION In 2006, new nomenclature for conditions previously referred to as intersex was proposed in a consensus statement from the Lawson Wilkins Pediatric Endocrine Society and European Society of Pediatric Endocrinology in response to advanced identification of molecular genetic causes of sex. Disorders of sexual differentiation (DSD) are congenital conditions within which the development
- [Congenital Adrenal Hyperplasia: Diagnosis and Emergency Treatment](https://www.endotext.org/chapter/congenital-adrenal-hyperplasia-diagnosis-and-emergency-treatment/) - CLINICAL RECOGNITION Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders that arise from defective steroidogenesis. The production of cortisol in the zona fasciculata of the adrenal cortex occurs in five major enzyme-mediated steps. CAH results from deficiency in any one of these enzymes. Impaired cortisol synthesis leads to chronic elevations of ACTH
- [Emergencies in Childhood Diabetes](https://www.endotext.org/chapter/acute-onset-of-diabetes-in-children/) - INTRODUCTION Diabetes Mellitus, after asthma, is the second most common chronic condition in children. It can be diagnosed at any age and the incidence has been rising. Type 1 Diabetes (T1D) is by far the most common type of diabetes in children and its incidence has been increasing slowly but steadily. By definition T1D
- [New Osteoporosis / Vertebral Compression Fractures](https://www.endotext.org/chapter/new-osteoporotic-vertebral-compression-fractures/) - CLINICAL RECOGNITION Osteoporosis is a prevalent disease characterized by reduced bone mass and architectural deterioration, which leads to structurally weakened bone and an increased risk of fragility fractures. A fragility fracture is defined as a fracture occurring with minimal trauma, such as falling from standing height. These fractures rise exponentially with age and most commonly
- [Disorders of Adrenal Glands and Sex Development in Children: Insights From the Tropics](https://www.endotext.org/chapter/disorders-of-adrenal-glands-and-sex-development-in-children-insights-from-the-tropics/) - ABSTRACT The adrenal gland is essential for survival, and its function is compartmentalized into specific zones. Disorders of the adrenal gland can be classified as those affecting the adrenal cortex or medulla. Pediatric adrenal disorders can have distinct presentations and etiologies in comparison to adults, such as adrenal insufficiency associated with genetic syndromes or Cushing’s
- [Fetal and Neonatal Cholesterol Metabolism](https://www.endotext.org/chapter/fetal-and-neonatal-cholesterol-metabolism/) - ABSTRACT Cholesterol is critical during in utero and early post-partum development as it is a structural component of every cell membrane, it is involved with numerous signaling events, and it is the precursor for key steroid hormones. Embryos, fetuses, and neonates have two sources of cholesterol, endogenous and exogenous. In the embryo and fetus, endogenous
- [Lysosomal Acid Lipase Deficiency](https://www.endotext.org/chapter/lysosomal-acid-lipase-deficiency/) - ABSTRACT Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive genetic disease with variable presentation which often leads to severe morbidity and mortality. More than 310 LIPA loss of function mutations have been identified, the most common reported mutation being a splice junction mutation in exon 8. The true prevalence of the disease is
- [Lysosomal Acid Lipase Deficiency](https://www.endotext.org/chapter/lysosomal-acid-lipase-deficiency-2/) - ABSTRACT Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive genetic disease with variable presentation which often leads to severe morbidity and mortality. More than 310 LIPA loss of function mutations have been identified, the most common reported mutation being a splice junction mutation in exon 8. The true prevalence of the disease is
- [Hypercalcemia](https://www.endotext.org/chapter/hypercalcemia/) - CLINICAL RECOGNITION Hypercalcemia can be defined as a serum calcium greater than 2 standard deviations above the normal mean in a reference laboratory. Calcium in the blood is normally transported: partly bound to plasma proteins (about 45%), notably to albumin; partly bound to small anions such as phosphate and citrate (about 10%); and partly in
- [Disorders of Pregnancy and Childhood](https://www.endotext.org/chapter/disorders-of-pregnancy-and-childhood/)
- [Sexual Dysfunction in Diabetes](https://www.endotext.org/chapter/sexual-dysfunction-in-diabetes/) - ABSTRACT Sexual dysfunction is a common but often underdiagnosed complication of diabetes, affecting both men and women through complex vascular, neurologic, hormonal, and psychosocial mechanisms. This chapter provides a detailed review of the pathophysiology, epidemiology, screening strategies, and treatment options for sexual dysfunction in individuals with diabetes. Erectile dysfunction (ED) is the most prevalent sexual
- [Physiology](https://www.endotext.org/chapter/physiology-2/)
- [Functional Anatomy of the Hypothalamus and Pituitary](https://www.endotext.org/chapter/functional-anatomy-of-the-hypothalamus-and-pituitary/) - ABSTRACT In mammals and man, historical investigation suggests that early recognition for a role of the hypothalamus as a site for integration of endocrine, autonomic and behavioral responses can be dated to the 2nd -18th centuries A.D. Although the hypothalamus comprises only 2% of the total brain volume, it is a key regulator of pituitary function and
- [Anatomy](https://www.endotext.org/chapter/anatomy/)
- [Visual Pathway Assessment In Pituitary Disease: Integrating Structure And Function](https://www.endotext.org/chapter/visual-pathway-assessment-in-pituitary-disease-integrating-structure-and-function/) - ABSTRACT Visual morbidity remains one of the most significant consequences of pituitary disease, and in many patients it is visual compromise, rather than hormone excess, that brings the tumor to clinical attention (1). While functioning adenomas may be detected through systemic effects of hormone hypersecretion, a large proportion of pituitary adenomas are clinically non-functioning (2).
- [Prostate Cancer Detection](https://www.endotext.org/chapter/test-5/) - ABSTRACT Prostate cancer is the second most common cause of male cancer deaths in Western countries. However, one of the most contentious topics in medicine continues to be whether testing for this very common tumor is in the best interests of individual patients. Although there is a spectrum of progression rates for this tumor, in
- [Adrenal Incidentalomas](https://www.endotext.org/chapter/test-3/) - ABSTRACT Wider application and technical improvement of abdominal imaging procedures in recent years, has led to the discovery of unsuspected adrenal tumors in an increasing frequency. These incidentally detected lesions, also called adrenal incidentalomas, have become a common clinical problem and need to be investigated for evidence of hormonal hypersecretion and/or malignancy. In this chapter,
- [Benign Prostate Disorders](https://www.endotext.org/chapter/test-4/) - ABSTRACT Benign prostatic hyperplasia (BPH) is among the commonest urological abnormalities affecting the aging male. The cause of the increase in prostatic volume is multifactorial, but current research has implicated hormonal aberrations. Clinical assessment of the patient is integral to determining the optimal treatment strategy. Exclusion of prostatic cancer and complications of BPH are
- [Thyroid Cancer In The Elderly](https://www.endotext.org/chapter/thyroid-cancer-in-the-elderly/) - ABSTRACT This article provides reviews and updates of thyroid cancer, with particular emphasis on aspects related to advanced age. After analyzing epidemiology and anatomical pathology, it addresses novel developments in molecular biology and biological markers and their impact on diagnosis and therapeutic selection. The main histological subtypes affecting older patients are reviewed in detail,
- [Miscellaneous](https://www.endotext.org/chapter/miscellaneous-3/)
- [Effects of the Environment, Chemicals and Drugs on Thyroid Function](https://www.endotext.org/chapter/effects-of-the-environment-chemicals-and-drugs-on-thyroid-function/) - ABSTRACT The sensitive and tightly regulated feedback control system, thyroid gland autoregulation, and the large intrathyroidal and extrathyroidal storage pools of thyroid hormone serve to provide a constant supply of thyroid hormone to peripheral tissues in the face of perturbations imposed by the external environment, chemicals and drugs, and a variety of diseases processes. The
- [The Non-Thyroidal Illness Syndrome](https://www.endotext.org/chapter/the-non-thyroidal-illness-syndrome/) - ABSTRACT NTIS refers to a syndrome found in seriously ill or starving patients with low fT3, usually elevated RT3, normal or low TSH, and if prolonged, low fT4. It is found in a high proportion of patients in the ICU setting, and correlates with a poor prognosis if TT4 is
- [Acute and Subacute, and Riedel’s Thyroiditis](https://www.endotext.org/chapter/acute-and-subacute-and-riedels-thyroiditis/) - ABSTRACT The thyroid, like any other structure, may be the seat of an acute or chronic suppurative or non-suppurative inflammation. Various systemic infiltrative disorders may leave their mark on the thyroid gland as well as elsewhere. Infectious thyroiditis is a rare condition, usually the result of bacterial invasion of the gland. Its signs are the
- [Parathyroid Function In the Elderly and Its Disorders](https://www.endotext.org/chapter/parathyroid-function-in-the-elderly-and-its-disorders/) - ABSTRACT Aging is accompanied by profound alterations in calcium and bone metabolism, many of which arise from changes in parathyroid hormone (PTH) regulation, secretion, age-related modifications of the physiology of PTH, and target-tissue responsiveness. With advancing age, reductions in vitamin D synthesis, impaired renal activation of 1,25(OH)₂D, and decreased intestinal calcium absorption contribute to a
- [Physiology And Diseases Of The Adrenal Glands In Older Adults](https://www.endotext.org/chapter/physiology-and-diseases-of-the-adrenal-glands-in-older-adults/) - ABSTRACT The adrenal glands are crucial to the maintenance of physiological homeostasis, contributing to the regulation of stress responses, electrolyte balance, and metabolic processes. This chapter provides an in-depth examination of the anatomical and physiological modifications in adrenal function that occur with aging and the implications of these changes for clinical assessment. It further
- [The Postmenopausal Woman](https://www.endotext.org/chapter/the-postmenopausal-women/) - ABSTRACT The menopausal transition marks a time of great variability in reproductive hormones, and this variability can be responsible for specific symptoms, such as hot flashes and mood disturbances. Once a woman who is more than 45 years old has gone for 12 months without a menstrual period, she is considered to be menopausal
- [Age-Related Changes in the Male Reproductive System](https://www.endotext.org/chapter/age-related-changes-in-the-male-reproductive-system/) - ABSTRACT In male mammals, changes at all levels of the hypothalamic-pituitary-testicular axis, including alterations in the GnRH pulse generator, gonadotropin secretion, and testicular steroidogenesis, in addition to alterations of feed-forward and feed-back relationships contribute to the age-related decline in circulating testosterone concentrations. The rate of age-related decline in testosterone levels is affected by the presence
- [The Epidemiology and Pathogenesis of Osteoporosis](https://www.endotext.org/chapter/the-epidemiology-and-pathogenesis-of-osteoporosis/) - ABSTRACT Osteoporosis is a multifactorial disorder associated with low bone mass and enhanced skeletal fragility. Although most prevalent in older females, some men are also at high risk. Risk factors in men and women include smoking, family history of fracture, age greater than 65 years, and low but also high BMI particularly in men.
- [Osteoporosis: Clinical Evaluation](https://www.endotext.org/chapter/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 dual-energy
- [Osteoporosis: Prevention and Treatment](https://www.endotext.org/chapter/osteoporosis-prevention-and-treatment/) - ABSTRACT Despite the health consequences of osteoporosis and the availability of effective treatments, it is under-diagnosed and under-treated. For example, although 90% of patients with hip fractures have osteoporosis, in 2007 only 20% of patients with fragility fractures were evaluated and treated. In a retrospective study of patients with hip fractures, less than 15% of
- [Clinical Problems Caused by Obesity](https://www.endotext.org/chapter/clinical-problems-caused-by-obesity/) - ABSTRACT Obesity constitutes a worldwide epidemic with prevalence rates which are increasing in most Western societies and in the developing world. By 2025, if this trend continues, the global obesity prevalence will reach 18% in men and exceed 21% in women. Furthermore, it is now well-established that obesity (depending on the degree, duration, and
- [Obesity In The Elderly](https://www.endotext.org/chapter/obesity-in-the-elderly/) - ABSTRACT As the proportion of population above age 65 grows, so too increases the prevalence of those individuals who are obese. This phenomenon of an elderly population with obesity is the source of much research and debate with regards to treatment recommendations. It appears that older individuals on the extreme ends of the BMI
- [Pediatric Endocrinology- A Tropical Perspective](https://www.endotext.org/chapter/pediatric-endocrinology-a-tropical-perspective/) - ABSTRACT Pediatric endocrine disorders are frequently seen in tropical countries. While broadly the spectrum of pediatric endocrine disorders in the tropics is not entirely different from that seen in other parts of the world, some aspects of these disorders are unique to the tropics. Many pediatric endocrine disorders are underreported from the tropics, presumably
- [Helminths And Endocrinology](https://www.endotext.org/chapter/helminths-and-endocrinology/) - ABSTRACT Helminths are parasitic worms that can infect humans. They are broadly classified as flatworms (including Cestodes and Trematodes) and roundworms (nematodes). These worms infect organs such as intestines, liver, skin as well as other tissues. These infections are more common in underdeveloped parts of the world affecting almost one-sixth of the world population. These
- [Triglyceride Lowering Drugs](https://www.endotext.org/chapter/triglyceride-lowering-drugs/) - ABSTRACT The two major goals of the treatment of hypertriglyceridemia are the prevention of cardiovascular disease and pancreatitis. Here we discuss the drugs used for the treatment of hypertriglyceridemia: (niacin, fibrates, omega-3-fatty acids, and apo CIII inhibitors). Niacin decreases total cholesterol, TGs (20-50% decrease), LDL-C, and Lp(a). Additionally, niacin decreases small dense LDL resulting
- [Cholesterol Lowering Drugs](https://www.endotext.org/chapter/cholesterol-lowering-drugs/) - ABSTRACT There are currently several different classes of drugs available for lowering cholesterol levels. There are seven HMG-CoA reductase inhibitors (statins) approved for lowering cholesterol levels and they are the first line drugs for treating cholesterol disorders and can lower LDL-C levels by as much as 50-60%. Statins also are effective in reducing triglyceride
- [Utility of Advanced Lipoprotein Testing in Clinical Practice](https://www.endotext.org/chapter/utility-of-advanced-lipoprotein-testing-in-clinical-practice/) - ABSTRACT A standard lipid panel includes total cholesterol, TGs, and HDL-C. LDL-C can then be calculated. While the Friedewald equation is the classical method to calculate LDL-C levels recently developed methods such as Martin Hopkins or Sampson-NIH methods are more accurate when TGs are elevated and/or LCL-C levels are low. Non-HDL-C and “remnant cholesterol”
- [Non-Invasive Techniques In Pediatric Dyslipidemia](https://www.endotext.org/chapter/non-invasive-techniques-in-pediatric-dyslipidemia/) - ABSTRACT Symptomatic and overt atherosclerosis in children is rare. The earliest lesion of atherosclerosis develops in childhood but may not correlate with traditional markers of atherosclerosis. Children are considered low risk populations for atherosclerosis. The use of non-invasive imaging can have a role in identifying early subclinical vascular changes. Imaging techniques are becoming useful
- [Nutritional Management of Pediatric Dyslipidemia](https://www.endotext.org/chapter/nutritional-management-of-pediatric-dyslipidemia/) - ABSTRACT Lifestyle therapies are important in helping to reduce risk of premature cardiovascular disease. A family-centered, behavioral approach to lifestyle modification is generally the most successful approach for children and adolescents. A registered dietitian nutritionist plays a pivotal role in implementing therapeutic lifestyle changes, uniquely trained to fully assess the child's nutrition status as
- [Guidelines For The Management Of Dyslipidemia](https://www.endotext.org/chapter/guidelines-for-the-management-of-dyslipidemia/) - ABSTRACT This chapter presents the highlights of the 2026 ACC/AHA guideline on the management of dyslipidemia and the 2019 ESC/EAS guidelines for the management of dyslipidemias and the 2025 focused update. The key principles for evaluating, deciding on treatment goals, and treating patients with dyslipidemia are addressed. This should provide the reader with the
- [Female Gonadal Disorders In The Tropics](https://www.endotext.org/chapter/female-gonadal-disorders-in-the-tropics/) - ABSTRACT Female gonadal disorders encompass a diverse group of conditions affecting ovarian function, often presenting as delayed puberty, menstrual irregularities, and infertility. In tropical regions, the etiological spectrum of hypogonadism differs significantly due to the high burden of infectious diseases, malnutrition, and unique environmental exposures. This review highlights the pathophysiology, clinical features, and management
- [Diabetes In The Tropics](https://www.endotext.org/chapter/diabetes-in-the-tropics/) - ABSTRACT Diabetes mellitus (DM), an important non-communicable disease, is a major global health problem. Of the major three types of DM, namely type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus, T2DM constitutes more than 90% of cases. The diabetes prevalence is on the rise in tropical regions. T1DM,
- [Fibrocalculous Pancreatic Diabetes](https://www.endotext.org/chapter/fibrocalculous-pancreatic-diabetes/) - ABSTRACT In tropical countries like India, there are several reports of a unique form of diabetes called fibrocalculous pancreatic diabetes (FCPD). In majority of the cases, FCPD occurs in young, lean individuals with diabetes, abdominal pain, and steatorrhea. Diabetes is typically ketosis resistant. Recent studies have shown that a proportion of the cases may have
- [Lean Non-Autoimmune Diabetes in Adults in the Tropics](https://www.endotext.org/chapter/lean-non-autoimmune-diabetes-in-adults-in-the-tropics/) - ABSTRACT Lean non-autoimmune diabetes represents a heterogeneous group of disorders characterized by hyperglycemia in individuals with normal or low body mass index (BMI), in the absence of autoimmune beta-cell destruction. Defining the condition is challenging due to inconsistent terminology and the variability in BMI cut-offs. Pathophysiologically, it is driven by beta-cell dysfunction influenced by
- [Diabetes Management During Ramadan](https://www.endotext.org/chapter/diabetes-management-during-ramadan/) - ABSTRACT Muslims contribute to 25% of the world population and majority of them reside in the diabetes and obesity endemic Asia-Pacific region. Fasting during Ramadan is one of the five pillars of Islam and an obligatory duty for all healthy adolescents and adult Muslims. However, Islam exempts the ill and pregnant women from fasting. Despite
- [Diabetic Striatopathy](https://www.endotext.org/chapter/diabetic-striatopathy/) - ABSTRACT Acute onset de novo movement disorders are increasingly being reported in the settings of hyperglycemia, particularly from Asian countries. Although hemichorea-hemiballism is the most common and classically described movement semiology in association with hyperglycemia, various other hyperkinetic (choreoathetosis, dystonia, tremors, akathisia, restless leg syndrome etc.) and hypokinetic (parkinsonism) movement disorders are recognized. Diabetic striatopathy
- [Thin Fat Obesity: The Tropical Phenotype of Obesity](https://www.endotext.org/chapter/thin-fat-obesity-the-tropical-phenotype-of-obesity/) - ABSTRACT Disorders like diabetes and obesity have reached pandemic proportions globally. However, this problem is a little different in some tropical countries especially in the south Asian region. Countries like India and China have the leading number of people living with type 2 diabetes mellitus but paradoxically a much lower number of people with
- [Snakebite Envenomation and Endocrine Dysfunction](https://www.endotext.org/chapter/snakebite-envenomation-and-endocrine-dysfunction/) - ABSTRACT Snakebite envenoming (SBE) is a life-threatening medical emergency encountered in tropical parts of Asia, Africa, and Latin America. Toxins in the venom cause local damage and multi-organ dysfunction, predominantly affecting neurological, hematological, and vascular systems. Endocrine anomalies are less frequently reported and often masked by more severe disorders. Anterior pituitary insufficiency is the
- [INFECTIONS](https://www.endotext.org/chapter/infections/)
- [Bacterial Infections in Endocrinology](https://www.endotext.org/chapter/bacterial-infections-in-endocrinology/) - ABSTRACT Bacteria are microscopic organisms that are ubiquitous in the environment and human body. Some bacteria exhibit symbiotic relationship with the human body, while other bacteria are harmful and cause various diseases. Bacteria may infect the endocrine glands either by direct invasion or local or hematogenous spread. Suppurative bacterial infections can involve the pituitary,
- [Infections in Endocrinology: Tuberculosis](https://www.endotext.org/chapter/infections-in-endocrinology-tuberculosis/) - ABSTRACT Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), is responsible for the largest number of deaths worldwide caused by a single organism. Over 25% of the world population is infected with M. tuberculosis, though active infections account only for a small percentage. Though some degree of endocrine dysfunction is invariable in all patients
- [Fungi and Endocrine Dysfunction](https://www.endotext.org/chapter/fungi-and-endocrine-dysfunction/) - ABSTRACT Fungi are ubiquitous microbes and form a fraction of the symbiotic human microbiome. Transition from normal commensals to opportunistic mycoses can occur in immunocompromised hosts. Endemic mycoses are caused by fungi that are acquired from environmental sources. Fungal infections can be classified based on the depth of tissue invasion. Superficial diseases are limited
- [Infections in Endocrinology: Viruses](https://www.endotext.org/chapter/infections-in-endocrinology-viruses/) - ABSTRACT Viruses are one of the simplest pathogenic organisms infecting the human body. Association between viral infections and endocrine system is complex and has not been fully studied. Viral infections can induce several physiological changes in the human endocrine system, resulting in cytokine mediated activation of hypothalamo-pituitary-adrenal axis to increase cortisol production, thus modulating
- [Protozoa and Endocrine Dysfunction](https://www.endotext.org/chapter/protozoa-and-endocrine-dysfunction/) - ABSTRACT Protozoa are parasitic organisms that are among the most important pathogens worldwide. They are classified into four groups and in infected persons, the disease process may be asymptomatic. Of the four groups, Flagellates and Sporozoa are implicated in the causation of endocrine dysfunction and metabolic abnormalities. The disease condition caused by the flagellates
- [Anaerobic Infections and Endocrinology](https://www.endotext.org/chapter/anaerobic-infections-and-endocrinology/) - ABSTRACT Anaerobic bacteria are present as part of the normal microbial flora in the human body. These bacteria turn virulent whenever the host defense mechanisms are compromised. Diabetes and glucocorticoid abuse are the two common endocrine conditions that predisposes individuals to anaerobic infections. Anaerobic infections are common in tropical countries and can affect any
- [Bacterial Infections In Diabetes](https://www.endotext.org/chapter/bacterial-infections-in-diabetes/) - ABSTRACT Bacteria are microscopic single-celled organisms that exist in millions inside and outside the human body. Some bacteria are harmful and can cause a multitude of diseases in human beings. Diabetes mellitus, being a global pandemic, serves as an important cause of susceptibility to bacterial infections. Uncontrolled hyperglycemia is associated with impaired innate and adaptive
- [Diabetes Mellitus and Tuberculosis](https://www.endotext.org/chapter/diabetes-mellitus-and-tuberculosis/) - ABSTRACT The converging epidemics of non-communicable disease like DM (DM) and an infectious disease like tuberculosis (TB) is a double burden. DM is increasing in the same population that is at high risk for developing TB. There is a two-to-four-fold higher risk of active TB in individuals with DM and up to 30% of
- [Monitoring Technologies - Continuous Glucose Monitoring, Mobile Technology, Biomarkers of Glycemic Control](https://www.endotext.org/chapter/monitoring-technologies-continuous-glucose-monitoring-mobile-technology-biomarkers-of-glycemic-control/) - ABSTRACT It is recognized that traditional measures of glucose control (such as hemoglobin A1c [A1c]) provide little information regarding the need for day-to-day changes in therapies. While intermittent self-monitored blood glucose (SMBG) provides additional information with which to make treatment decisions, significant barriers to its use exist, such as inconvenience and lack of timely
- [Management Of Type 2 Diabetes: Selecting Amongst Available Pharmacological Agents](https://www.endotext.org/chapter/management-of-type-2-diabetes-selecting-amongst-available-pharmacological-agents/) - ABSTRACT In the early 1990’s, clinicians’ choices for pharmacological management of type 2 diabetes were limited to insulin, sulfonylureas, and metformin. Since then, many classes of agents have been discovered, approved, and put into clinical use. Through a series of cardiovascular outcome trials and other clinical trials, some classes of agents have been found to
- [Cerebrotendinous Xanthomatosis](https://www.endotext.org/chapter/cerebrotendinous-xanthomatosis-3/) - ABSTRACT Cerebrotendinous xanthomatosis is a rare autosomal recessive disorder caused by homozygous or compound heterozygous mutations in the CYP27A1 gene. These patients lack mitochondrial sterol 27-hydroxylase enzyme, which is responsible for conversion of cholesterol to cholic acid and chenodeoxycholic acid (CDCA) in the bile acid synthesis pathway. CYP27A1 mutation leads to decreased synthesis of bile
- [Cerebrotendinous Xanthomatosis](https://www.endotext.org/chapter/cerebrotendinous-xanthomatosis/) - ABSTRACT Cerebrotendinous xanthomatosis is a rare autosomal recessive disorder caused by homozygous or compound heterozygous mutations in the CYP27A1 gene. These patients lack mitochondrial sterol 27-hydroxylase enzyme, which is responsible for conversion of cholesterol to cholic acid and chenodeoxycholic acid (CDCA) in the bile acid synthesis pathway. CYP27A1 mutation leads to decreased synthesis of bile
- [Lipoprotein Apheresis](https://www.endotext.org/chapter/lipoprotein-apheresis/) - ABSTRACT Lipoprotein apheresis (LA) involves the physical removal of lipoproteins from the blood and is employed only in patients where lifestyle and pharmacologic treatment is not capable of decreasing lipoproteins to acceptable levels. There are a number of different guidelines for the use of LA. The FDA has approved the use of LA for
- [Idiopathic Short Stature and Growth Failure of Unknown Etiology](https://www.endotext.org/chapter/idiopathic-short-stature-and-growth-failure-of-unknown-etiology/) - ABSTRACT Idiopathic short stature (ISS) is defined by a height standard deviation score (SDS) ≤ -2.25 (≤1.2nd percentile) in pediatric patients for whom diagnostic evaluation has excluded other causes of short stature, and growth hormone levels are above 10 nanograms per milliliter in response to physiologic/pharmacologic stimulation. This definition, while comprehensive, is static and does
- [Overview of Endocrine Hypertension](https://www.endotext.org/chapter/overview-of-endocrine-hypertension/) - ABSTRACT Endocrine hypertension most commonly refers to disorders originating from the adrenal gland, including primary aldosteronism, glucocorticoid excess, and pheochromocytoma–paraganglioma syndromes. Less frequent adrenal-based causes such as congenital adrenal hyperplasia and glucocorticoid resistance (Chrousos syndrome) may also lead to hypertension through mineralocorticoid and/or glucocorticoid pathway dysregulation. In addition, several non-adrenal endocrine disorders—including growth hormone excess
- [Multiple Endocrine Neoplasia Type 1](https://www.endotext.org/chapter/multiple-endocrine-neoplasia-type-1/) - ABSTRACT Multiple Endocrine Neoplasia Type 1 (MEN1) is a rare autosomal dominantly inherited endocrine tumor predisposition syndrome, caused by (likely) pathogenic variants ((L)PV) in the MEN1 gene. The three major manifestations are primary hyperparathyroidism (pHPT), pituitary adenomas (PA), and neuroendocrine tumors (NETs) of the pancreas (PanNET) and duodenum. Other manifestations are NETs of thymus,
- [Laboratory Assessment of Testicular Function](https://www.endotext.org/chapter/laboratory-assessment-of-testicular-function/) - ABSTRACT Since the symptoms of hypogonadism are nonspecific, and the signs of testosterone deficiency can be subtle and slow to develop, the assessment of testicular function relies heavily on laboratory testing. The laboratory diagnosis of hypogonadism is based on a consistent and unequivocally low serum total testosterone level measured in blood samples obtained in the
- [Update On Pancreatic Transplantation In The Management Of Diabetes](https://www.endotext.org/chapter/update-on-pancreatic-transplantation-in-the-management-of-diabetes/) - ABSTRACT Pancreas transplantation is the most effective therapeutic option that can restore insulin independence in people with diabetes. Because of life-long immunosuppression and the initial surgical risk, pancreas transplantation is indicated in selected diabetic patients. Based on renal function, candidates for pancreas transplantation can be classified into three categories: uremic patients, post-uremic patients (following
- [Obesity and Dyslipidemia](https://www.endotext.org/chapter/obesity-and-dyslipidemia/) - ABSTRACT Abnormalities in lipid metabolism are very commonly observed in patients who are obese. Approximately 60-70% of patients with obesity are dyslipidemic. The lipid abnormalities in patients who are obese include elevated serum TG, VLDL, apolipoprotein B, and non-HDL-C levels. The increase in serum TG is due to increased hepatic production of VLDL particles and
- [Multiple Endocrine Neoplasia Type 5](https://www.endotext.org/chapter/multiple-endocrine-neoplasia-type-5/) - INTRODUCTION The Multiple Endocrine Neoplasia type 5 (MEN5) syndrome involves multiple endocrine and non-endocrine tumors associated with germline MAX (MYC-associated factor X) mutations (OMIM 154950) (1,2,3,4). The MAX gene encodes a protein that interacts with the Myc protein to form a heterodimer with high affinity for the cognate DNA binding site of Myc. The Myc
- [Pathophysiology and Treatment of Pancreatic Neuroendocrine Neoplasms (PNENS): New Developments](https://www.endotext.org/chapter/pathophysiology-and-treatment-of-pancreatic-neuroendocrine-neoplasms-pnens-new-developments/) - ABSTRACT Pancreatic neuroendocrine neoplasms (PNENs) are a heterogenous group of relatively rare pancreatic malignancies with a unique biology and pathophysiology. Over the last few years, there have been significant improvements in imaging and treatment strategies, which have led to advances in patient’s management and quality of life (QOL). Yet, in practice, there are still
- [Gastrinoma](https://www.endotext.org/chapter/gastrinoma/) - ABSTRACT Gastrinomas are neuroendocrine neoplasms (NENs), that occur primarily in the duodenum and pancreas, which ectopically secrete gastrin, resulting in the Zollinger-Ellison syndrome (ZES), which is due to marked hypersecretion of gastric acid causing severe gastro-esophageal peptic disease. ZES patients have two management problems that must be dealt with: control of the acid hypersecretion and
- [Insulinoma](https://www.endotext.org/chapter/insulinoma/) - ABSTRACT Insulinomas are rare pancreatic neuroendocrine neoplasms (panNENs - incidence of 1-3 cases per million per year). Most are solitary and do not show signs of malignant spread. Multiple synchronous or metachronous panNENs / insulinomas may occur in multiple endocrine neoplasia type 1 (MEN-1). The diagnosis of an insulinoma requires demonstration of inappropriately high insulin,
- [Vasoactive Intestinal Peptide-Secreting Tumor (VIPoma)](https://www.endotext.org/chapter/vasoactive-intestinal-peptide-secreting-tumor-vipoma/) - ABSTRACT A VIPoma is a neuroendocrine neoplasm secreting vasoactive intestinal peptide (VIP), usually presenting with severe watery secretory diarrhea, which can result in hypokalemia and metabolic acidosis and with flushes. Hypochlorhydria, stimulation of glycogenolysis, and hypercalcemia can be also found in VIPoma patients. Plasma VIP levels are elevated in all patients with the VIPoma syndrome,
- [Glucagon & Glucagonoma Syndrome](https://www.endotext.org/chapter/glucagon-glucagonoma-syndrome-3/) - ABSTRACT The glucagonoma syndrome is caused by a glucagon-secreting pancreatic neuroendocrine neoplasm (panNEN)(glucagonoma). The syndrome includes: necrolytic migratory erythema, painful glossitis, cheilitis & stomatitis, weight loss, anemia, new-onset or worsening diabetes mellitus, hypoaminoacidemia, low zinc levels, deep vein thrombosis and depression. At diagnosis, a glucagonoma is usually larger than 4-5 cm in diameter and locoregional
- [Somatostatinoma](https://www.endotext.org/chapter/somatostatinoma/) - ABSTRACT Somatostatin-secreting tumors, or somatostatinomas represent less than 1% of functioning gastrointestinal neuroendocrine neoplasms (NENs) and their estimated incidence is about 1 in 40 million individuals per year. The spectrum of the somatostatinoma syndrome consists of diabetes mellitus, diarrhea/steatorrhea, cholelithiasis, hypochlorhydria, and weight loss. Tumors that demonstrate D-cell differentiation based on immunohistochemical labelling with
- [CCKoma](https://www.endotext.org/chapter/cckoma/) - ABSTRACT Cholecystokinin (CCK)-secreting neuroendocrine tumors (CCKomas) are very rare neuroendocrine tumors of the pancreas. CCKomas can present with persistent non-watery diarrhea, weight loss combined with more specific symptoms of gallbladder disease and duodenal ulcer disease. The diagnosis is based on elevated circulating CCK levels in the absence of elevated circulating gastrin concentrations. INTRODUCTION
- [Ghrelinoma](https://www.endotext.org/chapter/ghrelinoma/) - ABSTRACT Ghrelin is a 28 amino acid, acylated peptide mainly produced in the P/D1 neuroendocrine cells of the stomach wall. The peptide stimulates growth hormone release by acting on both the pituitary and hypothalamus, but also stimulates ACTH and prolactin as well as gastric acid secretion and intestinal motility. Ghrelin also increases appetite and
- [Paraneoplastic Syndromes Related to Neuroendocrine Tumors](https://www.endotext.org/chapter/paraneoplastic-syndromes-related-to-neuroendocrine-tumors/) - ABSTRACT Neuroendocrine neoplasms (NENs) are rare tumors that display marked heterogeneity with varying natural history, biological behavior, response to therapy and prognosis. Their management is complex, particularly as some may be associated with a secretory syndrome, and is undertaken in the context of a multidisciplinary team including a variety of surgical and medical options.
- [The Effect of Endocrine Disorders on Lipids and Lipoproteins](https://www.endotext.org/chapter/the-effect-of-endocrine-disorders-on-lipids-and-lipoproteins/) - ABSTRACT Endocrine disorders and the administration of various hormones can alter lipid metabolism and plasma lipid levels, which may increase or decrease the risk of atherosclerotic cardiovascular disease. In many instances the literature is not consistent with various studies reporting different results. These differences may be due to a variety of factors such as
- [Approach To Hypercalcemia](https://www.endotext.org/chapter/approach-to-hypercalcemia/) - ABSTRACT A reduction in serum calcium can stimulate parathyroid hormone (PTH) release which may then increase bone resorption, enhance renal calcium reabsorption, and stimulate renal conversion of 25-hydroxyvitamin D, to the active moiety 1,25-dihydroxyvitamin D [1,25(OH)2D] which then will enhance intestinal calcium absorption. These mechanisms restore the serum calcium to normal and inhibit further production
- [The Management of Type 1 Diabetes](https://www.endotext.org/chapter/the-management-of-type-1-diabetes/) - ABSTRACT Type 1 diabetes (T1D) is an autoimmune disease characterized by progressive pancreatic beta-cell loss resulting in insulin deficiency and hyperglycemia. Exogenous insulin therapy is essential to prevent fatal complications from hyperglycemia. The Diabetes Control and Complications Trial and its long-term follow up, the Epidemiology of Diabetes and its Complications study, demonstrated that stringent
- [Sight-Threatening Graves’ Orbitopathy/Thyroid Eye Disease](https://www.endotext.org/chapter/sight-threatening-graves-orbitopathy-thyroid-eye-disease/) - CLINICAL RECOGNITION Graves’ orbitopathy (GO), aka Thyroid Eye Disease (TED), may develop any time in the course of Graves’ disease, or infrequently in association with chronic autoimmune thyroiditis, and is infrequently accompanied by thyroid dermopathy or thyroid acropachy. GO, is usually mild, but may become moderately severe in 10% of cases, and about 75% of
- [Growth Hormone and Aging](https://www.endotext.org/chapter/growth-hormone-and-aging/) - *deceased, contributed to the 1st edition **contributed to the 1st edition ABSTRACT Growth hormone (GH) plays important roles in adult life, including maintaining lean and bone mass, promoting lipolysis to limit visceral adiposity, and regulating carbohydrate metabolism, cardiovascular function, aerobic exercise capacity, and cognitive function. Younger adults with growth hormone deficiency (AGHD) exhibit abnormalities
- [Behavioral Approaches to Obesity Management](https://www.endotext.org/chapter/behavioral-approaches-to-obesity-management/) - ABSTRACT Obesity is extremely prevalent, affecting 40.3% of adults in the United States. Advisory panels recommend a 5-10% reduction in initial weight for adults with obesity, or for those who are overweight, with a related comorbidity. This loss can significantly reduce the risk of the development and progression of type 2 diabetes and improve
- [Test EndNotes PubMed Links and Editor/Author Instructions](https://www.endotext.org/chapter/test-endnotes-pubmed-links-and-editor-author-instructions/) - ENDOTEXT – PUBMED LINKING WORKFLOW for Ken, Editors and Authors …………………………………………………………………………………………… EXAMPLE – WORKING CITATION and REFERENCE CLICKABLE with PUBMED LINK: Link to live Website Test: https://www.endotext.org/?p=41912 NOTE: only users who have this url link can view this page and download the pdf. …………………………………………………………………………………………… Example Chapter Text Example Current Reference Text (using
- [Lipid and Lipoprotein Metabolism in Liver Disease](https://www.endotext.org/chapter/lipid-and-lipoprotein-metabolism-in-liver-disease/) - ABSTRACT The liver plays a central role in lipid metabolism, serving as the center for lipoprotein uptake, formation, and export to the circulation. Alterations in hepatic lipid metabolism can contribute to the development of chronic liver disease, such as metabolic dysfunction-associated steatotic liver disease (MASLD) and accelerate the progression of other chronic liver diseases, as
- [Inpatient Diabetes Management](https://www.endotext.org/chapter/inpatient-diabetes-management/) - BACKGROUND Diabetes affects more than 500 million adults globally and is expected to rise in prevalence over the next few decades. Individuals living with diabetes have a 3-4-fold greater chance of hospitalization and those hospitalized with a diagnosis of diabetes have poorer outcomes including prolonged hospital length of stay. Appropriate inpatient glycemic management limits the
- [Male Contraception](https://www.endotext.org/chapter/male-contraception/) - ABSTRACT Men continue to have a strong interest and commitment to effective family planning. Traditional methods of male contraception have long included periodic abstinence, non-vaginal ejaculation, condoms, and vasectomy, the latter two representing physical methods that bar sperm from reaching the site of fertilization. However, for male contraception the reversible methods are not reliable,
- [Genetic Disorders Causing Hypertriglyceridemia in Children and Adolescents](https://www.endotext.org/chapter/genetic-disorders-causing-hypertriglyceridemia-in-children-and-adolescents/) - ABSTRACT Primary disorders of lipid metabolism causing hypertriglyceridemia (HTG) result from genetic defects in triglyceride synthesis and metabolism. These disorders, with the exception of mutations in the lipoprotein lipase complex, are often unmasked by precipitating factors including obesity, diabetes, or medications. Physical findings can include eruptive, palmer, or tuberoeruptive xanthomas. Other lipid abnormalities may or
- [Special Considerations Relevant to Pediatric Obesity](https://www.endotext.org/chapter/special-considerations-relevant-to-pediatric-obesity/) - ABSTRACT In most humans, body fatness is a quantitative trait reflecting the interactions among environment, genotype, and development. The metabolic predisposition to obesity and its comorbidities (throughout the lifespan) begins in the intrauterine environment, extends into early childhood, and is further shaped by puberty. Understanding the pathogenesis of childhood obesity and its implications for adult
- [Secondary Hypertriglyceridemia](https://www.endotext.org/chapter/secondary-hypertriglyceridemia/) - ABSTRACT Hypertriglyceridemia (HTG) is often secondary to obesity-related insulin resistance (1,2), which is caused by excessive intake of fats and carbohydrates without compensatory utilization of these calories, but other common and rare causes should be considered (3,4,5). Genetic influences, gestational conditions, and nutrition in infancy and childhood contribute to HTG associated with formation of an
- [Hyperaldosteronism](https://www.endotext.org/chapter/hyperaldosteronism-2026/) - ABSTRACT Aldosterone regulation plays a crucial role in maintaining intravascular and effective circulating plasma volume and potassium homeostasis. However, inappropriate regulation of aldosterone secretion results in adverse cardiovascular and metabolic consequences and can be encountered in several different phenotypes. Assessing plasma renin activity, in the presence or not of hypertension, is a simple method to
- [Lipid Screening in Youth](https://www.endotext.org/chapter/lipid-screening-in-youth/) - ABSTRACT As improvements in atherosclerotic cardiovascular disease (ASCVD) risk reduction in adults’ plateau, and risk factors accumulate in youth, the focus is shifting to children as the future of ASCVD prevention. Abnormal lipid levels are relatively common in the pediatric population, and effective treatments are available, thereby supporting the need to screen children for abnormal
- [Nephrolithiasis](https://www.endotext.org/chapter/nephrolithiasis/) - ABSTRACT Kidney stones are concretions of different mineral salts mixed with an organic matrix that form in the upper urinary tract. As a stone moves from the kidney to the ureter, it can present with renal colic symptoms and may cause urinary tract obstruction and/or infection. In fact, acute passage of a kidney stone is
- [Skeletal Dysplasias](https://www.endotext.org/chapter/skeletal-dysplasias/) - ABSTRACT Skeletal dysplasias represent a complex and heterogeneous group of over 770 genetic disorders characterized by abnormalities in the development, growth, and maintenance of the skeleton. Though individually rare, these conditions collectively present a significant burden in pediatrics, particularly within endocrinology. Disproportionate growth failure, metabolic bone disease, bone fragility, and developmental delays frequently prompt
- [Adrenal Insufficiency](https://www.endotext.org/chapter/adrenal-insufficiency-2/) - ABSTRACT Adrenal insufficiency (AI) is an uncommon clinical condition resulting from inadequate glucocorticoid secretion or action, either in the basal state or during stress. Hypothalamo-pituitary-adrenal axis disturbance or primary adrenal failure itself is responsible for this condition. The presentation of AI can range from asymptomatic hormonal dysfunction to an acute adrenal crisis. Prompt diagnosis and
- [Effect of Pregnancy on Lipid Metabolism and Lipoprotein Levels](https://www.endotext.org/chapter/effect-of-pregnancy-on-lipid-metabolism-and-lipoprotein-levels/) - ABSTRACT Lipoprotein and lipid physiology in pregnancy has important implications for the developing mother and her fetus/newborn.. Adequate cholesterol and essential fatty acids are needed for normal fetal development. In pregnancy, multiple physiological changes contribute to changes in lipid profiles of healthy, gestating women. Initially, an anabolic phase is characterized by increased lipid synthesis
- [Ambiguous Genitalia in the Newborn](https://www.endotext.org/chapter/ambiguous-genitalia-in-the-newborn/) - ABSTRACT Ambiguous genitalia in a newborn are the clinical sign of atypical sexual development of the external genitalia in utero. This condition is rare and can result from various underlying factors, including certain disorders with potentially severe consequences, such as cortisol deficiency due to congenital adrenal hyperplasia. Therefore, it is crucial to promptly determine etiology
- [Hypoglycemia in Neonates, Infants, and Children](https://www.endotext.org/chapter/hypoglycemia-in-neonates-infants-and-children/) - ABSTRACT Hypoglycemia in neonates, infants and children should be considered a medical emergency that can cause seizures, permanent neurological injury, and in rare cases, death, if inadequately treated. Under normal conditions, glucose is the primary fuel for brain metabolism. Due to the metabolic demands of the developing brain, infants and children have increased rates of
- [Congenital Adrenal Hyperplasia](https://www.endotext.org/chapter/congenital-adrenal-hyperplasia/) - ABSTRACT Disorders of steroidogenesis resulting in deficiencies of cortisol and/or aldosterone are collectively referred to as Congenital Adrenal Hyperplasia (CAH). These autosomal recessive enzymatic defects are typified by pathogenic variants in CYP21A2 encoding 21-hydroxylase. Deficiency in this important enzyme leads to deficiency of cortisol synthesis and accumulation of precursors, such as 17-hydroxyprogesterone, which are then
- [Congenital Hypothyroidism](https://www.endotext.org/chapter/congenital-hypothyroidism/) - INTRODUCTION Thyroid hormones are essential for normal development and growth of many target tissues, including the brain and the skeleton. Thyroid hormone (TH) action on critical genes for neurodevelopment is limited to a specific time window, and even a short period of deficiency of TH can cause irreversible brain damage. During the first trimester
- [Amiodarone Induced Thyrotoxicosis](https://www.endotext.org/chapter/amiodarone-induced-thyrotoxicosis/) - CLINICAL RECOGNITION Patients treated with amiodarone for a cardiac arrhythmia may develop amiodarone induced thyrotoxicosis (AIT). The risk of AIT is increased in iodine-deficient regions. The incidence of AIT varies greatly (between 0.003% and 10%). AIT occurs in 3% of patients treated with amiodarone in North America but is much more frequent (up to 10%)
- [Myxedema and Coma (Severe Hypothyroidism)](https://www.endotext.org/chapter/myxedema-and-coma-severe-hypothyroidism/) - CLINICAL RECOGNITION Myxedema coma is a rare life-threatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. PATHOPHYSIOLOGY Usually, a precipitating event disrupts homeostasis which is maintained in
- [Hyperthyroidism in Pregnancy](https://www.endotext.org/chapter/hyperthyroidism-in-pregnancy/) - CLINICAL RECOGNITION Hyperthyroidism occurs in approximately 0.2-1.0% of all pregnancies. Most cases are due to Graves’ disease. The clinical recognition of Graves’ disease may prove challenging in pregnancy since the features of normal pregnancy overlap with symptoms of hyperthyroidism. Specific features which may point to Graves’ hyperthyroidism include the presence of a diffuse goiter,
- [Adrenocortical Carcinoma](https://www.endotext.org/chapter/adrenocortical-carcinoma-2/) - CLINICAL RECOGNITION Adrenocortical cancer (ACC) is a rare disease with an annual incidence of 0.7-2 cases per million per year and two distinct age distribution peaks, the first occurring in early adulthood and the second between 40-50 years with women being more often affected (55-60%). Although the great majority of ACCs are of sporadic origin,
- [Florid Cushing's Syndrome](https://www.endotext.org/chapter/florid-cushings-syndrome/) - CLINICAL RECOGNITION Cushing’s syndrome (CS) results from long-standing exposure to supraphysiologic concentrations of circulating glucocorticoids. Untreated CS is associated with a high morbidity and increased mortality rates mainly because of its metabolic abnormalities and the risk of infection. When the presentation is florid, the diagnosis is usually straightforward (Tables 1 and 2). However, diagnosis might
- [Adrenal Suppression](https://www.endotext.org/chapter/adrenal-suppression/) - CLINICAL RECOGNITION Adrenal suppression, a form of secondary adrenal insufficiency (SAI), is a common clinical problem most often due to sudden cessation of chronic exposure to exogenous glucocorticoid administration or, rarely, after correction of endogenous hypercortisolism. It results from the inability of suprahypothalamic and hypothalamic centers of the hypothalamic-pituitary-adrenal (HPA) axis to recover their function
- [Lipid and Lipoprotein Levels in Patients with Covid-19 Infections](https://www.endotext.org/chapter/lipid-and-lipoprotein-levels-in-patients-with-covid-19-infections/) - ABSTRACT Numerous studies have observed a decrease in total cholesterol, LDL-C, HDL-C, apolipoprotein B and A-I levels in patients with COVID-19 infections, similar to what is observed with other infections. In most studies the decrease in LDL-C and/or HDL-C was more profound the greater the severity of the illness. LDL-C and HDL-C levels were
- [Diagnosis and Treatment of Graves' Disease](https://www.endotext.org/chapter/diagnosis-and-treatment-of-graves-disease/) - ABSTRACT The diagnosis of Graves’ disease is mostly straightforward, depending on recognition of the cardinal features of the disease and confirmation by tests including serum TSH, free T4, and TSH receptor antibodies. The differential diagnosis includes other causes of thyrotoxicosis, such as secretory thyroid nodules, various forms of inflammatory or destructive thyroiditis, or thyrotoxicosis factitia.
- [Initial Management of Severe Hyperglycemia in Type 2 Diabetes](https://www.endotext.org/chapter/initial-management-of-severe-hyperglycemia-in-type-2-diabetes/) - CLINICAL RECOGNITION OF SEVERE HYPERGLYCEMIA Diabetes Mellitus is a common condition that affects over 800 million adults globally. Type 2 diabetes mellitus represents almost 95% of these diagnoses. Type 2 diabetes typically has two pathophysiologic defects: an insulin secretory defect and insulin resistance. Symptoms of uncontrolled hyperglycemia include polyuria, polydipsia, blurry vision, possibly dehydration, and
- [Hyponatremia](https://www.endotext.org/chapter/hyponatremia-2/) - CLINICAL RECOGNITION Hyponatremia is common, being found in some 15–20% of non-selected emergency admissions to hospitals. It is associated with increased mortality, morbidity, and increased duration of hospital stay, independent of the cause of admission. Clinical presentation is diverse, ranging from seizure and coma at one extreme to apparent absence of symptoms. This spectrum reflects
- [Diabetes Insipidus (AVP-Deficiency and AVP-Resistance)](https://www.endotext.org/chapter/diabetes-insipidus-avp-deficiency-and-avp-resistance/) - CLINICAL RECOGNITION Diabetes Insipidus (DI) is the excess production of dilute urine. Because of the confusion with Diabetes Mellitus, there has been a move to renaming this to AVP-Deficiency (AVP-D; Central Diabetes Insipidus) and AVP-Resistance (AVP-R; Nephrogenic Diabetes Insipidus). Diagnosis requires a targeted history, examination, and confirmation through appropriate laboratory and radiological investigations. AVP-D and
- [Hypopituitarism: Emergencies](https://www.endotext.org/chapter/hypopituitarism-emergencies/) - CLINICAL RECOGNITION Hypopituitarism usually has an insidious presentation over weeks to months and often remains clinically silent until a particular stressful event such as a concurrent infection or trauma at which time marked symptoms are evident. The reason for a protracted course until deficiency is clinically evident is due to the slow depletion of pituitary
- [The Neurohypophysis: Endocrinology of Vasopressin and Oxytocin](https://www.endotext.org/chapter/the-neurohypophysis-endocrinology-of-vasopressin-and-oxytocin/) - ABSTRACT The neurohypophysis is the structural foundation of a neuro-humoral system coordinating fluid balance and reproductive function through the action of two peptide hormones: vasopressin and oxytocin. Vasopressin is the principle endocrine regulator of renal water excretion, facilitating adaptive physiological responses to maintain plasma volume and plasma osmolality. Oxytocin is important in parturition and
- [Pituitary Apoplexy](https://www.endotext.org/chapter/pituitary-apoplexy/) - CLINICAL RECOGNITION Insult to the pituitary can be in the form of hemorrhage, infarction, or both. When abrupt and sometimes catastrophic hemorrhagic infarction occurs in the pituitary it is defined as apoplexy. The constellation of headache, vomiting, visual impairment (Apoplexy Triad), and altered consciousness with hemodynamic instability, although not specific for pituitary apoplexy, are reasons
- [Thyroxine Poisoning](https://www.endotext.org/chapter/thyroxine-poisoning/) - CLINICAL RECOGNITION A massive L-Thyroxine (T4) overdose may be accidentally and unintentionally ingested, most commonly by children and adolescents. It may occur intentionally in young and older adults in an attempt to lose weight, with suicidal intentions, or for undeclared purposes. In some localities thyroxine may be obtained at drugstores without prescription (mostly in
- [Genetics and Epigenetics of Central Precocious Puberty](https://www.endotext.org/chapter/genetics-and-epigenetics-of-central-precocious-puberty/) - ABSTRACT Central precocious puberty (CPP) is defined as the early activation of the hypothalamic-pituitary-gonadal (HPG) axis, occurring before age 8 in girls and 9 in boys and leading to the early appearance of secondary sexual characteristics. While multiple environmental and pathological factors may contribute to the condition, genetic and epigenetic mechanisms have emerged as major
- [MULTIGLANDULAR DISORDERS](https://www.endotext.org/chapter/multiglandular-disorders/)
- [Autoimmune Polyglandular Syndromes](https://www.endotext.org/chapter/autoimmune-polyglandular-syndromes/) - ABSTRACT The autoimmune polyglandular syndromes (APS) are clusters of endocrine abnormalities that occur in discreet patterns in subjects with immune dysregulation and that permit treatment and anticipation of associated systemic or other hormonal deficiencies. Three major entities are recognized, APS1, APS2 and APS3; the rare X-linked syndrome of immune-dysregulation, poly-endocrinopathy, and enteropathy due to
- [Medical Interventions for Transgender Youth](https://www.endotext.org/chapter/medical-interventions-for-transgender-youth/) - ABSTRACT Up to 1.8% of youth and 0.6% of adults in the United States identify as transgender, meaning their gender identity differs from or is opposite their sex at birth. This chapter reviews epidemiology, gender development, and medical interventions for transgender youth as outlined in the Endocrine Society Clinical Practice Guidelines and World Professional Association
- [BONE DISORDERS](https://www.endotext.org/chapter/bone-disorder/)
- [Osteogenesis Imperfecta](https://www.endotext.org/chapter/osteogenesis-imperfecta/) - ABSTRACT Osteogenesis imperfecta (OI, or Brittle Bone Disease) is a clinically and genetically heterogeneous group of heritable disorders of connective tissue. The incidence of forms recognizable at birth is 1:10-20,000. The hallmark feature of OI is bone fragility, with susceptibility to fracture from minimal trauma, as well as bone deformity and growth deficiency. OI
- [Osteoporosis and Bone Fragility in Children](https://www.endotext.org/chapter/osteoporosis-and-bone-fragility-in-children/) - ABSTRACT Childhood is a unique time during which individuals accrue bone rapidly, and peak bone mass is achieved early in the third decade of life. Several factors may adversely influence bone accrual, including primary skeletal disorders as well as secondary causes of low bone density such as specific endocrinopathies, altered weight-bearing, and certain medications.
- [Fibrous Dysplasia](https://www.endotext.org/chapter/fibrous-dysplasia/) - ABSTRACT Fibrous dysplasia (FD) is an uncommon mosaic disorder falling along a broad clinical spectrum. It arises from post-zygotic mutations in GNAS, resulting in constitutive activation of the cAMP pathway-associated G-protein, Gsα, and proliferation of undifferentiated skeletal progenitor cells. FD may occur in isolation, or in association with skin pigmentation and hyperfunctioning endocrinopathies, termed
- [Primary Disorders of Phosphate Metabolism](https://www.endotext.org/chapter/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
- [Disorders in The Action of Vitamin D](https://www.endotext.org/chapter/disorders-in-the-action-of-vitamin-d/) - ABSTRACT Vitamin D is produced in the skin under the influence of UVB portion of the light spectrum in sunlight. This form of vitamin D is cholecalciferol or vitamin D3. Vitamin D may also be part of the diet either in certain foods such as fatty fish or as supplements either ingested separately or in
- [LIPID AND LIPOPROTEIN DISORDERS](https://www.endotext.org/chapter/lipid-lipoprotein-disorders/)
- [Is Atherosclerosis a Pediatric Disease](https://www.endotext.org/chapter/is-atherosclerosis-a-pediatric-disease/) - ABSTRACT In the US and other developed countries, cardiovascular disease is a major health burden and the leading cause of death. There are at least three lines of evidence that support the concept of atherosclerosis, the principal cause of cardiovascular disease, having its origins in childhood. Although the most direct evidence is in children with
- [Genetic Testing in Youth – A Primer for Pediatric Lipidologists](https://www.endotext.org/chapter/genetic-testing-in-youth-a-primer-for-pediatric-lipidologists/) - ABSTRACT The genetic causes of several dyslipidemias have been identified. Our knowledge of the role of genetics in disorders affecting lipid and lipoprotein metabolism continues to improve along with advancements in technology and access of testing. Genetic testing offers diagnostic confirmation of disease, risk stratification, the ability to identify at risk biologic relatives, and
- [Genetics and Dyslipidemia](https://www.endotext.org/chapter/genetics-and-dyslipidemia/) - ABSTRACT Pediatric primary or monogenic dyslipidemias are a heterogeneous group of disorders, characterized by severe elevation of cholesterol, triglycerides, or rarely a combination of the two. Monogenic hypercholesterolemias have elevated low-density lipoprotein-cholesterol (LDL-C) levels and very high risk of premature atherosclerotic disease. They are caused by mutations in genes involved in the receptor-mediated uptake
- [Guidelines for Screening, Prevention, Diagnosis, and Treatment of Dyslipidemia in Children and Adolescents](https://www.endotext.org/chapter/guidelines-for-screening-prevention-diagnosis-and-treatment-of-dyslipidemia-in-children-and-adolescents/) - ABSTRACT Clinical practice guidelines are developed to create a synthesis of evidence which, in turn, leads to recommendations that improve clinical decision-making. Guidelines are helpful for busy clinicians to improve outcomes and reduce unnecessary practice variation. Historically, guidelines were largely based on expert opinion. The modern approach to guideline development includes a complete review
- [Understanding Ethical Dilemmas in Pediatric Lipidology- Genetic Testing in Youth](https://www.endotext.org/chapter/ethical-dilemmas-in-pediatric-lipidology/) - ABSTRACT Over the past 25 years there has been an increasing focus on early identification of individuals at-risk of premature cardiovascular disease (CVD), with the goal of improving outcomes and reducing premature CVD-related events such as myocardial infarction and stroke. In 2011, a National Heart, Lung and Blood Institute (NHLBI) Expert Panel recommended universal
- [Reproductive Health and Its Impact On Lipid Management in Adolescent and Young Adult Females](https://www.endotext.org/chapter/reproductive-health-and-its-impact-on-lipid-management-in-adolescent-and-young-adult-females/) - ABSTRACT Lipids disorders are common in youth. Adolescents and young women of childbearing age who have moderate to severe lipid disorders may benefit from treatment with lipid lowering medications (LLM). However, most of these medications are contraindicated in pregnancy. Those who are sexually active should receive counseling on effective methods to prevent unplanned pregnancies. While
- [Familial Hypercholesterolemia](https://www.endotext.org/chapter/familial-hypercholesterolemia/) - ABSTRACT Familial hypercholesterolemia (FH) is a prevalent, autosomal co-dominant disorder of lipid metabolism that results in elevated low-density lipoprotein cholesterol (LDL-C) levels and premature atherosclerosis. Screening for and identifying heterozygous FH in childhood is critical, given its high prevalence and asymptomatic presentation. Furthermore, treatment of FH in childhood is effective at lowering LDL-C levels and
- [Sitosterolemia](https://www.endotext.org/chapter/sitosterolemia/) - ABSTRACT Sitosterolemia is a rare autosomal recessive disorder of non-cholesterol sterol metabolism, caused by mutations of the ABCG5 or ABCG8 transporter genes. This results in hyperabsorption and decreased biliary excretion of non-cholesterol sterol, especially sitosterol, from the gastrointestinal tract. Affected individuals have excessive accumulation of plant sterols and 5 alpha-saturated stanols in plasma and tissues,
- [Lipoprotein (a) in Youth](https://www.endotext.org/chapter/lipoprotein-a-in-youth/) - ABSTRACT Lipoprotein (a) [Lp(a)] represents a class of lipoproteins with structural similarity to low-density lipoprotein (LDL). In adults, Lp(a) has been shown to be an independent risk factor in the development of atherosclerotic cardiovascular diseases (ASCVD) and calcific aortic valve disease (CAVD). Outcomes in youth are limited by the paucity of data but several studies
- [Use of Lipid Lowering Medications in Youth](https://www.endotext.org/chapter/use-of-lipid-lowering-medications-in-youth/) - ABSTRACT The first comprehensive pediatric dyslipidemia guidelines were published by the National Cholesterol Education Program’s Expert Panel on Blood Cholesterol Levels in Children and Adolescents in 1992 and were updated by the American Academy of Pediatrics (AAP) in 1998. In 2008 the AAP issued an updated clinical report detailing recommendations for screening and evaluation
- [Clinical Management of Dyslipidemia in Youth with Chronic Kidney Disease](https://www.endotext.org/chapter/clinical-management-of-dyslipidemia-in-youth-with-chronic-kidney-disease/) - ABSTRACT Chronic kidney disease (CKD) is commonly associated with abnormal lipid metabolism which may contribute to the morbidity and premature mortality associated with impaired renal function. Dyslipidemia often occurs in the early phases and becomes progressively worse with disease severity and progression to end stage renal disease (ESRD). In this review, we discuss the clinical
- [The Role Of Parents In The Care Of Children With Dyslipidemia](https://www.endotext.org/chapter/the-role-of-parents-in-the-care-of-children-with-dyslipidemia/) - ABSTRACT Parents should be viewed as an integral part of the child’s healthcare team, being both legally and morally responsible for providing proper care to the child. In this paper, we discuss the role of parents as critical members of the healthcare team in caring for youth with dyslipidemia and how clinicians can best leverage
- [Subacute Thyroiditis](https://www.endotext.org/chapter/subacute-thyroiditis/) - CLINICAL RECOGNITION Subacute thyroiditis (SAT) is an inflammatory condition of the thyroid with characteristic presentations and clinical course. Patients with the classic, painful (DeQuervain’s; Granulomatous) thyroiditis, (PFSAT) typically present with painful swelling of the thyroid. Transient vocal cord paresis may occur. At times, the pain begins and may be confined to the one lobe,
- [Severe Hypothyroidism in the Elderly](https://www.endotext.org/chapter/severe-hypothyroidism-in-the-elderly/) - CLINICAL RECOGNITION Elderly patients with severe hypothyroidism often present with variable symptoms that may be masked or potentiated by co-morbid conditions. Characteristic symptoms may include fatigue, weight gain, cold intolerance, hoarseness, constipation, and myalgias. Neurologic symptoms may include ataxia, depression, and mental status changes ranging from mild confusion to overt dementia. Clinical findings that may
- [Severe Thyrotoxicosis in the Elderly](https://www.endotext.org/chapter/severe-thyrotoxicosis-in-the-elderly/) - CLINICAL RECOGNITION Thyrotoxicosis in the elderly may elude detection by manifesting only fatigue, weakness, and relative apathy. More commonly it presents with any of a range of symptoms including fatigue, weight loss, heat intolerance, palpitations, weakness, insomnia, irritability, confusion, and agitation. Clinical findings that may raise suspicion include tachycardia, proptosis, goitrous enlargement of the thyroid,
- [Pathogenesis of Type 1 Diabetes](https://www.endotext.org/chapter/pathogenesis-of-type-1-diabetes/) - *Dana VanBuecken, ARNP and Sandra Lord, MD Contributed equally to submission ABSTRACT In the U.S. alone, more than one million people are living with type 1 diabetes (TID) and approximately 80 people per day, or 30,000 individuals per year, are newly diagnosed (1, 2). Recent epidemiological studies demonstrate that the global T1D incidence is increasing
- [Endocrinology Of The Testis and Spermatogenesis](https://www.endotext.org/chapter/endocrinology-of-the-testis-and-spermatogenesis/) - ABSTRACT The testes synthesize two important products: sperm for fertility and androgens necessary for sexual function and fertility. The synthesis of both products is regulated by endocrine hormones. Testosterone (an androgen) is indispensable for sperm production, and both testosterone and Follicle Stimulating Hormone (FSH) are needed for optimal testis development and sperm production. Luteinizing
- [Evaluation and Treatment of Gender-Dysphoric/Gender Incongruent Adults](https://www.endotext.org/chapter/evaluation-and-treatment-of-gender-dysphoric-gender-incongruent-adults/) - ABSTRACT Gender dysphoria refers to the suffering due to an incongruence between one’s sex assigned at birth and one’s self-perceived gender. Primary care physicians often play an important role in diagnosis and initiation of treatment of gender dysphoria. However, gender dysphoria is preferentially diagnosed by a specialized psychologist or psychiatrist. This does not imply
- [Diabetic Ketoacidosis](https://www.endotext.org/chapter/diabetic-ketoacidosis/) - INTRODUCTION Diabetic ketoacidosis (DKA) is an acute life-threatening emergency resulting from severe metabolic decompensation. DKA more commonly affects individuals with type 1 diabetes (T1DM). Approximately 2/3 of adults admitted with DKA have T1DM. DKA is relatively common and in the US; 240,000 patients had a primary diagnosis of DKA in 2020. Early diagnosis and
- [ADRENAL](https://www.endotext.org/chapter/adrenal/)
- [Hyperglycemic Hyperosmolar State](https://www.endotext.org/chapter/hyperglycemic-hyperosmolar-state/) - CLINICAL RECOGNITION The hyperglycemic hyperosmolar state (HHS) is a life-threatening metabolic decompensation of diabetes which presents with severe hyperglycemia, marked hyperosmolality, and profound dehydration, typically accompanied by alteration in consciousness ranging from lethargy and focal deficits to coma; the mental status changes are thought to be a direct consequence of the severe hypertonicity and resultant
- [Hypoglycemia](https://www.endotext.org/chapter/hypoglycemia/) - CLINICAL RECOGNITION Hypoglycemia is frequently seen in patients treated tor diabetes but is uncommon in people who do not have diabetes. Low blood glucose concentrations lead to both adrenergic and neuroglycopenia symptoms (Table 1). Glucose levels below 55 mg/dl cause adrenergic symptoms while glucose levels below 48-50 mg/dL result in neuroglycopenic symptoms. In individuals with
- [Pancreatitis Secondary to Hypertriglyceridemia](https://www.endotext.org/chapter/pancreatitis-secondary-to-hypertriglyceridemia/) - CLINICAL ASPECTS After ethanol and gallstones hypertriglyceridemia is the third leading cause of acute pancreatitis causing between 5-25% of episodes. During pregnancy hypertriglyceridemia is the leading cause of acute pancreatitis accounting for up to 50% of cases. During pregnancy acute pancreatitis occurs most commonly in the third trimester but may occur in the first or
- [MINERAL DISORDERS](https://www.endotext.org/chapter/mineral-disorders/)
- [Hypocalcemia](https://www.endotext.org/chapter/hypocalcemia/) - CLINICAL RECOGNITION Hypocalcemia can occur acutely over minutes to hours or chronically over weeks to months. Correspondingly, the signs and symptoms of hypocalcemia 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
- [Kidney Stone Emergencies](https://www.endotext.org/chapter/kidney-stone-emergencies/) - CLINICAL RECOGNITION The acute passage of a kidney stone is the 9th most common cause of emergency room visits. Approximately 7-8% of women and 11-16% of men will have stone disease by age 70. Stone disease has an estimated heritability of ~45% indicating that genetic factors strongly influence the occurrence. The acute syndrome complex called renal
- [Pheochromocytoma and Paraganglioma](https://www.endotext.org/chapter/pheochromocytoma-and-paraganglioma/) - ABSTRACT Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or neural crest progenitors located outside of the adrenal gland, respectively. These tumors are derived from either sympathetic tissue in the adrenal or extra-adrenal abdominal locations (sympathetic PPGLs) or parasympathetic tissue in the thorax, head, and neck (parasympathetic
- [Existing and Emerging Molecular Targets for The Pharmacotherapy of Obesity](https://www.endotext.org/chapter/existing-and-emerging-molecular-targets-for-the-pharmacotherapy-of-obesity-3/) - ABSTRACT Obesity is pandemic and a multidisciplinary approach is critical for its management. Anti-obesity treatment includes lifestyle modifications combined with anti-obesity medications. Anti-obesity drugs target either central nervous system pathways, which regulate sensations of satiety and fullness, or peripheral modulators of digestion, metabolism and lipogenesis. Combined anti-obesity agents is a novel, promising field, especially
- [Thyroid Nodules](https://www.endotext.org/chapter/thyroid-nodules-4/) - ABSTRACT Thyroid cancer accounts for only 0.4% of all cancer deaths, with an incidence of 11 cases and about 0.5-0.6 deaths per 100,000 population in the United States each year,according to the November 2011 SEER report (http://seer.cancer.gov/statfacts/html/thyro.html). Its clinical importance, by contrast, is out of all proportion to its incidence, because cancers of the thyroid
- [A Systems‑Based Approach to Safety In Pituitary Surgery](https://www.endotext.org/chapter/a-systems‑based-approach-to-safety-in-pituitary-surgery/) - ABSTRACT Background. Perioperative management of patients with pituitary tumors is challenging, because it involves complex anatomical, physiological, and pathological considerations that require meticulous attention and seamless teamwork across all stages of care. Objective. This review aims to explore a comprehensive, safety-oriented approach to pituitary surgery by integrating technical precision with system-level safeguards. Scope and Methods.
- [Adrenal Insufficiency In Children](https://www.endotext.org/chapter/adrenal-insufficiency-in-children-3/) - ABSTRACT Adrenal insufficiency (AI) is an uncommon but potentially life-threatening condition related to impaired secretion of cortisol by the adrenal gland. In general, this condition can be divided into primary (adrenal failure) and central (hypothalamic/pituitary) causes. In this chapter, we categorize the causes of adrenal insufficiency and systematically review the etiologies and associations to
- [Medical Management of the Postoperative Bariatric Surgery Patient](https://www.endotext.org/chapter/medical-management-of-the-postoperative-bariatric-surgery-patient/) - ABSTRACT Bariatric surgery can result in substantial weight loss and significant metabolic improvements. Therefore, postoperatively, clinicians should be prepared to taper treatments for weight-related chronic metabolic diseases. For patients with type 2 diabetes, early and dramatic improvements in glucose homeostasis require anticipatory management. This includes insulin dose reductions, discontinuation of certain oral agents, and close
- [Diabetic Neuropathies](https://www.endotext.org/chapter/diabetic-neuropathies/) - ABSTRACT Diabetic neuropathy (DN) is the most common form of neuropathy in developed countries and may affect about half of all patients with diabetes (DM), contributing to substantial morbidity and mortality and resulting in a huge economic burden. DN encompasses multiple different disorders involving proximal, distal, somatic, and autonomic nerves. It may be acute and
- [Diabetes, Cardiomyopathy, and Heart Failure](https://www.endotext.org/chapter/diabetes-cardiomyopathy-and-heart-failure/) - ABSTRACT Heart failure (HF) is an underappreciated complication of diabetes. HF occurs in individuals with diabetes at higher rates, even in the absence of other HF risk factors such as coronary artery disease and hypertension. Comorbid ischemic heart disease and cardiovascular risk factors significantly contribute to the etiology of cardiomyopathy and HF in patients with
- [Hypertension in Diabetes](https://www.endotext.org/chapter/hypertension-in-diabetes/) - ABSTRACT The coexistence of diabetes and hypertension is known to have a multiplicative effect on adverse clinical outcomes with respect to both microvascular and macrovascular disease. Effective management of diabetes should therefore include a multifaceted approach combining optimal control of blood pressure and lipids with appropriate glycemic control. The pathophysiology of hypertension in diabetes
- [Hypoglycemia During Therapy of Diabetes](https://www.endotext.org/chapter/hypoglycemia-during-therapy-of-diabetes/) - ABSTRACT The major cause of hypoglycemia is iatrogenic. Treatment with an insulin secretagogue, including sulfonylureas or glinides, or insulin, particularly when coupled with compromised defenses against the resulting falling plasma glucoseconcentrations, is the limiting factor in the glycemic management of diabetes. It causes recurrent morbidity in most peoplewith type 1 diabetes mellitus (T1DM) and
- [Diabetes Mellitus in People with Cancer](https://www.endotext.org/chapter/diabetes-mellitus-in-people-with-cancer/) - *Joint First Authors ABSTRACT There is increasing evidence of an association between cancer and diabetes mellitus. People with Type 2 diabetes are at increased risk of malignancy due to shared risk factors between the two conditions, and people with a diagnosis of cancer may develop new onset diabetes or impaired glycemic control, partly as
- [Surgical Prevention and Treatment of Diabetes](https://www.endotext.org/chapter/surgical-prevention-and-treatment-of-diabetes/) - ABSTRACT The effective treatment of obesity is challenging. This in part reflects the complexity of the underlying disease process. However, there are a growing number of effective surgical, endoscopic, and pharmacologic treatments which are available. Although there has long been a preference on lifestyle modification such as diet and exercise, there is a relative paucity
- [Changing the Course of Disease in Type 1 Diabetes](https://www.endotext.org/chapter/changing-the-course-of-disease-in-type-1-diabetes/) - Dana VanBuecken, ARNP and Sandra Lord, MD contributed equally to submission ABSTRACT In the U.S. alone, more than one million people are living with type 1 diabetes (T1D) and approximately 50,000 individuals per year are newly diagnosed (1) (2). Recent epidemiological studies demonstrate that the global T1D incidence is increasing at a rate of approximately
- [Diabetes Mellitus After Solid Organ Transplantation](https://www.endotext.org/chapter/diabetes-mellitus-after-solid-organ-transplantation/) - ABSTRACT Post transplantation diabetes mellitus (PTDM) is a common and important complication following solid organ transplantation. PTDM may arise from both transplant-related and traditional risk factors and has variably been reported to be associated with decreased patient and graft survival and other adverse outcomes including increased cardiovascular disease risk, infection, and graft rejection. This
- [Pathogenesis of Type 2 Diabetes Mellitus](https://www.endotext.org/chapter/pathogenesis-of-type-2-diabetes-mellitus/) - ABSTRACT Numerous distinct pathophysiologic abnormalities have been associated with type 2 diabetes mellitus (T2DM). It is well established that decreased peripheral glucose uptake (mainly muscle) combined with augmented endogenous glucose production are characteristic features of insulin resistance. Increased lipolysis, elevated free fatty acid levels, along with accumulation of intermediary lipid metabolites contributes to further increase
- [46,XY Differences of Sexual Development](https://www.endotext.org/chapter/46xy-differences-of-sexual-development/) - ABSTRACT The 46,XY differences of sex development (46,XY DSD) can result either from decreased synthesis of testosterone and/or DHT or from impairment of androgen action. 46,XY DSD are characterized by micropenis, atypical or female external genitalia, caused by incomplete intrauterine masculinization with or without the presence of Müllerian structures. Male gonads are identified in
- [Sexual Differentiation](https://www.endotext.org/chapter/sexual-differentiation/) - ABSTRACT The chromosomal sex of the embryo is established at fertilization. However, 6 weeks elapse in humans before the first signs of sex differentiation are noticed. Sex differentiation involves a series of events whereby the sexually indifferent gonads and genitalia progressively acquire male or female characteristics. Believed initially to be governed entirely by the presence
- [Mineralocorticoid Defects in Children](https://www.endotext.org/chapter/mineralocorticoid-defects-in-children/) - ABSTRACT Isolated aldosterone deficiency in children related either to impaired secretion by the adrenal gland or to aldosterone resistance in target tissues is rare. The incidence is estimated to be
- [Cardiovascular Risk Reduction In Youth With Diabetes- Opportunities And Challenges](https://www.endotext.org/chapter/cardiovascular-risk-reduction-in-youth-with-diabetes-opportunities-and-challenges/) - ABSTRACT Despite a notable decline over the past few decades, cardiovascular disease (CVD) remains the leading cause of premature mortality in individuals with diabetes mellitus. Compared to individuals without diabetes, there is ~2-fold or higher increase in CVD and mortality in those with diabetes. While CVD-related complications are seen predominantly during adulthood, the atherosclerotic process
- [Etiology and Pathogenesis of Diabetes Mellitus in Children and Adolescents](https://www.endotext.org/chapter/etiology-and-pathogenesis-of-diabetes-mellitus-in-children-and-adolescents/) - ABSTRACT In this chapter, we review the etiology and pathogenesis of Type 1 diabetes mellitus (T1DM), with particular emphasis on the most common immune mediated form. Whereas Type 2 diabetes (T2DM) appears to be an increasing price paid for worldwide societal affluence, there is also evidence worldwide of a rising tide of T1DM. The
- [Adrenal Disorders in the Tropics](https://www.endotext.org/chapter/adrenal-disorders-in-the-tropics/) - ABSTRACT The adrenal gland in conjunction with the pituitary gland is one of the major components of the endocrine system and regulates blood volume, blood pressure, serum electrolytes, and stress responses. Dysfunction of the adrenal glands may be related to diseases of the adrenal glands or pituitary gland. Adrenal disorders may present either due
- [Chronic Fatigue Syndrome](https://www.endotext.org/chapter/chronic-fatigue-syndrome/) - ABSTRACT Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an enigmatic medical condition that has growing prevalence across the globe, often diagnosed after exclusion of other medical or mental illnesses. As there is no clinical test to confirm the presence of this condition, the diagnosis is syndromic based on different clinical definitions. There was mixed evidence to
- [Aldosterone Deficiency and Resistance](https://www.endotext.org/chapter/aldosterone-deficiency-and-resistance/) - ABSTRACT Aldosterone is crucial for regulating sodium conservation in the kidney, salivary glands, sweat glands, and colon. This adrenal steroid hormone acts via the mineralocorticoid receptor (MR) to promote active transport of sodium and potassium excretion in its target tissues, through activation of specific amiloride-sensitive sodium channels (ENaC) and a Na-K ATP-ase pump. Defective
- [Carney Complex](https://www.endotext.org/chapter/carney-complex-3/) - ABSTRACT Carney complex (CNC) is a rare dominantly inherited syndrome of multiple neoplasias combined with cardio-cutaneous manifestations. Approximately 70% of index cases have a familial history, while the remaining 30% have a de novo germline mutation. Hitherto, two loci have been principally involved in the genetics of CNC: the CNC1 gene, located on 17q22-24, which
- [Adrenal Insuffciency Due To X-Linked Adrenoleukodystrophy](https://www.endotext.org/chapter/adrenal-insuffciency-due-to-x-linked-adrenoleukodystrophy/) - ABSTRACT X-linked adrenoleukodystrophy (X-ALD) is a rare inherited neurodegenerative disorder, involving mainly the white matter and axons of the central nervous system and the adrenal cortex and is a frequent but under-recognized cause of primary adrenocortical insufficiency. X-ALD is caused by a defect in the gene ABCD1 that maps to Xq 28 locus. The
- [Glucocorticoid Therapy and Adrenal Suppression](https://www.endotext.org/chapter/glucocorticoid-therapy-and-adrenal-suppression/) - ABSTRACT Glucocorticoids are steroid hormones produced by the adrenal cortex. They have pleiotropic effects and contribute substantially to the maintenance of resting and stress-related homeostasis. Although the molecular mechanisms of their actions are not fully understood, most of glucocorticoid effects are mediated by a ubiquitously expressed transcription factor, the glucocorticoid receptor. The latter influences
- [Adrenal Insufficiency](https://www.endotext.org/chapter/adrenal-insufficiency/) - ABSTRACT Adrenal insufficiency (AI) is an uncommon clinical condition resulting from inadequate glucocorticoid secretion or action, either at the basal state or during stress. Hypothalamic-pituitary-adrenal (HPA) axis disturbance or primary adrenal failure itself are responsible for this condition. AI presentation can range from asymptomatic hormonal dysfunction to adrenal crisis. Prompt diagnosis and management are crucial
- [Familial Or Sporadic Adrenal Hypoplasia Syndrome](https://www.endotext.org/chapter/familial-or-sporadic-adrenal-hypoplasia-syndrome/) - ABSTRACT Congenital adrenal hypoplasia is a rare cause of primary adrenocortical failure, which was first described in 1948. During the last two decades, the genetic basis for several forms of familial adrenal insufficiency syndromes has been elucidated. The molecular mechanisms for these disorders involve a broad spectrum of cellular and physiologic processes, including metabolism,
- [ACTH Action on the Adrenals](https://www.endotext.org/chapter/acth-action-on-the-adrenals/) - ABSTRACT The adrenocorticotropin hormone (ACTH) is synthesized by the corticotroph cells of the anterior pituitary gland. ACTH, a post-translational product of the proopiomelanocortin protein (POMC), is a 39-amino acid peptide, its sequence being highly conserved in mammals. ACTH binds to the highly specific, for ACTH, melanocortin (MC) 2 receptors (MC2R) located on the surface
- [Adrenal Androgens](https://www.endotext.org/chapter/adrenal-androgens/) - ABSTRACT Adrenal androgens (AA) are 19 carbon (C19) steroids that are secreted by the adrenal cortex through complicated biosynthetic pathways, which are regulated by complex mechanisms not completely understoodas of yet. Adrenal steroidogenesis differs between the fetal and adult adrenal not only in regard tothe site of production, but also in their significance for
- [Adrenal Cortex: Embryonic Development, Anatomy, Histology and Physiology](https://www.endotext.org/chapter/adrenal-cortex-embryonic-development-anatomy-histology-and-physiology/) - ABSTRACT The adrenal glands consist of the adrenal cortex and medulla, which have distinct, albeit interdependent functional properties. The adrenal cortex contains the zona glomerulosa that produces mineralocorticoids, the zona fasciculatathat is the site of glucocorticoid biosynthesis, and the zona reticularis, which is responsible for the production of adrenal androgens. In this chapter, we
- [Stress: Endocrine Physiology and Pathophysiology](https://www.endotext.org/chapter/stress-endocrine-physiology-and-pathophysiology/) - ABSTRACT Stress constitutes a state of threatened homeostasis triggered by intrinsic or extrinsic adverse forces (stressors) and is counteracted by an intricate repertoire of physiologic and behavioral responses aiming to maintain/reestablish the optimal body equilibrium (eustasis). The adaptive stress response depends upon a highly interconnected neuroendocrine, cellular, and molecular infrastructure, i.e. the stress system.
- [Thermal Ablation for Thyroid Nodules](https://www.endotext.org/chapter/thermal-ablation-for-thyroid-nodules/) - ABSTRACT Thermal ablation (TA) of thyroid lesions has revolutionized the management of thyroid nodules over the past two decades. TA has emerged as an innovative, minimally invasive treatment modality for benign thyroid nodules and recurrent thyroid cancers. More recently, TA has been proposed as an alternative therapeutic option for selected cases of primary thyroid
- [Multinodular Goiter](https://www.endotext.org/chapter/multinodular-goiter/) - ABSTRACT Multinodular goiter (MNG) is the most common of all the disorders of the thyroid gland. MNG is the result of the genetic heterogeneity of follicular cells and apparent acquisition of new cellular qualities that become inheritable. Nodular goiter is most often detected simply as a mass in the neck, but sometimes an enlarging gland
- [Impaired Sensitivity to Thyroid Hormone: Defects of Transport, Metabolism and Action](https://www.endotext.org/chapter/impaired-sensitivity-to-thyroid-hormone-defects-of-transport-metabolism-and-action/) - ABSTRACT Resistance to thyroid hormone (RTH), a syndrome of reduced responsiveness of target tissues to thyroid hormone (TH) was identified in 1967 (1). An early report proposed various mechanisms including defects in TH transport, metabolism and action (2). However, with the identification of TH receptor beta (THRB) gene mutations in 1989 (3, 4), the
- [Genetic Defects in Thyroid Hormone Supply](https://www.endotext.org/chapter/genetic-defects-in-thyroid-hormone-supply-2/) - ABSTRACT Congenital hypothyroidism (CH) is the most frequent endocrine-metabolic disease in infancy, with an incidence of about 1/2500 newborns [1, 2]. In the last 20-30 years the incidence of congenital hypothyroidism in newborns has increased from 1:4000 to 1:2000 [3, 4]. This phenomenon could be explained by using a lower b-TSH cutoff, that allowed
- [TSH Receptor Mutations and Diseases](https://www.endotext.org/chapter/tsh-receptor-mutations-and-diseases-2/) - ABSTRACT The thyroid-stimulating hormone (TSH) receptor (TSHR) is a member of the glycoprotein hormone receptors (GPHRs), a sub-group of class A G protein-coupled receptors (GPCRs). TSHR and its ligand thyrotropin are of essential importance for growth and function of the thyroid gland. The TSHR activates different G-protein subtypes and signaling pathways, of which Gs and
- [Metabolism of Thyroid Hormone](https://www.endotext.org/chapter/metabolism-of-thyroid-hormone/) - ABSTRACT Thyroid hormone is indispensable for normal development and metabolism of most cells and tissues. Thyroid hormones are metabolized by different pathways: glucuronidation, sulfation, and deiodination, the latter being the most important. Three enzymes catalyzing deiodination have been identified, called type 1 (D1), type 2 (D2) and type 3 (D3) iodothyronine deiodinases. D1 and D2
- [Ontogeny, Anatomy, Metabolism and Physiology of the Thyroid](https://www.endotext.org/chapter/ontogeny-anatomy-metabolism-and-physiology-of-the-thyroid/) - ABSTRACT This chapter presents an analysis and a summarized synthesis of our present knowledge of the biology of the thyroid gland, phylogeny ,ontogeny ,anatomy ,structure ,general metabolism ,regulatory factors and hormones , signalling cascades and their regulations , ( eg TSH ), functions including iodine metabolism and thyroid hormones synthesis , control of gene expression ,differentiation
- [Multiple Endocrine Neoplasia Type 4](https://www.endotext.org/chapter/multiple-endocrine-neoplasia-type-4/) - ABSTRACT MEN4 (OMIM #610755) has many similarities with MEN1 but is caused by germline mutations in CDKN1B. MEN4 is rarer than MEN1. Clinical manifestations of MEN4 encompass primary hyperparathyroidism, pituitary adenomas, and gastroenteropancreatic neuroendocrine neoplasms. In line with MEN1 other neoplasms may occur. INTRODUCTION MEN4 (OMIM #610755) was initially named MENX and was first described
- [Multiple Endocrine Neoplasia Type 2](https://www.endotext.org/chapter/multiple-endocrine-neoplasia-type-2/) - ABSTRACT Multiple Endocrine Neoplasia (MEN) type 2 A and B are rare autosomal dominant inherited cancer syndromes characterized by tumors of the C cells of the thyroid, of the adrenal medulla, and parathyroid glands. MEN2 is caused by a genetic defect in the REarranged during Transfection (RET) proto-oncogene on chromosome 10 (10q11-2), leading to
- [Gastrointestinal Neuroendocrine Tumors and The Carcinoid Syndrome](https://www.endotext.org/chapter/gastrointestinal-neuroendocrine-tumors-and-the-carcinoid-syndrome/) - ABSTRACT Neuroendocrine neoplasms originating from the gut are increasingly diagnosed as a result of the rise in radiological and endoscopic procedures, improved pathological classification, and likely an increase in true incidence. The diffuse neuroendocrine gastrointestinal system can trigger cancer formation into a wide variety of neoplasm subtypes, ranging from well-differentiated tumors to poorly differentiated carcinomas.
- [Diffuse Hormonal Systems](https://www.endotext.org/chapter/diffuse-hormonal-systems/) - ABSTRACT Neuroendocrine (NE) cells are rare epithelial cells that, in addition to having an endocrine function, express markers and peptides otherwise associated with neurons and the central nervous system. NE cells can be found as either single cells or small clusters of cells dispersed throughout the parenchymal surface epithelium of different tissues, including the
- [An Historical Review of Steps and Missteps in the Discovery of Anti-Obesity Drugs](https://www.endotext.org/chapter/an-historical-review-of-steps-and-missteps-in-the-discovery-of-anti-obesity-drugs/) - ABSTRACT The epidemic of obesity cries out for strategies to prevent it, and for treatment when prevention fails. Yet despite the obvious need, the path to developing anti-obesity medications is strewn with failures. This review examines some historical developments in the management of obesity prior to the 20th century followed by more recent efforts to
- [Exercise Treatment of Obesity](https://www.endotext.org/chapter/exercise-treatment-of-obesity/) - ABSTRACT Surveillance data from the general US population indicate a continued increase in the prevalence of overweight and obesity that is consistent with weight gain trends observed globally among industrialized countries. Physical inactivity and obesity are closely linked conditions and they account for a large burden of chronic disease and impaired function. The underlying
- [Dietary Treatment of Obesity](https://www.endotext.org/chapter/dietary-treatment-of-obesity/) - Introduction NHANES data reveals that 33% of U.S. adults are overweight, (BMI of 25-29), over 35% are obese (BMI 30 or higher) and over 6% are extremely obese (BMI greater than or equal to 40.0) (1). Obesity is a chronic medical condition requiring long-term therapy (2, 3-5). If left untreated, overweight and obesity can increase
- [Metabolic Syndrome](https://www.endotext.org/chapter/metabolic-syndrome/) - ABSTRACT Significant interest exists in understanding the shared metabolic dysregulation leading to obesity, diabetes, and cardiovascular disease (CVD). Hence came the concept of the “metabolic syndrome” (MetS). Reaven first described MetS in his 1988 Banting lecture as “Syndrome X”. Reaven suggested that the syndrome hinged on the existence of insulin resistance and resulted in
- [Endocrine Changes In Obesity](https://www.endotext.org/chapter/endocrine-changes-in-obesity/) - ABSTRACT Obesity can be associated with several endocrine alterations arising from changes in the hypothalamic-pituitary hormones axes. These include hypothyroidism, Cushing’s disease, hypogonadism, and growth hormone deficiency. Besides its role in energy storage, adipose tissue has many other important functions that can be mediated through hormones or substances synthesized and released by adipocytes, including
- [Body Weight Regulation](https://www.endotext.org/chapter/body-weight-regulation/) - ABSTRACT Body weight reflects the chronic balance between energy intake and energy expenditure. The pathophysiology of weight loss and gain is complex with genetic, physiological, and environmental factors contributing to a person’s ability to maintain, lose or gain weight. The inability for the body to counteract chronic caloric surplus leads to overweight and obesity.
- [Non-Exercise Activity Thermogenesis in Human Energy Homeostasis](https://www.endotext.org/chapter/non-exercise-activity-thermogenesis-in-human-energy-homeostasis/) - ABSTRACT Low levels of physical activity combined with food intake in excess of daily energy expenditure over extended time periods precede weight gain and promote increases in body fat. Obesity and related insulin resistance are common sequelae of a chronically positive energy balance, potentially resulting in type 2 diabetes (T2D) and nonalcoholic/metabolic dysfunction associated fatty
- [The Control of Food Intake in Humans](https://www.endotext.org/chapter/the-control-of-food-intake-in-humans/) - ABSTRACT Knowledge of the factors influencing food intake is crucial to form an understanding of energy balance and obesity. Classical physiological feedback models propose that eating behavior is stimulated and inhibited by internal signaling systems (for the drive and suppression of eating, respectively) to maintain stability of the internal environment (usually energy or nutrient
- [Pituitary Gigantism](https://www.endotext.org/chapter/pituitary-gigantism/) - ABSTRACT Pituitary gigantism in a child is an extraordinarily rare condition that results from excessive production of growth hormone. It can present as early as infancy or not until adolescence. It may be congenital or acquired, occurring as a sporadic condition or in the context of a known syndrome in which hypersecretion of GH
- [Pituitary Tumors in Childhood](https://www.endotext.org/chapter/pituitary-tumors-in-childhood/) - ABSTRACT The pituitary region in childhood can be mainly affected by two kinds of neoplasia: craniopharyngiomas and pituitary adenomas. Craniopharyngiomas accounts for 1.2 to 4% of all childhood intracranial tumors, at this age adamantinomatous with cyst formation is the most common histological type. Craniopharyngiomas are benign from a histological point of view, but they
- [Disorders of Growth Hormone in Childhood](https://www.endotext.org/chapter/disorders-of-growth-hormone-in-childhood/) - ABSTRACT Growth is a fundamental process of childhood and growth disorders remain one of the commonest reasons for referral to a pediatric endocrinologist. Growth can be divided into four phases – fetal, infancy, childhood and the pubertal phase with different hormonal components influencing growth at each stage. The GH-IGF1 axis plays a major role
- [Surgical Treatment of Pituitary Adenomas](https://www.endotext.org/chapter/surgical-treatment-of-pituitary-adenomas/) - ABSTRACT The overwhelming majority of pituitary adenomas are benign and present either with characteristic syndromes of excess hormone secretion or secondary to mass effect by the growing tumor. The common hypersecretory syndromes include Cushing’s disease, acromegaly/gigantism, and hyperprolactinemia. Local mass effects on the pituitary can cause varying degrees of hypopituitarism. As the tumor grows beyond
- [Familial Isolated Pituitary Adenoma](https://www.endotext.org/chapter/familial-isolated-pituitary-adenoma/) - ABSTRACT Familial Isolated Pituitary Adenoma (FIPA) is a term used to identify a genetic condition with pituitary tumors without other endocrine or other associated abnormalities. FIPA families contribute around 2% to the overall incidence of pituitary tumors. FIPA is a heterogeneous disease both in terms of the clinical phenotype as well as from the genetic
- [Cushing's Syndrome](https://www.endotext.org/chapter/cushings-syndrome/) - ABSTRACT Cushing’s syndrome results from chronic exposure to excessive circulating levels of glucocorticoids. Cushing’s disease, pituitary-dependent Cushing’s syndrome, is the most common cause of endogenous hypercortisolism. The recommended screening tests include the 1mg overnight dexamethasone suppression test, late-night salivary cortisol (at least 2 samples), and 24-hour urinary free cortisol (at least two 24-hour collections). If
- [Pharmacological Causes of Hyperprolactinemia](https://www.endotext.org/chapter/pharmacological-causes-of-hyperprolactinemia/) - ABSTRACT Hyperprolactinemia represents a multifaceted endocrine disorder with both physiological and pathological causes. The increased use of anti-psychotic and anti-depressant medications has increased the role pharmaceutical agents play in inducing hyperprolactinemia, being the most frequent cause of hyperprolactinemia in clinical practice. This has particularly impacted females, who demonstrate a higher susceptibility to drug-induced hyperprolactinemia. Of
- [Hyperprolactinemia](https://www.endotext.org/chapter/hyperprolactinemia/) - ABSTRACT Hyperprolactinemia is the most common hypothalamic-pituitary dysfunction, being an important cause of irregular menses and infertility amongst young women. Clinical and laboratorial investigation is crucial to determine hyperprolactinemia etiology and to indicate the proper treatment. Prolactinoma is the most common cause of pathological hyperprolactinemia, but physiological and pharmacological causes must be ruled out.
- [Physiology of the Pineal Gland and Melatonin](https://www.endotext.org/chapter/physiology-of-the-pineal-gland-and-melatonin/) - ABSTRACT The pineal gland was described as the “Seat of the Soul” by Renee Descartes and it is located in the center of the brain. The main function of the pineal gland is to receive information about the state of the light-dark cycle from the environment and convey this information by the production and secretion
- [Physiology of GnRH and Gonadotropin Secretion](https://www.endotext.org/chapter/physiology-of-gnrh-and-gonadotropin-secretion/) - ABSTRACT Gonadotropin hormone-releasing hormone (GnRH) is the key regulator of the reproductive axis. Its pulsatile secretion determines the pattern of secretion of the gonadotropins, follicle stimulating hormone and luteinizing hormone, which then regulate both the endocrine function and gamete maturation in the gonads. Recent years have seen rapid developments in how GnRH secretion is regulated,
- [Normal Physiology of ACTH and GH Release in the Hypothalamus and Anterior Pituitary in Man](https://www.endotext.org/chapter/normal-physiology-of-acth-and-gh-release-in-the-hypothalamus-and-anterior-pituitary-in-man/) - ABSTRACT This chapter summarizes the intimate relationship between the hypothalamus and the anterior pituitary with respect to the secretion of ACTH and GH from the physiological viewpoint. Other chapters in Endotext cover the hormones prolactin, LH, FSH, TSH and the posterior pituitary. Adrenocorticotropic hormone (ACTH) and growth hormone (GH) are both peptide hormones secreted
- [Normal Physiology of Growth Hormone in Adults](https://www.endotext.org/chapter/normal-physiology-of-growth-hormone-in-adults/) - ABSTRACT Growth hormone (GH) is an ancestral hormone, secreted episodically from somatotroph cells in the anterior pituitary. Since the recognition of its multiple and complex effects in the early 1960s, the physiology and regulation of GH has become a major area of research interest in the field of endocrinology. In adulthood its main role is
- [Male Androgenetic Alopecia](https://www.endotext.org/chapter/male-androgenetic-alopecia/) - ABSTRACT Male androgenetic alopecia (MAA) is the most common form of hair loss in men, affecting 30-50% of men by age 50. MAA occurs in a highly reproducible pattern, preferentially affecting the temples, vertex and mid frontal scalp. Although MAA is often regarded as a relatively minor dermatological condition, hair loss impacts self-image and
- [Gynecomastia: Etiology, Diagnosis, and Treatment](https://www.endotext.org/chapter/gynecomastia-etiology-diagnosis-and-treatment/) - ABSTRACT Gynecomastia is a relatively common disorder. Its causes range from benign physiological processes to rare neoplasms. To diagnose the etiology of the gynecomastia, the clinician must understand the hormonal factors involved in breast development. Parallel to female breast development, estrogen, growth hormone (GH), and IGF-1 are required for breast growth in males. Since a
- [Testicular Cancer: Pathogenesis, Diagnosis and Management with Focus on Endocrine Aspects](https://www.endotext.org/chapter/testicular-cancer-pathogenesis-diagnosis-and-endocrine-aspects/) - ABSTRACT Testicular cancer comprises different neoplasms, depending on the cell of origin and the typical age at presentation, but germ cell-derived tumors constitute the vast majority of cases. Testicular germ cell tumors (TGCT) can be diagnosed in every age group, but more than 90% of cases occur in young men. These tumors, comprising seminoma
- [Primary Testicular Failure](https://www.endotext.org/chapter/primary-testicular-failure/) - Abstract Primary testicular failure may result in endocrine failure, leading to testosterone deficiency or exocrine failure causing impaired spermatogenesis and subsequently male infertility. While some aspects of primary testicular failure are described in detail in separate chapters of Endotext.com, this chapter focuses on congenital or acquired anorchia, Leydig cell hypoplasia, and spermatogenic failure including germ
- [Hypogonadotropic Hypogonadism (HH) and Gonadotropin Therapy](https://www.endotext.org/chapter/hypogonadotropic-hypogonadism-hh-and-gonadotropin-therapy/) - TAKE HOME POINTS 1-The differential diagnosis of HH includes structural, functional and genetic abnormalities affecting the hypothalamic-pituitary-gonadal axis. 2-While our understanding of the genetic basis of HH has expanded considerably in the past decade, mutations have only been identified in approximately 40% of patients to date. 3-The traditional view that congenital HH is a simple
- [Androgen Physiology: Receptor and Metabolic Disorders](https://www.endotext.org/chapter/androgen-physiology-receptor-and-metabolic-disorders/) - ABSTRACT Androgens are an important class of C19 steroid hormones that control normal male development and reproductive function. The main circulating androgen is testosterone, which is produced in the Leydig cells of the testis and can also act as a pro-hormone after being metabolized to dihydrotestosterone (DHT) or estradiol (E2). The biological actions of
- [Post-Transplant Osteoporosis](https://www.endotext.org/chapter/post-transplant-osteoporosis-3/) - ABSTRACT Organ transplantation has become an established treatment for end-stage diseases, and in recent decades, survival rates have significantly improved. This progress has made diagnosing osteoporosis and other complications essential for prevention, treatment, and enhancing the quality of life for transplant patients. Patients who undergo solid organ transplantation often have risk factors for bone loss
- [An Overview of Glucocorticoid-Induced Osteoporosis](https://www.endotext.org/chapter/an-overview-of-glucocorticoid-induced-osteoporosis/) - ABSTRACT Glucocorticoid (GC)-induced osteoporosis (GCOP) is the most common cause of iatrogenic osteoporosis (OP). Fractures may occur in 30-50% of patients on chronic GC therapy. Most of the epidemiological data associating fracture risk with GC therapy are from the use of oral GCs. The process of bone remodeling is complex, regulated by an intricate network
- [Hypoparathyroidism and Pseudohypoparathyroidism](https://www.endotext.org/chapter/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
- [Primary Hyperparathyroidism](https://www.endotext.org/chapter/primary-hyperparathyroidism/) - ABSTRACT Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and elevated or inappropriately normal parathyroid hormone (PTH) levels. PHPT results from excessive secretion of PTH from one or more of the parathyroid glands. The clinical presentation of PHPT has evolved since the 1970’s with the advent of the routine measurement of serum calcium at that time.
- [Calcium and Phosphate Homeostasis](https://www.endotext.org/chapter/calcium-and-phosphate-homeostasis/) - ABSTRACT Calcium and phosphate are critical to human physiology (e.g., neuromuscular function) and are also needed for skeletal mineralization. An understanding of calcium and phosphate metabolism is required for the clinician to evaluate disorders of the levels of calcium and phosphorus as well as metabolic skeletal disorders. In this chapter, we review calcium and phosphate
- [Anatomy and Ultrastructure of Bone - Histogenesis, Growth and Remodeling](https://www.endotext.org/chapter/anatomy-and-ultrastructure-of-bone-histogenesis-growth-and-remodeling/) - ABSTRACT Bones have three major functions: to serve as mechanical support, sites of muscle insertion and as a reserve of calcium and phosphate for the organism. Recently, a fourth function has been attributed to the skeleton: an endocrine organ. The organic matrix of bone is formed mostly of collagen, but also non-collagenous proteins. Hydroxyapatite
- [Prolactinoma Management](https://www.endotext.org/chapter/prolactinoma-management/) - ABSTRACT Prolactinomas comprise nearly 40% of all pituitary tumors. Patients with prolactinomas usually come to medical attention as a result of symptoms caused by elevated prolactin levels, such as hypogonadism, menstrual irregularities, infertility or galactorrhea, or due to mass effects. Sometimes these patients can present as an emergency, either due to a visual field defect
- [Hypothyroidism in Pregnancy](https://www.endotext.org/chapter/hypothyroidism-in-pregnancy/) - CLINICAL RECOGNITION The prevalence of overt and subclinical hypothyroidism in pregnancy is 0.3-0.5% and 2-3% respectively. Overt hypothyroidism in pregnancy may present classically but is often subtle and difficult to distinguish from the symptoms of normal pregnancy. A high index of suspicion is therefore required, especially in women with a predisposition to thyroid disease such
- [Thyroid Storm](https://www.endotext.org/chapter/thyroid-storm/) - CLINICAL RECOGNITION Thyroid (or thyrotoxic) storm is an acute, life-threatening syndrome due to an exacerbation of thyrotoxicosis. It is now an infrequent condition because of earlier diagnosis and treatment of thyrotoxicosis and better pre- and postoperative medical management. In the United States the incidence of thyroid storm ranged between 0.57 and 0.76 cases/100,000 persons per
- [Outpatient Management of Diabetes Mellitus in Elderly Patients](https://www.endotext.org/chapter/outpatient-management-of-diabetes-mellitus-in-elderly-patients/) - ABSTRACT The number of older adults with diabetes is increasing in the United States and worldwide due to increased lifespan and the increased prevalence of diabetes in the geriatric population. The global prevalence of diabetes in people aged 65 years and older is estimated to be 19.3% (135.6 million), and it is projected to reach
- [TREATMENT](https://www.endotext.org/chapter/treatment-2/)
- [Dyslipidemia in Chronic Kidney Disease](https://www.endotext.org/chapter/dyslipidemia-in-chronic-kidney-disease-3/) - ABSTRACT Chronic kidney disease (CKD) is associated with a dyslipidemia comprising high triglycerides, low HDL-C, and altered lipoprotein composition. Cardiovascular diseases are the leading cause of mortality in CKD, especially in end stage renal disease patients. Thus, therapies to reduce cardiovascular risk are urgently needed in CKD. Robust clinical trial evidence has found that the
- [Diagnostic Testing for Diabetes Insipidus](https://www.endotext.org/chapter/diagnostic-testing-for-diabetes-insipidus/) - ABSTRACT Diabetes insipidus (DI) is a disorder characterized by excretion of large volumes of hypotonic urine. The underlying cause is either a deficiency of the hormone arginine vasopressin (AVP) in the pituitary gland/hypothalamus [central DI or Arginine Vasopressin Deficiency (AVP-D)], or resistance to the actions of AVP in the kidneys [nephrogenic DI or Arginine
- [Endometriosis](https://www.endotext.org/chapter/test-2/) - ABSTRACT Endometriosis is a disease in which endometrial glands and stroma implant and grow in areas outside the uterus. The disease has a multi-factorial etiology including genetic and environmental factors. Exposure to ovarian hormones appears to be essential. Estrogens stimulate ectopic endometrium growth and aberrations in estrogen signaling have been associated with the disease. Caucasians appear
- [Thyroid Nodules and Cancer in the Elderly](https://www.endotext.org/chapter/thyroid-nodules-and-cancer-in-the-elderly/) - ABSTRACT Thyroid nodules and thyroid 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 pre-operatively has reduced the need for diagnostic surgery in many individuals. In patients with differentiated thyroid cancer, total thyroidectomy and radioactive iodine
- [Hypothyroidism in Older Adults](https://www.endotext.org/chapter/hypothyroidism-in-older-adults/) - ABSTRACT Hypothyroidism is more common among elderly individuals due to the increasing incidence and prevalence of autoimmune thyroiditis that occurs with aging. Accurate diagnosis of this condition in the elderly may be challenging due to several factors including a relative paucity of referable symptoms, confounding findings that may be related to comorbid disorders, changes in
- [Hyperthyroidism in Aging](https://www.endotext.org/chapter/hyperthyroidism-in-aging/) - ABSTRACT Hyperthyroidism in older people is a serious clinical condition that is associated with significant morbidity. It may be difficult to diagnose due to the confounding effects of drugs and acute or chronic illnesses on the interpretation of thyroid function tests. In addition, there is a relative paucity of typical hyperadrenergic symptoms in older patients
- [Physiology and Diseases Of The Hypothalamic-Pituitary Axis In The Elderly](https://www.endotext.org/chapter/physiology-and-diseases-of-the-hypothalamic-pituitary-axis-in-the-elderly/) - ABSTRACT Aging is characterized by changes in virtually all biological systems, and the hypothalamic-pituitary axis is no exception. With aging, the secretory patterns of the hormones produced by the hypothalamic–pituitary axis gradually shift with the axis becoming less responsive to feedback from end hormones. This is accompanied by physical and cognitive changes that coincide with
- [Assessing Insulin Sensitivity and Resistance in Humans](https://www.endotext.org/chapter/assessing-insulin-sensitivity-and-resistance-in-humans/) - ABSTRACT In this chapter we discuss a representative variety of methods currently available for estimating insulin sensitivity/resistance. These range from complex, time consuming, labor-intensive, invasive procedures to simple testsinvolving a single fasting blood sample. It is important to understand the physiological concepts informing each method so that relative merits and limitations of particular approaches
- [Acromegaly](https://www.endotext.org/chapter/acromegaly/) - ABSTRACT Acromegaly is a rare condition with an approximate incidence of 3-11 new cases per million of population per year and a prevalence of approximately 60 per million (1). There are approximately 3000 identified individuals in the UK and 15000 in the USA, although it is possible that more cases exist but do not come
- [Endocrine Testing Protocols: Hypothalamic Pituitary Adrenal Axis](https://www.endotext.org/chapter/endocrine-testing-protocols-hypothalamic-pituitary-adrenal-axis/) - ABSTRACT Abnormalities in the hypothalamic pituitary adrenal (HPA) axis are identified by a careful analysis of both direct and non-stimulated measurements of the hormones as well as provocative tests. Dynamic testing is useful to determine if elevated levels are suppressible and whether there is sufficient hormone reserve when low levels are measured under stimulation. A
- [Ovarian Reserve Testing](https://www.endotext.org/chapter/ovarian-reserve-testing/) - ABSTRACT The ovaries affect far more than reproductive health. Estrogen affects cardiovascular, skeletal, mental health, and numerous other aspects of wellness. Additionally, ovarian dysfunction can reflect disequilibrium relating to multiple conditions. Efficient and effective ovarian testing can give women valuable answers about their fertility, time to menopause, and other conditions and symptoms they may face.
- [Endocrinology of Pregnancy](https://www.endotext.org/chapter/endocrinology-of-pregnancy-2/) - ABSTRACT A coordinated sequence of events must occur in order to establish and successfully maintain a healthy pregnancy. Synchrony between the development of the early embryo and establishment of a receptive endometrium is necessary to allow implantation and subsequent progression of pregnancy. The endocrinology of human pregnancy involves endocrine and metabolic changes that result from
- [Abnormalities of Female Pubertal Development](https://www.endotext.org/chapter/abnormalities-of-female-pubertal-development/) - ABSTRACT Puberty is the period of growth that bridges childhood to adulthood and results in physical and sexual maturity as well as the capacity for reproduction. Over half of pubertal timing is considered heritable. Significant pathology can result in both advanced and delayed puberty and can result in altered attainment of adult height, secondary sexual
- [Medication Induced Changes in Lipid and Lipoproteins](https://www.endotext.org/chapter/medication-induced-changes-in-lipid-and-lipoproteins/) - ABSTRACT Several medications and medication classes have been reported to affect the lipid profile. This should be considered when evaluating patients with elevated levels of total cholesterol (TC), low-density lipoproteins cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C), triglycerides (TG), and reductions in high-density lipoprotein cholesterol (HDL-C). Glucocorticoids, atypical antipsychotics, anticonvulsants, hormones, and certain immunosuppressives are
- [Evaluation and Treatment of Dyslipidemia in the Elderly](https://www.endotext.org/chapter/evaluation-and-treatment-of-dyslipidemia-in-the-elderly/) - ABSTRACT The definition of elderly is arbitrary. In this chapter we will define elderly as greater than 75 years of age because both the US and European lipids guidelines use this age to differentiate therapy recommendations. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality in the elderly. Age is a
- [Thyrotropin-Secreting Pituitary Adenomas](https://www.endotext.org/chapter/thyrotropin-secreting-pituitary-adenomas/) - ABSTRACT Thyrotropin-secreting pituitary tumors (TSH-omas or TSH-PitNET) are a rare cause of hyperthyroidism and account for about 1% of all pituitary adenomas. It is, however, noteworthy that the number of reported cases increased over the last few decades because of the improved awareness of this condition. Indeed, ultrasensitive TSH assays allow a clear distinction between
- [DIABETES](https://www.endotext.org/chapter/diabetes-2/)
- [Management of Diabetes and Hyperglycemia in Hospitalized Patients](https://www.endotext.org/chapter/management-of-diabetes-and-hyperglycemia-in-hospitalized-patients/) - ABSTRACT Diabetes is the most prevalent metabolic disorder, and in 2021, the International Diabetes Federation estimated that it affected 537 million adults globally. In 2024, the United States Centers for Disease Control reported that 38.1 million adult Americans, or 14.7% of the adult population, have diabetes. Patients with diabetes have a 3-4-fold greater chance ofhospitalization
- [Aggressive Pituitary Tumors and Pituitary Carcinomas](https://www.endotext.org/chapter/aggressive-pituitary-tumors-and-pituitary-carcinomas/) - ABSTRACT Aggressive pituitary tumors (APT) refer to pituitary adenomas exhibiting radiological invasiveness and an unusually rapid tumor growth rate, or clinically relevant tumor growth despite optimal standard treatments. Pituitary carcinomas (PC) are defined by non-contiguous craniospinal or distant metastasis. PC is exceedingly rare, comprising only 0.1-0.4% of all pituitary neoplasms, whereas APT accounts for up
- [Fibromyalgia](https://www.endotext.org/chapter/fibromyalgia/) - ABSTRACT Fibromyalgia is a clinical entity characterized by the combination of chronic widespread pain and other non-pain symptoms, including fatigue, poor sleep, and cognitive disturbances, which can exhibit symptom variation not only between different patients, but also in the same patient during the course of the disease. These symptoms are relatively common and non-specific. They
- [Primary Generalized Glucocorticoid Resistance Syndrome](https://www.endotext.org/chapter/primary-generalized-glucocorticoid-resistance-syndrome/) - ABSTRACT Primary generalized glucocorticoid resistance syndrome is a rare genetic disorder characterized by resistance of entire tissues to glucocorticoids. Affected subjects demonstrate elevation of serum cortisol without Cushingoid manifestations, as the hypothalamic-pituitary-adrenal (HPA) axis is upregulated to compensate for the reduced action of this steroid in local tissues. Instead, these patients develop hypertension and/or signs
- [HPA Axis and Sleep](https://www.endotext.org/chapter/hpa-axis-and-sleep/) - ABSTRACT Sleep is an important component of mammalian homeostasis, vital for our survival. Sleep disorders are common in the general population and are associated with significant adverse behavioral and health consequences. Sleep, in particular deep sleep, has an inhibitory influence on the hypothalamic-pituitary- adrenal (HPA) axis, whereas activation of the HPA axis or administration
- [Glucocorticoid Receptor](https://www.endotext.org/chapter/glucocorticoid-receptor/) - ABSTRACT The glucocorticoid receptor (GR) is an evolutionally conserved nuclear receptor superfamily protein that mediates the diverse actions of glucocorticoids as a ligand-dependent transcription factor. This receptor is a protein that shuttles from the cytoplasm to the nucleus upon binding to its ligand glucocorticoid hormone, where it modulates the transcription rates of glucocorticoid-responsive genes
- [Paget's Disease of Bone](https://www.endotext.org/chapter/pagets-disease-of-bone/) - ABSTRACT Sir James Paget described a skeletal disorder affecting one or more areas of the skeleton in 1876. It is most common in England and in countries to which the English migrated. In recent years the prevalence in most countries has decreased. A common feature is skeletal deformity which evolves over many years and
- [Thyrotoxicosis of other Etiologies](https://www.endotext.org/chapter/thyrotoxicosis-of-other-etiologies/) - INTRODUCTION Thyrotoxicosis is defined as the clinical syndrome of hypermetabolism resulting from increased free thyroxine (T4) and/or free triiodothyronine (T3) serum levels (1). The term thyrotoxicosis is not synonymous with hyperthyroidism, the elevation in thyroid hormone levels caused by an increase in their biosynthesis and secretion by the thyroid gland (Table 1) (2). For example,
- [Endocrine testing for the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)](https://www.endotext.org/chapter/endocrine-testing-for-the-syndrome-of-inappropriate-antidiuretic-hormone-secretion-siadh/) - ABSTRACT The diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) relies on an adequate assessment of a hyponatremic state (that is a serum sodium level
- [Growth hormone Stimulation Tests in Assessing Adult Growth Hormone Deficiency](https://www.endotext.org/chapter/growth-hormone-stimulation-tests-in-assessing-adult-growth-hormone-deficiency/) - ABSTRACT Adult growth hormone deficiency (GHD) is a clinical syndrome that can manifest either as isolated or associated with additional pituitary hormone deficiencies. Its clinical features are subtle and nonspecific, requiring GH stimulation testing to arrive at a correct diagnosis. However, diagnosing adult GHD can be challenging due to the episodic and pulsatile endogenous GH
- [Testing for Endocrine Hypertension](https://www.endotext.org/chapter/testing-for-endocrine-hypertension/) - ABSTRACT Endocrine hypertension belongs to the group of secondary forms of hypertension and mostly is caused by disorders of the adrenal gland. There are also nonadrenal endocrine conditions that can lead to hypertension secondary to hormonal imbalance and this chapter reviews how to best identify patients with and test for such disorders. For complete coverage
- [Surgical Treatment of Obesity](https://www.endotext.org/chapter/surgical-treatment-of-obesity/) - ABSTRACT Obesity is one of the most prevalent pathogens in the developed world, causing numerous common and lethal diseases. Non-surgical treatments to date have failed to provide an effective, durable solution. Bariatric surgery includes the procedures of gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic bypass. These procedures have been shown to produce substantial and durable
- [Diabetic Retinopathy](https://www.endotext.org/chapter/diabetic-retinopathy/) - ABSTRACT Diabetic retinopathy is a significant life-altering complication affecting patients with diabetes. Understanding its pathogenesis, prevention, and treatment is critical to delivering effective and comprehensive care for patients with diabetes at all stages. This review discusses the risk factors, epidemiology, pathogenesis, clinical features, and treatment options for diabetic retinopathy, with an emphasis on practical information
- [Estrogens, Male Reproduction and Beyond](https://www.endotext.org/chapter/estrogens-male-reproduction-and-beyond/) - ABSTRACT In males, estrogens exert pleiotropic effects by acting on several tissue and organs, including the male reproductive system. The action of estrogens is manifest from prenatal life during which the exposure to estrogen excess might influence the development of some structures of the male reproductive tract. Male fertility is under the control of estrogens,
- [Medical and Surgical Therapy of Erectile Dysfunction](https://www.endotext.org/chapter/medical-and-surgical-therapy-of-erectile-dysfunction/) - ABSTRACT Erectile dysfunction (ED) is the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse. Approximately 23% of men aged 40-80 years worldwide have symptoms of ED. The prevalence of ED is higher in older men but this condition can occur in men of any age. The prevalence of ED ranges
- [Clinical Management of Male Infertility](https://www.endotext.org/chapter/clinical-management-of-male-infertility/) - ABSTRACT This chapter provides a comprehensive overview of the clinical, "hands-on" approach to the diagnosis and treatment of male infertility. It is a resource of evidence-based information for those who are practicing in this fascinating field as reproductive endocrinologists, fertility specialists, urologists, gynecologists and general practitioners. This chapter has been revised with a particular focus on
- [Androgen Physiology, Pharmacology Use and Misuse](https://www.endotext.org/chapter/androgen-physiology-pharmacology-use-and-misuse/) - ABSTRACT Testosterone, together with its bioactive metabolites dihydrotestosterone and estradiol, determines the development and maintenance of male sexual differentiation and the characteristic mature masculine features. Defects in androgen action at various epochs of life produce characteristic clinical features. From an outline of the biochemistry and physiology of androgen action, the pathophysiology of defects in androgen
- [Benign Breast Disease in Women](https://www.endotext.org/chapter/benign-breast-disease-in-women/) - ABSTRACT Benign breast disease in women is a very common finding and results in a diagnosis in approximately one million women annually in the United States (1). An understanding of the hormonal and growth factor control of breast development and function is key to the rational and systematic evaluation and treatment of patients. A firm
- [Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome)](https://www.endotext.org/chapter/premenstrual-dysphoric-disorder-formerly-premenstrual-syndrome/) - ABSTRACT Premenstrual syndrome, the recurrent luteal phase deterioration in quality of life due to disruptive physical and psychiatric symptomatology, is a distinct clinical condition caused by an abnormal central nervous system response to the hormonal changes of the female reproductive cycle. Better definition and research based on strict inclusion/ exclusion criteria have allowed the development
- [Evaluation of Infertility, Ovulation Induction and Assisted Reproduction](https://www.endotext.org/chapter/evaluation-of-infertility-ovulation-induction-and-assisted-reproduction/) - ABSTRACT Infertility is a prevalent condition among men and women and can be emotionally devastating. The cause of a couple’s infertility may be female, male, a combination, or unexplained. This chapter serves to outline the evidence-based evaluation of infertility and treatments including ovulation induction and assisted reproductive technologies. Reproduction is a mandate of nature. The
- [Evaluation and Treatment of Polycystic Ovary Syndrome](https://www.endotext.org/chapter/evaluation-and-treatment-of-polycystic-ovary-syndrome/) - Abstract Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among adult women in the developed world and is characterized by anovulation, androgen excess (primarily ovarian, but also adrenal in origin) and the appearance of polycystic ovaries on ultrasound. Diagnostic criteria are expert-based and debated as they do not incorporate known metabolic abnormalities related to
- [Evaluation of Amenorrhea, Anovulation, and Abnormal Bleeding](https://www.endotext.org/chapter/evaluation-of-amenorrhea-anovulation-and-abnormal-bleeding/) - ABSTRACT Amenorrhea not due to pregnancy, lactation, or menopause is a relatively common abnormality of the reproductive years and indicative of a defect somewhere in the hypothalamic-pituitary-ovarian-uterine axis. This chapter considers the various causes of amenorrhea and their treatment. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of
- [Morphology and Physiology of the Ovary](https://www.endotext.org/chapter/morphology-and-physiology-of-the-ovary/) - INTRODUCTION A major aspect of reproductive capacity in women is its cyclical activity, a feature strikingly reflected in the growth and development of dominant follicles. Normally, the human ovaries produce a single dominant follicle that results in a single ovulation each menstrual cycle. The dominant follicle is responsible for the production of estradiol during the
- [Calcium & Phosphate Metabolism and Related Disorders During Pregnancy and Lactation](https://www.endotext.org/chapter/calcium-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 and phosphate absorption more than double, and this appears to be
- [Hypocalcemia: Diagnosis and Treatment](https://www.endotext.org/chapter/hypocalcemia-diagnosis-and-treatment-3/) - ABSTRACT Hypocalcemia is an electrolyte derangement commonly encountered on surgical and medical services. This derangement can result from a vast spectrum of disorders. The condition may be transient, reversing with addressing the underlying cause expeditiously, or chronic and even lifelong, when due to a genetic disorder or the result of irreversible damage to the parathyroid
- [Hyperparathyroidism in Chronic Kidney Disease](https://www.endotext.org/chapter/hyperparathyroidism-in-chronic-kidney-disease/) - ABBREVIATIONS [Ca2+e] : extracellular Ca2+ concentration Calcidiol : 25 OH vitamin D3 Calcitriol : 1,25 diOH vitamin D3 CaSR : Ca2+-sensing receptor CKD : chronic kidney disease CKD-MBD : CKD-associated mineral and bone disorder EGF-R : epidermal growth factor receptor ESKD, end-stage kidney disease FGF23: fibroblast growth factor-23 FGFR-1, fibroblast growth factor receptor-1 FGFR-3, fibroblast
- [Vitamin D: Production, Metabolism, and Mechanisms of Action](https://www.endotext.org/chapter/vitamin-d-production-metabolism-and-mechanisms-of-action/) - ABSTRACT Vitamin D production in the skin under the influence of sunlight (UVB) is maximized at levels of sunlight exposure that do not burn the skin. Further metabolism of vitamin D to its major circulating form (25(OH)D) and hormonal form (1,25(OH)2D) takes place in the liver and kidney, respectively, but also in other tissues
- [Cryptorchidism and Hypospadias](https://www.endotext.org/chapter/cryptorchidism-and-hypospadias/) - ABSTRACT Undescended testis (UDT) is a common abnormality, affecting about 1/20 males at birth. Half of these have delayed testicular descent, with the testis in the scrotum by 10-12 weeks after term. Beyond this spontaneous descent is rare. Current treatment recommendations are that UDT beyond 3 months of age need surgery before 12 months of
- [Diagnosis and Clinical Management of Monogenic Diabetes](https://www.endotext.org/chapter/diagnosis-and-clinical-management-of-monogenic-diabetes/) - ABSTRACT Monogenic forms of diabetes are responsible for 1-3% of all young-onset diabetes. The multiple genes involved can cause one or both of the main phenotypes- congenital (neonatal) diabetes or MODY (maturity-onset diabetes of the young). The timely and accurate genetic diagnosis of monogenic diabetes provides an opportunity to target therapy to the underlying
- [Growth and Growth Disorders](https://www.endotext.org/chapter/growth-and-growth-disorders/) - ABSTRACT The process of growth is complex and is influenced by various factors that act centrally and peripherally. In this chapter, we describe conditions associated with multiple pituitary hormone deficiency, isolated growth hormone deficiency, and abnormal growth without growth hormone deficiency, discuss the genes that are associated with these conditions, and prepare guidelines for
- [Radiology of the Pituitary](https://www.endotext.org/chapter/radiology-of-the-pituitary/) - ABSTRACT MRI is the primary imaging modality for the pituitary gland. This chapter reviews and illustrates the normal anatomy and MRI appearances of the pituitary gland and hypothalamic region. The optimal MRI technique relies on thin section T1-weighted sequences in the sagittal and coronal planes before and after gadolinium contrast enhancement. T2-weighted sequences can add
- [Defects of Thyroid Hormone Transport in Serum](https://www.endotext.org/chapter/defects-of-thyroid-hormone-transport-in-serum/) - ABSTRACT Inherited abnormalities of thyroid hormone-binding proteins are not uncommon and can predominate in some ethnic groups. They alter the number of iodothyronines present in serum and, although the concentration of free hormones remains unaltered, routine measurement can give erroneous results. With a single exception, inherited defects in thyroxine-binding globulin (TBG), are X-chromosome linked and
- [Thyroid Hormones in Brain Development and Function](https://www.endotext.org/chapter/thyroid-hormones-in-brain-development-and-function/) - ABSTRACT Thyroid hormones are essential for normal brain development. They influence neurogenesis, neuronal and glial cell differentiation and migration, synaptogenesis, and myelination. Thyroid hormone deficiency may severely affect the brain during fetal and postnatal development, causing retarded maturation, intellectual deficits, and neurological impairment. Neural cells express the thyroid hormone nuclear receptors THRA and THRB,
- [Graves' Disease: Complications](https://www.endotext.org/chapter/graves-disease-complications/) - ABSTRACT Thyroid storm is an acute and life-threatening worsening of hyperthyroidism, characterized by an exacerbation of symptoms and signs of hyperthyroidism, with high fever, dehydration, marked tachycardia or tachyarrhytmias, heart failure, hepatomegaly, respiratory distress, abdominal pain, delirium, possibly seizures. It may occur in patients submitted to thyroidectomy or radioactive iodine treatment while hyperthyroid, or as
- [Adult Hypothyroidism](https://www.endotext.org/chapter/adult-hypothyroidism/) - 9.1 HISTORICAL The full-blown expression of hypothyroidism is known as myxedema. Adult myxedema escaped serious attention until Gull described it in 1874 1 . That it was a state resembling the familiar endemic cretinism, but coming on in adult life, was what chiefly impressed Gull. Ord 2 invented the term myxedema in 1873. The disorder
- [Thyroid Hormone Serum Transport Proteins](https://www.endotext.org/chapter/thyroid-hormone-serum-transport-proteins-2/) - ABSTRACT Thyroid hormone (TH) effects are dependent on the quantity of the hormone that reaches the tissues, hormone activation, and the availability of unaltered TH receptors in the cell’s nuclei and cytoplasm. Since TH enters the cell unbound, the concentration of free rather than total hormone reflects more accurately the activity level of TH-dependent
- [Assay of Thyroid Hormone and Related Substances](https://www.endotext.org/chapter/assay-of-thyroid-hormone-and-related-substances3/) - ABSTRACT This chapter reviews how improvements in the sensitivity and specificity of thyroid tests [total and free thyroid hormones (T4 and T3), TSH, thyroid autoantibodies (TRAb, TPOAb, and TgAb) and thyroglobulin (Tg)] have advanced the detection and treatment of thyroid disorders. The strengths and limitations of current methodologies [Radioimmunoassay (RIA), Immunometric assay (IMA) and
- [Physiology of the Hypothalamic-Pituitary-Thyroid Axis](https://www.endotext.org/chapter/physiology-of-the-hypothalamic-pituitary-thyroid-axis/) - ABSTRACT The activity of the thyroid gland is predominantly regulated by the concentration of the pituitary glycoprotein hormone, thyroid-stimulating hormone (TSH). In the absence of the pituitary or of thyrotroph function, hypothyroidism ensues. Thus, regulation of thyroid function in normal individuals is to a large extent determined by the factors which regulate the synthesis
- [Prevention of Obesity](https://www.endotext.org/chapter/prevention-of-obesity-2/) - ABSTRACT Obesity has become a major public problem which is associated with increased risk to health and enhanced mortality along with increased medical costs. Prevention is obviously the first line of attack and this chapter outlines preventive strategies starting with a model which translates the energy imbalance which produces obesity into the social framework in
- [Molecular links between Obesity and Diabetes: "Diabesity"](https://www.endotext.org/chapter/molecular-links-between-obesity-and-diabetes-diabesity/) - ABSTRACT Severe obesity represents a major risk factor for the development of type 2 diabetes mellitus (T2DM). Due to the strong association of obesity and diabetes, the term “diabesity” was coined, suggesting a causal pathophysiological link between both phenomena. The majority of individuals with T2DM are obese, highlighting the pivotal role of increased adiposity
- [Control of Energy Expenditure in Humans](https://www.endotext.org/chapter/control-of-energy-expenditure-in-humans/) - ABSTRACT Resting and meal-related energy requirements can be assessed by measuring energy expenditure with indirect calorimetry. The indicated method to assess free-living energy expenditure is the doubly labelled water technique. Variation in energy expenditure is mainly a function of body size and composition (resting energy expenditure) and of physical activity (activity energy expenditure). Thus,
- [Genetic Obesity Syndromes](https://www.endotext.org/chapter/genetic-obesity-syndromes/) - ABSTRACT Genetic factors play a major role in the regulation of body weight and in the susceptibility to obesity in the population. A subset of people with severe obesity carry rare, highly penetrant genetic variants that can result in severe childhood-onset obesity. Current estimates suggest that up to 20% of children with severe obesity
- [Oral and Injectable (Non-Insulin) Pharmacological Agents for the Treatment of Type 2 Diabetes](https://www.endotext.org/chapter/oral-and-injectable-non-insulin-pharmacological-agents-for-the-treatment-of-type-2-diabetes/) - ABSTRACT While lifestyle changes such as dietary modification and increased physical activity can be very effective in improving glycemic control, over the long-term most individuals with Type 2 diabetes (T2DM) will require medications to achieve and maintain glycemic control. The purpose of this chapter is to provide the healthcare practitioner with an overview of the
- [Performance Enhancing Hormone Doping in Sport](https://www.endotext.org/chapter/performance-enhancing-hormone-doping-in-sport/) - ABSTRACT Sport is the organized playing of competitive games according to rules. Hence doping represents drug cheating, a fraud on competitors, the sport, and the public. The charter of the World Anti-doping Agency (WADA) forms a harmonized Code that authorizes an annually updated list of prohibited doping substances and methods, accrediting national anti-doping labs around
- [Pituitary and Adrenal Disorders of Pregnancy](https://www.endotext.org/chapter/pituitary-and-adrenal-disorders-of-pregnancy/) - ABSTRACT The pituitary and adrenal glands play an integral role in the endocrine and physiological changes of normal pregnancy. These changes are associated with alterations in the normal ranges of endocrine tests and in the appearance of the glands. It is important for the medical team to be aware of these altered normal ranges
- [Development And Microscopic Anatomy Of The Pituitary Gland](https://www.endotext.org/chapter/development-and-microscopic-anatomy-of-the-pituitary-gland/) - ABSTRACT The pituitary gland is an organ of dual origin. The anterior part (adenohypophysis) arises from embryonic buccal mucosa, whereas the posterior part (neurohypophysis) derives from neural ectoderm. Precise spatial and temporal co-ordination of transcription factor expression in both structures is critical for pituitary gland formation and the differentiation of hormone-producing cells. Disruption of this
- [Hypopituitarism](https://www.endotext.org/chapter/hypopituitarism/) - ABSTRACT Hypopituitarism is described as partial or complete loss of isolated or combined deficits of pituitary hormones. The clinical presentation of this condition varies depending on the age of onset, underlying cause of the disease, severity of deficiency, and number of affected hormones. Investigation to confirm the diagnosis is based on basal hormone status and
- [Radiotherapy for Pituitary Tumors](https://www.endotext.org/chapter/radiotherapy-for-pituitary-tumors/) - ABSTRACT Pituitary adenomas have been historically managed on a multidisciplinary level with surgery, medical therapy, and radiotherapy to control symptoms secondary to mass-effects and hypersecretion of hormones. While transsphenoidal surgery represents the standard initial approach in the majority of cases, radiotherapy is a valuable and effective treatment option for recurrent adenomas, or lesions not amenable
- [Hypopituitarism](https://www.endotext.org/chapter/hypopituitarism-3/)
- [Adult Growth Hormone Deficiency Clinical Management](https://www.endotext.org/chapter/adult-growth-hormone-deficiency-clinical-management/) - ABSTRACT The clinical syndrome of GH deficiency (GHD) is characterized by non-specific features including variable presence of decreased mood and general well-being, reduced bone remodeling activity, change in body fat distribution with increased central adiposity, hyperlipidemia, and increased predisposition to atherogenesis. The goal of GH replacement therapy in adults with GH deficiency is to
- [Hypophysitis](https://www.endotext.org/chapter/hypophysitis/) - ABSTRACT Hypophysitis is an inflammation of the pituitary gland and is a rare cause of hypopituitarism. It can be primary (idiopathic) or secondary to sella and parasellar lesions, systemic diseases, or drugs (mainly immune checkpoint inhibitors [ICI]). Primary hypophysitis has five histologic variants: lymphocytic, granulomatous, xanthomatous, IgG4-related, and necrotizing. Lymphocytic hypophysitis is the most common
- [Hypopituitarism Following Cranial Radiotherapy](https://www.endotext.org/chapter/hypopituitarism-following-cranial-radiotherapy/) - ABSTRACT Radiation treatment is used for patients with secreting and non-secreting pituitary adenomas, with residual pituitary adenomas, or recurrent pituitary adenomas with the aim to achieve long term disease control. Radiotherapy is an integral component of the management of other tumors in the sellar region (craniopharyngiomas) and for certain types of cancers and lymphomas. Pituitary
- [Empty Sella](https://www.endotext.org/chapter/empty-sella/) - ABSTRACT Empty sella is a radiological finding of a flattened pituitary in a sellar space filled with cerebrospinal fluid. It may be primary or secondary consequent to various processes causing injury and shrinkage of the pituitary gland (postpartum hemorrhage, pituitary surgery, irradiation, apoplexy, infection, head trauma, hypophysitis, etc.). The mechanisms involved in the pathogenesis
- [Infections Of The Hypothalamic-Pituitary Region](https://www.endotext.org/chapter/infections-of-the-hypothalamic-pituitary-region/) - ABSTRACT Infections of the hypothalamic-pituitary region are rare lesions, accounting for less than 1% of all pituitary lesions. The clinical diagnosis of these infections can be difficult due to the nonspecific nature of the disease (in many patients without symptoms of infection) and may be misdiagnosed as other pituitary lesions. The risk factors for infections
- [Genetic Etiology of Congenital Hypopituitarism](https://www.endotext.org/chapter/genetic-etiology-of-congenital-hypopituitarism/) - ABSTRACT Congenital hypopituitarism refers to a deficiency of one or more pituitary hormones resulting from issues in fetal development. Embryological pituitary development involves a complex interplay of transcription factors, extrinsic and intrinsic to the oral ectoderm and neuroectoderm which develop to form the mature pituitary during early embryogenesis. Disruption of this process can result in
- [Pediatric Issues](https://www.endotext.org/chapter/pediatric-issues/)
- [Pediatric implications of normal insulin-GH-IGF-axis physiology](https://www.endotext.org/chapter/pediatric-implications-of-normal-insulin-gh-igf-axis-physiology/) - ABSTRACT Understanding the involvement of the insulin-GH-IGF-axis in the different phases of human growth, development, and metabolism is the key to understanding human pathophysiology. The normal physiological actions of the axis optimize human growth and metabolism to impact adult height by approximately one third. IGF binding proteins modulate access of circulating IGF-I to the tissues
- [Pituitary and Hypothalamic Tumor Syndromes in Childhood](https://www.endotext.org/chapter/pituitary-and-hypothalamic-tumor-syndromes-in-childhood/) - ABSTRACT Central nervous system (CNS) tumors are the second commonest childhood malignancy, with 10% of these affecting the suprasellar and/or intrasellar regions. Survival has increased significantly over the last decade as a result of improved multimodality cancer therapies and better supportive care. Measurements of serum prolactin, α-fetoprotein, and β-hCG as well as baseline pituitary
- [Definitions, Classification, and Epidemiology of Obesity](https://www.endotext.org/chapter/definitions-classification-and-epidemiology-of-obesity/) - ABSTRACT Recent research has established the physiology of weight regulation, the pathophysiology that leads to unwanted weight gain with establishment of a higher body-weight set point, and the defense of the overweight and obese state even when reasonable attempts in lifestyle improvement are made. This knowledge has informed our approach to obesity as a
- [GENERAL](https://www.endotext.org/chapter/general/)
- [Thyroid Disease in Older Adults](https://www.endotext.org/chapter/thyroid-disease-in-the-elderly/)
- [MISCELLANEOUS](https://www.endotext.org/chapter/miscellaneous-2/)
- [ADRENAL MEDULLA](https://www.endotext.org/chapter/adrenal-medulla/)
- [The Iodine Deficiency Disorders](https://www.endotext.org/chapter/the-iodine-deficiency-disorders/) - ABSTRACT This chapter provides an overview of the disorders caused by iodine deficiency. Extensively referenced, it includes data on dietary sources of iodine, goitrogens, the effects of iodine deficiency throughout the lifecycle, the pathophysiology of iodine deficiency, as well as strategies for control and monitoring of the iodine deficiency disorders, such as iodized salt and
- [Islet Transplantation](https://www.endotext.org/chapter/islet-transplantation/) - ABSTRACT Transplanting islets of Langerhans consists of the infusion of purified endocrine pancreatic tissue, typically into the hepatic portal system of the recipient. The field of islet transplantation has evolved significantly since the pioneering experiments of Minkowski and von Mering in 1882, with remarkable acceleration over the past four decades thanks to continuous improvements in
- [The Role of Exercise in Diabetes](https://www.endotext.org/chapter/the-role-of-exercise-in-diabetes/) - ABSTRACT Exercise is a key component to lifestyle therapy for prevention and treatment of diabetes. These recommendations are based on positive associations between physical activity and type 2 diabetes (T2D) prevention, treatment, and disease-associated morbidity and mortality. For type 1 diabetes (T1D), there is evidence to support that exercise can reduce diabetes-associated complications. However, there
- [BACKGROUND](https://www.endotext.org/chapter/introduction-2/)
- [Risk of Fasting and Non-Fasting Hypertriglyceridemia in Coronary Vascular Disease and Pancreatitis](https://www.endotext.org/chapter/risk-of-fasting-and-non-fasting-hypertriglyceridemia-in-coronary-vascular-disease-and-pancreatitis/) - ABSTRACT Cardiovascular disease (CVD) remains a major cause of mortality in the Western world and in spite of the reduction of CVD risk by the use of lipid lowering agents per current treatment goals there remains substantial residual and absolute risk of CVD in high-risk populations. Focus on elevated triglyceride (TG) levels deserves renewed attention,
- [BACKGROUND](https://www.endotext.org/chapter/background/)
- [The Role of Lipids and Lipoproteins in Atherosclerosis](https://www.endotext.org/chapter/the-role-of-lipids-and-lipoproteins-in-atherosclerosis/) - ABSTRACT Atherosclerosis is the underlying cause of heart attack and stroke. Early observations that cholesterol is a key component of arterial plaques gave rise to the cholesterol hypothesis for the pathogenesis of atherosclerosis. Population studies have demonstrated that elevated levels of LDL cholesterol and apolipoprotein B (apoB) 100, the main structural protein of LDL,
- [HYPERTRIGLYCERIDEMIA](https://www.endotext.org/chapter/hypertriglyceridemia/)
- [TREATMENT](https://www.endotext.org/chapter/treatment/)
- [HYPERCHOLESTEROLEMIA](https://www.endotext.org/chapter/hypercholesterolemia/)
- [Familial Hypercholesterolemia: Genes and Beyond](https://www.endotext.org/chapter/familial-hypercholesterolemia-genes-and-beyond/) - ABSTRACT Genetic disorders resulting in familial hypercholesterolemia (FH) include autosomal dominant hypercholesterolemia (ADH), polygenic hypercholesterolemia, as well as other rare conditions such as autosomal recessive hypercholesterolemia (ARH). All of these disorders cause elevations in low-density lipoprotein (LDL)-cholesterol (LDL-C) and, as a result, greatly increase the risk of cardiovascular disease (CVD). Genetic loci involved in
- [SCREENING AND GUIDELINES](https://www.endotext.org/chapter/screening-and-guidelines/)
- [The Effect of Inflammation and Infection on Lipids and Lipoproteins](https://www.endotext.org/chapter/the-effect-of-inflammation-and-infection-on-lipids-and-lipoproteins/) - ABSTRACT Chronic inflammatory diseases, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis and infections, such as periodontal disease and HIV, are associated with an increased risk of cardiovascular disease. Patients with these disorders also have an increase in coronary artery calcium measured by CT and carotid intima media thickness measured by
- [SECONDARY DISORDERS OF LIPID AND LIPOPROTEIN METABOLISM AND SPECIAL POPULATIONS](https://www.endotext.org/chapter/secondary-disorders-of-lipid-and-lipoprotein-metabolism-and-special-populations/)
- [Introduction to Lipids and Lipoproteins](https://www.endotext.org/chapter/introduction-to-lipids-and-lipoproteins/) - ABSTRACT Cholesterol and triglycerides are insoluble in water and therefore these lipids must be transported in association with proteins. Lipoproteins are complex particles with a central core containing cholesterol esters and triglycerides surrounded by free cholesterol, phospholipids, and apolipoproteins, which facilitate lipoprotein formation and function. Plasma lipoproteins can be divided into seven classes based on
- [PEDIATRIC LIPIDOLOGY](https://www.endotext.org/chapter/pediatric-lipid-disorders-2/)
- [Hypertriglyceridemia: Pathophysiology, Role of Genetics, Consequences, and Treatment](https://www.endotext.org/chapter/hypertriglyceridemia-pathophysiology-role-of-genetics-consequences-and-treatment/) - ABSTRACT Hypertriglyceridemia (HTG) can result from a variety of causes. Mild to moderate HTG tracks along with the metabolic syndrome, obesity and diabetes. HTG can be the result of multiple small gene variants or secondary to several diseases and drugs. Severe HTG with plasma triglyceride (TG) levels >1000-1500 mg/dL typically results from: (1) rare
- [The Effect of Diet on Cardiovascular Disease and Lipid and Lipoprotein Levels](https://www.endotext.org/chapter/the-effect-of-diet-on-cardiovascular-disease-and-lipid-and-lipoprotein-levels/) - ABSTRACT The role of lipids and lipoproteins as causal factors for cardiovascular disease (CVD) is well established. Dietary saturated fatty acids (SFA), which are in milk, butter, cheese, beef, lamb, pork, poultry, palm oil, and coconut oil increase LDL-C and HDL-C. The increase in LDL-C is due to a decrease in hepatic LDL clearance
- [GENETIC DISORDERS OF LIPID AND LIPOPROTEIN METABOLISM](https://www.endotext.org/chapter/genetic-disorders-of-lipid-and-lipoprotein-metabolism/)
- [Lipodystrophy Syndromes: Presentation and Treatment](https://www.endotext.org/chapter/lipodystrophy-syndromes-presentation-and-treatment/) - ABSTRACT Lipodystrophy syndromes are a heterogeneous group of diseases, characterized by selective absence of adipose tissue. In one sense, these diseases are lipid-partitioning disorders, where the primary defect is the loss of functional adipocytes, leading to ectopic steatosis, severe dyslipidemia, and insulin resistance. These syndromes have attracted significant attention since the mid-1990s as the understanding
- [Monogenic Disorders Altering HDL Levels](https://www.endotext.org/chapter/monogenic-disorders-altering-hdl-levels/) - ABSTRACT Very low HDL-C levels (
- [Dysbetalipoproteinemia (Type III Hyperlipoproteinemia)](https://www.endotext.org/chapter/dysbetalipoproteinemia-type-iii-hyperlipoproteinemia/) - ABSTRACT Dysbetalipoproteinemia is an underrecognized and underdiagnosed genetic lipid disorder characterized by pathogenic variants in the APOE gene, which encodes apolipoprotein (apo) E. It leads to the abnormal accumulation of triglyceride-rich remnant lipoproteins, elevated levels of both cholesterol and triglycerides, and an increased risk of cardiovascular disease. Typically, patients with autosomal recessive form of dysbetalipoproteinemia
- [Sitosterolemia](https://www.endotext.org/chapter/sitosterolemia-2/) - ABSTRACT Sitosterolemia is a rare autosomal recessive disorder of non-cholesterol sterol metabolism, caused by mutations of the ABCG5 or ABCG8 transporter genes. This results in hyperabsorption and decreased biliary excretion of non-cholesterol sterol, especially sitosterol, from the gastrointestinal tract. Affected individuals have excessive accumulation of plant sterols and 5 alpha-saturated stanols in plasma and tissues,
- [Monogenic Disorders Causing Hypobetalipoproteinemia](https://www.endotext.org/chapter/monogenic-disorders-causing-hypobetalipoproteinemia/) - ABSTRACT Monogenic mutations leading to hypobetalipoproteinemia are rare. The monogenic causes of hypobetalipoproteinemia include familial hypobetalipoproteinemia, abetalipoproteinemia, chylomicron retention disease, loss of function mutations in PCSK9, and loss of function mutations in angiopoietin-like protein 3 (ANGPTL3) (Familiar Combined Hypolipidemia). This chapter describes the etiology, pathogenesis, clinical and laboratory findings, and the treatment of these
- [Approach to the Patient with Dyslipidemia](https://www.endotext.org/chapter/approach-to-the-patient-with-dyslipidemia/) - ABSTRACT In evaluating a patient with dyslipidemia, the initial step is to decide which particular lipid/lipoprotein abnormalities need to be evaluated and whether they need treatment. These disorders can be divided into elevations of LDL-C, TGs, non-HDL-C, and Lp(a) and decreases in plasma HDL-C. Frequently a patient can have multiple lipid/lipoprotein abnormalities. The next step
- [Lipoprotein (a)](https://www.endotext.org/chapter/lipoprotein-a/) - ABSTRACT Lipoprotein(a) is an apo B-containing lipoprotein which has a unique plasminogen-like apolipoprotein(a) attached to apo B-100. The levels of lipoprotein(a) are under strong genetic regulation and vary by several hundred-fold in the general population. Although the exact function of lipoprotein(a) is still a mystery, recent studies have shown that lipoprotein(a) has a causal role
- [Lipid Disorders In People With HIV](https://www.endotext.org/chapter/lipid-disorders-in-people-with-hiv/) - ABSTRACT Dyslipidemia is highly prevalent in people with HIV (PWH) and contributes to the increased risk of cardiovascular disease seen in this patient population. Factors that contribute to dyslipidemia include HIV infection itself and certain types of antiretroviral therapy (ART). Moreover, the effects of ART on lipids have changed over time as newer therapies have
- [Sexual Dysfunction in Female Patients with Diabetes](https://www.endotext.org/chapter/sexual-dysfunction-in-female-patients-with-diabetes/) - ABSTRACT Female sexual dysfunction (FSD) is a significant complication of diabetes mellitus, affecting 20-80% of women with type 2 diabetes. The condition stems from multiple factors including vascular damage, neuropathy, hormonal imbalances, and psychological aspects. Sustained hyperglycemia leads to blood vessel damage and reduces nitric oxide bioavailability, affecting vaginal blood flow and lubrication. Management
- [Male Gonadal Disorders In The Tropics](https://www.endotext.org/chapter/male-gonadal-disorders-in-the-tropics/) - ABSTRACT Male hypogonadism arising from disorders of the hypothalamic-pituitary-gonadal axis is characterized by insufficient testosterone production. It is usually associated with subfertility or infertility. While hypogonadism is a global health concern, its diagnosis and management in tropical regions present unique challenges due to a combination of factors. Infectious etiologies often dominate the cause of
- [Thyroid Disorders In The Tropics](https://www.endotext.org/chapter/thyroid-disorders-in-the-tropics/) - ABSTRACT Thyroid disorders are a major cause of non-communicable diseases in developing nations, with the tropical regions presenting unique challenges due to diverse environmental, socio-economic, and cultural factors. Iodine deficiency remains a significant public health concern, leading to conditions such as endemic goiter and cretinism. The prevalence of iodine deficiency disorders has declined due
- [Cushing Syndrome/Disease in Children and Adolescents](https://www.endotext.org/chapter/cushing-syndrome-disease-in-children-and-adolescents/) - ABSTRACT Endogenous Cushing syndrome (CS) is a rare pediatric endocrine condition commonly caused by pituitary corticotroph tumors or less often by adrenal or ectopic sources. The typical presentation of the child with CS includes weight gain with height deceleration, characteristic skin findings, and hormonal and biochemical findings indicative of excessive glucocorticoid production. The diagnostic
- [Type 2 Diabetes In Children and Adolescents – A Focus On  Diagnosis and Treatment](https://www.endotext.org/chapter/type-2-diabetes-in-children-and-adolescents-a-focus-on-diagnosis-and-treatment/) - ABSTRACT Nearly three decades have passed since the first publications on type 2 diabetes (T2D) in children and adolescents, and it is now well established as a global problem. As the prevalence of obesity continues to increase within the general population, diagnosing T2D in adolescents presents a multifaceted challenge. In this chapter, we shall delve
- [Diabetes and Hypoglycemia in Children and Adolescence](https://www.endotext.org/chapter/diabetes-and-hypoglycemia-in-children-and-adolescence/)
- [TEST FOR TABLE DESIGN](https://www.endotext.org/chapter/test-for-table-design/) - WEBSITE TABLES TESTING Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur.
- [Metabolic Bone Disease in The Tropics](https://www.endotext.org/chapter/metabolic-bone-disease-in-the-tropics/) - ABSTRACT Metabolic bone disease (MBD) encompasses a heterogeneous group of disorders having a diverse spectrum of manifestations varying from asymptomatic to florid. MBD is prevalent globally, but certain unique features characterize those occurring in the tropics. Dietary deviations, including malnutrition, environmental influences, genetic factors, and limited access to healthcare, modify the tropical presentation of
- [Thyroid Nodules and Thyroid Cancer Prior to, During, and Following Pregnancy](https://www.endotext.org/chapter/thyroid-nodules-and-cancer-prior-to-during-and-following-pregnancy/) - ABSTRACT Thyroid cancer is the second most common malignancy to co-occur in pregnancy. Further, the rising prevalence of treated thyroid cancer in women of child-bearing age means that survivors of thyroid cancer are frequently presenting for obstetric care, occasionally in the setting of persisting structural disease. To ensure that optimal health outcomes are achieved
- [Platelets, Coagulation, and Antithrombotic Therapy in Diabetes](https://www.endotext.org/chapter/platelets-coagulation-and-antithrombotic-therapy-in-diabetes/) - ABSTRACT Diabetes mellitus is a strong, independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) and therefore for atherothrombotic events. Compared to those without diabetes, individuals with diabetes are also at increased risk of cardioembolic stroke in the presence of atrial fibrillation (AF) and of venous thromboembolism. Activation of platelets and the
- [Immune Checkpoint Inhibitors Related Endocrine Adverse Events](https://www.endotext.org/chapter/immune-checkpoint-inhibitors-related-endocrine-adverse-events/) - ABSTRACT Immune checkpoint inhibitors (ICIs) are currently used for the treatment of various types of cancers. Despite the important clinical benefits, these medications can lead to a spectrum of side effects called immune-related adverse events (irAEs). Endocrine irAEs are among the most common irAEs that have been reported in clinical trials and post-marketing settings
- [OBESITY](https://www.endotext.org/chapter/obesity/)
- [Monogenic Disorders Causing Hypobetalipoproteinemia - copy](https://www.endotext.org/chapter/monogenic-disorders-causing-hypobetalipoproteinemia-copy/) - ABSTRACT Monogenic mutations leading to hypobetalipoproteinemia are rare. The monogenic causes of hypobetalipoproteinemia include familial hypobetalipoproteinemia, abetalipoproteinemia, chylomicron retention disease, loss of function mutations in PCSK9, and loss of function mutations in angiopoietin-like protein 3 (ANGPTL3) (Familiar Combined Hypolipidemia). This chapter describes the etiology, pathogenesis, clinical and laboratory findings, and the treatment of these
- [Adolescent Bariatric Surgery](https://www.endotext.org/chapter/adolescent-bariatric-surgery/) - ABSTRACT The prevalence of adolescent obesity has rapidly increased over the past several decades. With this increase, there has also been a rise in the prevalence of complications of obesity leading to premature mortality. While lifestyle and medical management remain a part of the initial treatment of obesity, these therapies have been shown to
- [Pregestational Diabetes Mellitus](https://www.endotext.org/chapter/pregestational-diabetes-mellitus/) - ABSTRACT The physiological changes which occur during pregnancy with diabetes are vast and involve every body system. In this chapter, we will review the metabolic changes that occur during normal pregnancies and those affected by pregestational diabetes. Due to the significant overlap in maternal and perinatal risks secondary to pregestational diabetes and obesity, we
- [Diabetes Mellitus and Infections](https://www.endotext.org/chapter/diabetes-mellitus-and-infections/) - ABSTRACT Diabetes presents a significant risk factor for all kinds of infections. It has been well described to increase rates of outpatient infection as well as the incidence of infections requiring hospitalization. This appears to be related to deficits in the immune system, particularly changes seen in innate immunity. Respiratory infections, skin and soft
- [Endocrine Disruptor Chemicals](https://www.endotext.org/chapter/endocrine-disruptor-chemicals/) - Appendix updated May 2, 2025 ABSTRACT Endocrine Disrupting Chemicals (EDCs) impact health and disease. Scientific research conducted over the last few decades has solidified our knowledge of the health impacts of these chemicals. Intrauterine exposure of EDCs can have transgenerational effects, thus laying the foundation for disease in later life, when exposure may not
- [Environmental Endocrinology: An Expanding Horizon](https://www.endotext.org/chapter/environmental-endocrinology-an-expanding-horizon/) - ABSTRACT Environment is an important determinant of endocrine health and certain endocrine disorders could also have a significant impact on the surroundings. Environmental endocrinology is an emerging field of medicine which encompasses the bidirectional impact of endocrine disorders and the physical, chemical, biological, and social environment of an individual. As we aim to improve endocrine
- [Pituitary Diseases in the Tropics](https://www.endotext.org/chapter/pituitary-diseases-in-the-tropics/) - ABSTRACT The pituitary gland is the master controller of the hormonal axes in the body and modulates its hormonal output based on the information received from the hypothalamus and the peripheral target organs. The traditional feedback hormonal loop involving the central and peripheral organs is termed the hypothalamo-pituitary-target organ axis. Pituitary disorders may present
- [Adipose Tissue: Physiology to Metabolic Dysfunction](https://www.endotext.org/chapter/adipose-tissue-physiology-to-metabolic-dysfunction/) - ABSTRACT Like the obesity epidemic, our understanding of adipocytes and adipose tissue is expanding. Just in the past decade, substantial advances have led to new insights into the contributions of adipose tissue to normal physiology and obesity-related complications, which places adipocyte biology at the epicenter of a global pandemic of metabolic diseases. In addition
- [Endocrinology of The Gut and the Regulation of Body Weight and Metabolism](https://www.endotext.org/chapter/endocrinology-of-the-gut-and-the-regulation-of-body-weight-and-metabolism/) - ABSTRACT Obesity prevalence continues to increase globally, leading to ill-health and reduced life expectancy in those affected and an urgent need for effective preventative and therapeutic strategies. Until recently obesity was viewed simplistically as an imbalance between energy expenditure and consumption that could be easily corrected by lifestyle changes. However, obesity is now recognized
- [Osteoporosis in Men](https://www.endotext.org/chapter/osteoporosis-in-men/) - ABSTRACT While progress has been made, osteoporosis in men is still under-diagnosed and under-treated. In general, men fracture about 10 years later than women, with large increases in fracture risk after about age 75, although a small number of men may present with vertebral fractures in middle age. There is overlap between secondary causes
- [Subcutaneous Adipose Tissue Diseases:  Dercum Disease, Lipedema, Familial Multiple Lipomatosis and Madelung Disease](https://www.endotext.org/chapter/subcutaneous-adipose-tissue-diseases-dercum-disease-lipedema-familial-multiple-lipomatosis-and-madelung-disease/) - ABSTRACT Subcutaneous adipose tissue diseases involving adipose tissue and its fascia, also known as adipofascial disorders, represent variations in the spectrum of obesity. The adipofascia diseases discussed in this chapter can be localized or generalized and include a common disorder primarily affecting women, lipedema, and four rare diseases, familial multiple lipomatosis, angiolipomatosis, Dercum disease,
- [Gastrointestinal Disorders in Diabetes](https://www.endotext.org/chapter/gastrointestinal-disorders-in-diabetes/) - ABSTRACT Gastrointestinal manifestations of type 1 and 2 diabetes are common and represent a substantial cause of morbidity and health care costs, as well as a diagnostic and therapeutic challenge. Predominant among them, and most extensively studied, is abnormally delayed gastric emptying or diabetic gastroparesis. Abnormally increased retention of gastric contents may be associated
- [DIABETES TREATMENT – STRATEGIES](https://www.endotext.org/chapter/diabetes-treatment-strategies-2/)
- [Nonalcoholic Fatty Liver Disease: The Overlooked Complication of Type 2 Diabetes](https://www.endotext.org/chapter/nonalcoholic-fatty-liver-disease-the-overlooked-complication-of-type-2-diabetes/) - * Denotes equal effort ABSTRACT Nonalcoholic fatty liver disease (NAFLD) is a common complication of obesity and type 2 diabetes mellitus (T2DM). Most times it is an unrecognized comorbidity to the primary care provider and endocrinologist. Today it is the most common chronic liver disease in developed countries. It is characterized by insulin resistance
- [Diabetes in People Living with HIV](https://www.endotext.org/chapter/diabetes-in-people-living-with-hiv/) - ABSTRACT People living with HIV (PLWH) are living longer and also have unique risk factors for developing several metabolic diseases, including diabetes. This has been observed in both high income and low to middle income countries. Risk factors for diabetes in PLWH consist of specific antiretroviral therapies (ART), including older generation protease inhibitors and nucleoside
- [Use of the Historial Weight Trajectory to Guide an Obesity-Focused Patient Encounter](https://www.endotext.org/chapter/use-of-the-historial-weight-trajectory-to-guide-an-obesity-focused-patient-encounter/) - ABSTRACT Obesity is a chronic, complex, and challenging disease to address by clinicians. Thus, it is crucial for practitioners to obtain a thorough weight history from patients to identify potential triggers that influence weight gain trajectories and their relationships to development of disease co-morbidity and mortality. Obtaining a weight history from a patient can
- [Thyroid Cancer](https://www.endotext.org/chapter/thyroid-cancer/) - Incidence and Distribution The annual incidence of thyroid cancer varies considerably in different registries, ranging from 1.2-2.6 per 100,000 individuals in men and from 2.0-3.8 per 100,000 in women (106,107). It is particularly elevated in Iceland and Hawaii, being nearly two times higher than in North European countries, Canada and the USA. In Hawaii, the
- [Surgery of the Thyroid](https://www.endotext.org/chapter/chapter-21surgery-of-the-thyroid/) - ABSTRACT Incidence rates of thyroid cancer have increased substantially worldwide in the past several decades. Thus, diseases of the thyroid gland and their treatment remain one of the most interesting and dynamic areas of study in medicine. This chapter presents a clear and concise description of current thought and practice concerning the surgical treatment of
- [Nodules and Cancer](https://www.endotext.org/chapter/nodules-and-cancer/)
- [Genetic Disorders](https://www.endotext.org/chapter/genetic-disorders/)
- [Disorders of the Thyroid Gland in Infancy, Childhood and Adolescence](https://www.endotext.org/chapter/disorders-of-the-thyroid-gland-in-infancy-childhood-and-adolescence-3/) - This chapter is, in part, based on the previous version written by Prof. Rosalind Brown. ABSTRACT Thyroid disorders in infancy, childhood and adolescence represent common and usually treatable endocrine disorders. Thyroid hormones are essential for normal development and growth of many target tissues, including the brain and the skeleton. Thyroid hormone action on critical genes
- [Graves' Disease and the Manifestations of Thyrotoxicosis](https://www.endotext.org/chapter/graves-disease-and-the-manifestations-of-thyrotoxicosis/) - ABSTRACT Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism and various systemic manifestations, including thyroid eye disease (TED) and, less commonly, dermopathy. This chapter provides an in-depth review of GD, covering its history, epidemiology, risk factors, and the molecular mechanisms underlying autoimmune hyperthyroidism. Emphasis is placed on emerging insights into the genetic,
- [Autoimmunity to the Thyroid Gland](https://www.endotext.org/chapter/autoimmunity-to-the-thyroid-gland/) - ABSTRACT This discussion stresses the normal occurrence of immune self-reactivity, the genetic and environmental forces that may amplify such responses, the role of the antigen-driven immune attack, secondary disease-enhancing factors, and the important contributory role of antigen-independent immune reactivity. Research on thyroid autoimmunity has benefited greatly by knowledge of the specific target antigens and easy
- [Hashimoto's Thyroiditis](https://www.endotext.org/chapter/hashimotos-thyroiditis1/) - ABSTRACT Hashimoto's thyroiditis is characterized clinically as a commonly occurring, painless, diffuse enlargement of the thyroid gland occurring predominantly in middle-aged women. The patients are often euthyroid, but hypothyroidism may develop. The thyroid parenchyma is diffusely replaced by a lymphocytic infiltrate and fibrotic reaction; frequently, lymphoid germinal follicles are visible. Persons with Hashimoto's thyroiditis have
- [Hypothyroidism and Hyperthyroidism](https://www.endotext.org/chapter/hypothyroidism-and-hyperthyroidism/)
- [Evaluation of Thyroid Function in Health and Disease](https://www.endotext.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/) - Archived This chapter has been superceded by newer chapters (See Homepage). However this Chapter, written originally by Dr Samuel Refetoff and updated by Drs Franklyn and Shephard, remains a treasure trove of information on many now-obscure thyroid tests, and references. For that reason we maintain it as a part of our Archive for use of
- [Ultrasonography of the Thyroid](https://www.endotext.org/chapter/ultrasonography-of-the-thyroid/) - ABSTRACT Thyroid ultrasonography (US) is the most common, extremely useful, safe, and cost-effective way to image the thyroid gland and its pathology. US has largely replaced the need for thyroid scintigraphy except to detect iodine-avid thyroid metastases after thyroidectomy and to identify hyper-functioning (toxic) thyroid nodules. This chapter reviews the literature; discusses the science and
- [Clinical Strategies in the Testing of Thyroid Function](https://www.endotext.org/chapter/clinical-strategies-in-the-testing-of-thyroid-function/) - ABSTRACT In the past decades, emphasis has shifted from testing thyroid function in individuals who are likely to have clinically overt thyroid disorders to a broader population, an approach that includes also identification of so-called subclinical or mild thyroid dysfunctions. The key measurement methods used to detect thyroid dysfunction are still serum thyroid stimulating
- [Fine-Needle Aspiration of the Thyroid Gland](https://www.endotext.org/chapter/fine-needle-aspiration-of-the-thyroid-gland/) - ABSTRACT Thyroid nodules are common in clinical practice and the majority are benign with the risk of malignancy varying from 7 to 15%. Clinical evaluation includes careful history and physical examination, laboratory tests, neck ultrasound (US), and a fine-needle aspiration (FNA). Thyroid FNA or biopsy is an accurate test for determining malignancy in a
- [Thyroid Testing](https://www.endotext.org/chapter/thyroid-testing/)
- [Cellular Uptake of Thyroid Hormones](https://www.endotext.org/chapter/cellular-uptake-of-thyroid-hormones/) - ABSTRACT The biological activity of thyroid hormone (TH) is regulated at the target tissue level by two important processes, i.e. deiodination and plasma membrane transport. The first process involves the expression of the deiodinase D2, which converts the prohormone T4 to bioactive T3, and/or of the deiodinase D3 which converts both T4 and T3 to
- [Cellular Action of Thyroid Hormone](https://www.endotext.org/chapter/cellular-action-of-thyroid-hormone/) - ABSTRACT Thyroid hormones (THs) regulate growth, development, metabolism. This chapter aims to provide a comprehensive overview of the molecular and cellular mechanism(s) for intracellular signaling by TH. At the cellular level, THs bind to thyroid hormone receptors (TRs) that are members of the nuclear hormone receptor family. TRs act as ligand-activated transcription factors that bind
- [Anatomy and Physiology](https://www.endotext.org/chapter/anatomy-and-physiology/)
- [Thyroid Hormone Synthesis and Secretion](https://www.endotext.org/chapter/chapter-2-thyroid-hormone-synthesis-and-secretion/) - ABSTRACT The main function of the thyroid gland is to make hormones, T4 and T3, which are essential for the regulation of metabolic processes throughout the body. As at any factory, effective production depends on three key components - adequate raw material, efficient machinery, and appropriate controls. Iodine is the critical raw material, because 65%
- [Drugs that Affect Body Weight, Body Fat Distribution, and Metabolism](https://www.endotext.org/chapter/drugs-that-affect-body-weight-body-fat-distribution-and-metabolism/) - ABSTRACT Weight gain or body fat redistribution are common side effects of many widely used drugs. Weight gain amounts varying between a few kg to an increase of 10% or more of initial body weight have been described. Often accompanying this weight gain are worsened health risks, including an increased incidence of the metabolic
- [Craniopharyngiomas](https://www.endotext.org/chapter/craniopharyngiomas/) - ABSTRACT Craniopharyngiomas are rare intracranial tumors that mainly arise in the sellar/parasellar (particularly suprasellar) region. They present in both children and adults with a wide range of clinical manifestations. Histologically, they are benign tumors with distinct adamantinomatous and papillary subtypes. Beta-catenin gene mutations have been identified in the adamantinomatous subtype and activating mutations in
- [Prediabetes](https://www.endotext.org/chapter/prediabetes/) - ABSTRACT The global epidemic of type 2 diabetes remains one of the greatest health challenges of our time. The collective human and economic costs are staggering and rising. Widespread initiatives now exist to prevent diabetes wherever possible. These initiatives are singularly focused on preventing diabetes in the very highest risk group: people with prediabetes.
- [Pituitary and Other Tumors](https://www.endotext.org/chapter/pituitary-and-other-tumors/)
- [Posterior Pituitary](https://www.endotext.org/chapter/posterior-pituitary/)
- [Non-Functioning Pituitary Adenomas](https://www.endotext.org/chapter/non-functioning-pituitary-adenomas/) - ABSTRACT Pituitary adenomas comprise approximately 10-20% of intracranial tumors. Non-functioning pituitary adenomas (NFPAs) are benign adenohypophyseal tumors not associated with clinical evidence of hormonal hypersecretion. NFPAs comprise different histological subtypes, classified according to their immunostaining to different adenohypophyseal hormones and transcription factors. The silent gonadotroph adenoma is the most common subtype, followed by corticotroph,
- [Diabetes and Depression](https://www.endotext.org/chapter/diabetes-and-depression/) - ABSTRACT Depression is characterized by a disturbance of mood, affecting between 3–5% of the general population at any one time. The prevalence of depression is approximately doubled in people with diabetes compared to the general population, with similar rates between type 1 diabetes and type 2 diabetes. Although many cases of depression are
- [Skin Manifestations of Diabetes Mellitus](https://www.endotext.org/chapter/skin-manifestations-of-diabetes-mellitus/) - ABSTRACT Diabetes mellitus is a common and debilitating disease that affects a variety of organs including the skin. Between thirty and seventy percent of patients with diabetes mellitus, both type 1 and type 2, will present with a cutaneous complication of diabetes mellitus at some point during their lifetime. A variety of dermatologic manifestations
- [DIABETES](https://www.endotext.org/chapter/diabetes/)
- [ADRENAL DISORDERS](https://www.endotext.org/chapter/adrenal-disorders/)
- [SEXUAL DISORDERS](https://www.endotext.org/chapter/sexual-disorders/)
- [DISORDERS OF GROWTH AND PITUITARY DISEASE](https://www.endotext.org/chapter/disorders-growth-pituitary-disease/)
- [THYROID DISORDERS](https://www.endotext.org/chapter/thyroid-disorders/)
- [ADRENAL CORTEX](https://www.endotext.org/chapter/adrenal-cortex/)
- [THYROID](https://www.endotext.org/chapter/thyroid/)
- [PITUITARY](https://www.endotext.org/chapter/pituitary/)
- [GLUCOSE AND LIPIDS](https://www.endotext.org/chapter/glucose-and-lipids/)
- [Pathology And Pathogenesis Of Pituitary Adenomas And Other Sellar Lesions](https://www.endotext.org/chapter/pathology-and-pathogenesis-of-pituitary-adenomas-and-other-sellar-lesions/) - ABSTRACT The pituitary gland, or hypophysis, and adjacent structures of the sellar region can be affected by a wide range of pathologies leading to endocrine and neurological disorders. These include neoplasms arising from the adenohypophysis, such as pituitary adenomas associated with distinctive endocrine disorders such as acromegaly or Cushing’s disease; cysts or neoplasms derived from
- [Diabetic Foot](https://www.endotext.org/chapter/diabetic-foot-2/)
- [The Diabetic Foot](https://www.endotext.org/chapter/the-diabetic-foot/) - ABSTRACT Diabetic foot ulcers (DFU) are associated with significant impairment of quality of life, increased morbidity and mortality, and are a huge drain on health care resources. In Western countries, the annual incidence of foot ulceration in the diabetic population is around 2%. DFUs develop as a consequence of a combination of factors, most
- [Fetal Cholesterol Metabolism](https://www.endotext.org/chapter/fetal-cholesterol-metabolism/)
- [Introduction](https://www.endotext.org/chapter/introduction/)
- [PEDIATRIC LIPID DISORDERS-](https://www.endotext.org/chapter/pediatric-lipid-disorders/)
- [Non-Diabetic Hypoglycemia](https://www.endotext.org/chapter/non-diabetic-hypoglycemia/) - ABSTRACT Objective: To review the diagnosis, evaluation, and management of non-diabetic hypoglycemia in adults. Methods: A literature review using PubMed and Google Scholar was performed. In absence of data, clinical expert opinion was provided. Results: Hypoglycemia in an individual without diabetes is uncommon mainly because of a tightly regulated counterregulatory physiological response. A detailed
- [Dyslipidemia in Chronic Kidney Disease](https://www.endotext.org/chapter/dyslipidemia-in-chronic-kidney-disease/) - Recieved 2/23/15 Abstract Chronic kidney disease (CKD) is associated with a dyslipidemia comprising high triglycerides, low HDL-cholesterol and altered lipoprotein composition. Cardiovascular diseases are the leading cause of mortality in CKD, especially in end stage renal disease patients. Thus, therapies to reduce cardiovascular risk are urgently needed in CKD. Robust clinical trial evidence has found
- [LESSONS FROM RODENT MODELS OF OBESITY](https://www.endotext.org/chapter/lessons-from-rodent-models-of-obesity-2/) - LESSONS FROM RODENT MODELS OF OBESITY Martin G. Myers, Jr., MD, PhD, Professor of Diabetes Research, Departments of Internal Medicine and Physiology, Director, Michigan Diabetes Research Center, University of Michigan Rudolph L. Leibel, MD, Christopher J. Murphy Professor of Diabetes Research, Co-Director Naomi Berrie Diabetes Center, Russ Berrie Medical Science Pavilion, Columbia University Updated: 6
- [AGE-RELATED CHANGES IN THE MALE REPRODUCTIVE AXIS](https://www.endotext.org/chapter/age-related-changes-in-the-male-reproductive-axis-2/) - Revised 1 Nov 2014 Outline Aging of male mammals is a very recent evolutionary event observed mostly in humans and animals in captivity. Most animal species in the wild do not live beyond their reproductive years; during periods of food deprivation, many small animals may not even live beyond puberty. Even among humans, only the
- [Test Chaper](https://www.endotext.org/chapter/test-chaper/) - Test Audio Narration Below is a sample narration from The Adventures of Huckleberry Finn. The audio file can be started when the "Play" button is clicked. Once the audio has started, the player indicates the position on the audio and has volume control.
- [DIABETIC COMPLICATIONS](https://www.endotext.org/chapter/diabetic-complications/)
- [HYPOGLYCEMIA](https://www.endotext.org/chapter/tumor-syndromes/)
- [CLINICAL ASPECTS](https://www.endotext.org/chapter/the-obesity-syndrome-clinical-pathophysiology/)
- [PATHOGENESIS OF DIABETES](https://www.endotext.org/chapter/pathogenesis-of-diabetes/)
- [DIABETES DIAGNOSIS, ASSESSMENT, AND MONITORING](https://www.endotext.org/chapter/diabetes-treatment-diagnosis/)
- [MODALITIES FOR TREATMENT OF DIABETES](https://www.endotext.org/chapter/modalities-for-treatment-of-diabetes/)
- [PHYSIOLOGY AND PATHOPHYSIOLOGY OF WEIGHT REGULATION](https://www.endotext.org/chapter/factors-influencing-obesity/)
- [TREATMENT OF THE OVERWEIGHT AND OBESE](https://www.endotext.org/chapter/health-implications-of-obesity/)
- [Diagnostic Tests For Diabetes Mellitus](https://www.endotext.org/chapter/diagnostic-tests-for-diabetes-mellitus/) - ABSTRACT In this chapter, indications for screening for diabetes mellitus are reviewed. Criteria for diagnosis are fasting plasmaglucose ≥ 126 mg/dl (7.0 mmol/l) or random glucose ≥200 mg/dl (11.1 mmol/l) with hyperglycemic symptoms, hemoglobin A1c (HbA1c) ≥6.5%, and oral glucose tolerance testing (OGTT) 2-h glucose ≥200 mg/dl (11.1 mmol/l) after 75 g of glucose.
- [Endocrine Hypertension in Childhood and Adolescence](https://www.endotext.org/chapter/endocrine-hypertension-in-childhood-and-adolescence/) - ABSTRACT Hypertension in children and adolescents is defined as a blood pressure ≥ 95th percentile (stage 1) or a blood pressure ≥ 95th percentile + 12 mmHg (stage 2), according to the Clinical Practice Guidelines of American Academy of Pediatrics published in 2017. Hypertension may be primary or idiopathic or secondary due to renal
- [Treatment of Diabetes mellitus in Children and Adolescents](https://www.endotext.org/chapter/treatment-of-diabetes-mellitus-in-children-and-adolescents/) - ABSTRACT The incidence of Type 1 Diabetes continues to increase around the world. Advances in technology of insulin delivery systems including closed loop and continuous glucose monitoring are improving the possibilities of maintaining desirable glucose control. Type 2 Diabetes is increasing in the adolescent age groups across the world, in certain populations especially including Native
- [Normal and Abnormal Puberty](https://www.endotext.org/chapter/normal-and-abnormal-puberty/) - ABSTRACT Puberty is a biological process that represents the development of secondary sexual characteristics and attainment of reproductive capacity, influenced by genetic, metabolic, environmental, ethnic, geographic, and economic factors. Pubertal onset is characterized by the increased kisspeptin and neurokinin B secretion leading to re-emergence of pulsatile gonadotropin releasing hormone signaling from the hypothalamus which
- [Social and Environmental Factors Influencing Obesity](https://www.endotext.org/chapter/social-and-environmental-factors-influencing-obesity/) - ABSTRACT The evidence for social and environmental factors that contribute to obesity are often underappreciated. Obesity prevalence is significantly associated with sex, racial ethnic identity, and socioeconomic status, which creates complex relationships between each of these characteristics. Food availability remains an important factor associated with obesity that relates to differences in prevalence seen across
- [Neuroendocrine Control of Body Energy Homeostasis](https://www.endotext.org/chapter/neuroendocrine-control-of-body-energy-homeostasis/) - ABSTRACT The brain integrates the response to a variety of signals of energy need and availability to match food intake with energy expenditure, thereby maintaining body weight stability. Early work with rodent models with disrupted energy balance (generally obesity) identified many hypothalamic genes and signaling pathways that impact energy homeostasis. More recent studies have
- [REGULATION OF ENERGY EXPENDITURE](https://www.endotext.org/chapter/regulation-of-energy-expenditure/) - Humans gain or lose weight when a mismatch exists between energy intake and energy expenditure (Figure 1). Due to the potentially important role of energy expenditure in controlling body weight, there has been much interest in processes which contribute to and regulate total body energy expenditure. This interest takes the form of three general questions.
- [REGULATION OF ENERGY INTAKE](https://www.endotext.org/chapter/regulation-of-energy-intake/) - INTRODUCTION Body weight in adults is remarkably stable over the course of months to years. This stability in body weight occurs despite large fluctuations in caloric intake, thus demonstrating that energy intake and energy expenditure are precisely matched. Indeed it has been shown under defined experimental conditions that changes in body weight result in compensatory
- [EFFECTS OF OBESITY ON THE QUALITY OF LIFE](https://www.endotext.org/chapter/effects-of-obesity-on-the-quality-of-life/) - INTRODUCTION In 1947 the World Health Organization defined health as both the absence of disease and infirmity and the presence of physical, mental, and social well being (1). Accordingly, health-related quality of life refers to well being in the physical, psychological and social domains, and each domain can be measured by objective functioning and subjective
- [Androgens and Cardiovascular Disease in Men](https://www.endotext.org/chapter/androgens-and-cardiovascular-disease-in-men/) - ABSTRACT Testosterone is the principal male sex hormone or androgen, which regulates sexual characteristics and body composition. Testosterone is converted to bioactive metabolites dihydrotestosterone and estradiol. Circulating testosterone peaks in early adulthood and declines gradually across middle and older age: older men exhibit lower testosterone and dihydrotestosterone concentrations compared to younger men. In older
- [Contraception](https://www.endotext.org/chapter/contraception/) - ABSTRACT Contraception is important for the prevention of unintended pregnancies worldwide. Many contraceptives also have other medical benefits, such as decreasing endometrial and ovarian cancer risk or regulating the pain and bleeding of menstruation. It is essential for all physicians to have a basic knowledge of contraceptives, given that 99% of women in the United
- [Central Causes of Amenorrhea](https://www.endotext.org/chapter/central-causes-of-amenorrhea/) - ABSTRACT Normal ovulatory menstrual cycles reflect a coordination of an intact hypothalamic-pituitary-ovarian unit. This process involves neuroendocrine messaging between the hypothalamus, pituitary, and gonads. Common central causes of amenorrhea include functional hypothalamic anovulation, exercise-associated anovulation, pharmacologic-induced anovulation, psychiatric associated disorders such as anorexia nervosa and bulimia, and genetic-developmental defects of the gonadotropin releasing hormone (GnRH)
- [The Normal Menstrual Cycle and the Control of Ovulation](https://www.endotext.org/chapter/the-normal-menstrual-cycle-and-the-control-of-ovulation/) - ABSTRACT Menstruation is the cyclic, orderly sloughing of the uterine lining, in response to the interactions of hormones produced by the hypothalamus, pituitary, and ovaries. The menstrual cycle may be divided into two phases: (1) follicular or proliferative phase, and (2) the luteal or secretory phase. The length of a menstrual cycle is the
- [Postpartum Thyroiditis](https://www.endotext.org/chapter/postpartum-thyroiditis/) - CLINICAL RECOGNITION Postpartum thyroiditis is the term used for patients who develop painless thyroiditis in the postpartum period. It occurs within 6 months (typically 2 to 4 months) after delivery and runs a clinical course identical to that of painless thyroiditis occurring without relation to pregnancy. The clinical course of thyroid dysfunction is similar
- [Atypical Forms of Diabetes](https://www.endotext.org/chapter/atypical-forms-of-diabetes/) - ABSTRACT While most patients with diabetes have Type 1 diabetes (T1D) or Type 2 diabetes (T2D) 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
- [Diabetic Kidney Disease](https://www.endotext.org/chapter/diabetic-kidney-disease/) - ABSTRACT Diabetes is the most common cause of end-stage kidney disease (ESKD) in the US and other developed countries. Diabetic nephropathy is a chronic condition characterized by a gradual increase in urinary albumin excretion, blood pressure levels and cardiovascular risk, and declining glomerular filtration rate (GFR), which can progress to ESKD. Chronic kidney disease
- [Etiologic Classification of Diabetes Mellitus](https://www.endotext.org/chapter/etiologic-classification-of-diabetes-mellitus/) - Table 1 lists the various disorders that can either cause or contribute to the development of diabetes and the Endotext chapters where these disorders are discussed in detail. It should be noted that a patient can have characteristics of more than one type of diabetes. For example, a patient with Type 1 diabetes with positive
- [Hyperglycemic Crises](https://www.endotext.org/chapter/hyperglycemic-crises/) - ABSTRACT Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), are life-threatening complications requiring urgent treatment. DKA is more common in type 1 diabetes and results from absolute insulin deficiency, leading to hyperglycemia, dehydration, ketonemia and metabolic acidosis. Symptoms include polyuria, polydipsia, nausea, vomiting, and altered mental status. HHS is typically seen
- [Gestational Diabetes](https://www.endotext.org/chapter/gestational-diabetes/) - ABSTRACT Gestational Diabetes (GDM) is characterized by glucose intolerance first manifesting during pregnancy and is an important risk factor for abnormal birthweight including large-for-gestational age birth, birth injury, and neonatal metabolic alterations--particularly when persistent maternal hyperglycemia exists. Individuals with GDM face short-term pregnancy complications, such as cesarean section and hypertensive disorders, and long-term complications,
- [Dietary Advice for Individuals with Diabetes](https://www.endotext.org/chapter/dietary-advice-for-individuals-with-diabetes/) - ABSTRACT The chapter summarizes the current information available from a variety of scientifically based guidelines and resources on dietary advice for those with diabetes. It is a practical overview for health care practitioners working in diabetes management. The chapter is divided into sections by content and includes sources for further reading. A primary message
- [Non-Pharmaceutical Intervention Options for Type 2 Diabetes: Complementary Health Approaches and Integrative Health (Including Natural Products and Mind/Body Practices)](https://www.endotext.org/chapter/non-pharmaceutical-intervention-options-for-type-2-diabetes-omplementary-health-approaches-and-integrative-health/) - ABSTRACT Complementary and Integrative Health (CIH) approaches, otherwise known as non-mainstream practices or Complementary and Alternative Medicine (CAM), are commonly used by patients with diabetes. Natural products, including dietary supplements, are the most frequently used complementary approach by patients with diabetes. While popular, there are regulatory, safety, and efficacy concerns regarding natural products. Commonly
- [Insulin – Pharmacology, Therapeutic Regimens And Principles Of Intensive Insulin Therapy](https://www.endotext.org/chapter/insulin-pharmacology-therapeutic-regimens-and-principles-of-intensive-insulin-therapy/) - ABSTRACT Since the introduction of insulin analogs in 1996, insulin therapy options for patients with type 1 and type 2 diabetes have expanded. Insulin therapies are now able to more closely mimic physiologic insulin secretion and thus achievebetter glycemic control in patients with diabetes. This chapter reviews the pharmacology of available insulins, types of
- [Immune System Effects on the Endocrine System](https://www.endotext.org/chapter/immune-system-effects-on-the-endocrine-system/) - ABSTRACT Among the most important and complex systems in the human body are the endocrine and immune systems. Emerging research over the last decade has shed light on their remarkable interplay, revealing a multitude of bidirectional communication pathways and reciprocal regulation mechanisms. Endocrine diseases, such as autoimmune thyroiditis, diabetes mellitus type 1 and type
- [Post-Transplant Osteoporosis](https://www.endotext.org/chapter/post-transplant-osteoporosis/) - ABSTRACT Organ transplantation has become an established treatment for end-stage diseases, and in recent decades, survival rates have significantly improved. This progress has made diagnosing osteoporosis and other complications essential for prevention, treatment, and enhancing the quality of life for transplant patients. Patients who undergo solid organ transplantation often have risk factors for bone
- [Adrenal Insufficiency In Children](https://www.endotext.org/chapter/adrenal-insufficiency-in-children/) - ABSTRACT Adrenal insufficiency (AI) is an uncommon but potentially life-threatening condition related to impaired secretion of cortisol by the adrenal gland. In general, this condition can be divided into primary (adrenal failure) and central (hypothalamic/pituitary) causes. In this chapter, we categorize the causes of adrenal insufficiency and systematically review the etiologies and associations to
- [Thyroid Nodules](https://www.endotext.org/chapter/thyroid-nodules/) - ABSTRACT Thyroid cancer accounts for only 0.4% of all cancer deaths, with an incidence of 11 cases and about 0.5-0.6 deaths per 100,000 population in the United States each year,according to the November 2011 SEER report (http://seer.cancer.gov/statfacts/html/thyro.html). Its clinical importance, by contrast, is out of all proportion to its incidence, because cancers of the thyroid
- [Physiology](https://www.endotext.org/chapter/physiology/)
- [Diabetic Foot](https://www.endotext.org/chapter/diabetic-foot/)
- [Existing and Emerging Molecular Targets for The Pharmacotherapy of Obesity](https://www.endotext.org/chapter/existing-and-emerging-molecular-targets-for-the-pharmacotherapy-of-obesity/) - ABSTRACT Obesity is pandemic and a multidisciplinary approach is critical for its management. Anti-obesity treatment includes lifestyle modifications combined with anti-obesity medications. Anti-obesity drugs target either central nervous system pathways, which regulate sensations of satiety and fullness, or peripheral modulators of digestion, metabolism and lipogenesis. Combined anti-obesity agents is a novel, promising field, especially
- [Glucagon & Glucagonoma Syndrome](https://www.endotext.org/chapter/glucagon-glucagonoma-syndrome/) - ABSTRACT The glucagonoma syndrome is caused by a glucagon-secreting pancreatic neuroendocrine neoplasm (panNEN)(glucagonoma). The syndrome includes: necrolytic migratory erythema, painful glossitis, cheilitis & stomatitis, weight loss, anemia, new-onset or worsening diabetes mellitus, hypoaminoacidemia, low zinc levels, deep vein thrombosis and depression. At diagnosis, a glucagonoma is usually larger than 4-5 cm in diameter and
- [Hyponatremia](https://www.endotext.org/chapter/hyponatremia/) - CLINICAL RECOGNITION Hyponatremia is common, being found in some 15–20% of non-selected emergency admissions to hospitals. It is associated with increased mortality, morbidity and increased duration of hospital stay, independent of the cause of admission. Clinical presentation is diverse, ranging from seizure and coma at one extreme to apparent absence of symptoms. This spectrum
- [Hyperaldosteronism](https://www.endotext.org/chapter/hyperaldosteronism/) - ABSTRACT Aldosterone regulation plays a crucial role in maintaining intravascular and effective circulating volume and potassium homeostasis; however, inappropriate regulation of aldosterone results in adverse cardiovascular and metabolic consequences. Hyperaldosteronism can be seen in a broad range of phenotypes. Approaching hyperaldosteronism by assessing plasma renin activity and hypertensive status is a simple method to
- [Carney Complex](https://www.endotext.org/chapter/carney-complex/) - ABSTRACT Carney complex (CNC) is a rare dominantly inherited syndrome of multiple neoplasias combined with cardio-cutaneous manifestations. Approximately 70% of index cases have a familial history, while the remaining 30% have a de novo germline mutation. Hitherto, two loci have been principally involved in the genetics of CNC: the CNC1 gene, located on 17q22-24,

## Questions

- [DO DDP4 INHIBITORS  INCREASE BETA CELL MASS?](https://www.endotext.org/question/do-ddp4-inhibitors-increase-beta-cell-mass/) - QUESTION-- what is the effect of of ddp4 inhibitors on c peptide ?and if increasing it does it mean beta cell regeneration? mailto:ymodmenna@gmail.com RESPONSE--Your questions are good ones and a field of interest of mine. Namely, can Dpp-4i and/or GLP-1 RAs increase beta cell mass and serve as a potential disease modifying agent in diabetes.The

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## Sections

- [Pituitary Disease and Neuroendocrinology](https://www.endotext.org/sections/neuroendo/) - Miles Levy, MD and Marta Korbonits, MD
- [Diabetes Mellitus and Carbohydrate Metabolism-DiabetesManager](https://www.endotext.org/sections/diabetes/) - Kathleen Dungan, MD, MPH, Ketan Dhatariya, MBBS, MSc, MD, MS, FRCP, PhD and Dr Emma Hamilton MBBS FRACP PhD
- [Endocrinology of Male Reproduction](https://www.endotext.org/sections/male/) - Robert McLachlan, MD, PhD and Bradley Anawalt, MD
- [Endocrinology of Female Reproduction](https://www.endotext.org/sections/female/) - Elizabeth A. McGee, MD and Wendy Kuohung, MD
- [Adrenal Disease and Function](https://www.endotext.org/sections/adrenal/) - George Chrousos, MD and Dr. Gregory Kaltsas, MD, FRCP
- [Diseases of Bone and Mineral Metabolism](https://www.endotext.org/sections/parathyroid/) - Robert A. Adler, MD and Suzanne Jan de Beur, MD
- [Diffuse Hormonal Systems and Endocrine Tumor Syndromes](https://www.endotext.org/sections/guthormone/) - Wouter W. de Herder, MD and Hans Hofland, MD
- [Pediatric Endocrinology](https://www.endotext.org/sections/pediatrics/) - Constantine A. Stratakis, MD, D(med)Sci, PhD(hc), Mark A. Sperling, MD, Radhika Muzumdar, MD, S. Faisal Ahmed, MD and Rodolfo Rey, MD, PhD
- [Obesity](https://www.endotext.org/sections/obesity/) - Jonathan Purnell, MD, Blandine Laferrère, MD PhD and Nitin Kapoor, MD, DM, PhD
- [Endocrine Physiology and Disease in Pregnancy and Lactation](https://www.endotext.org/sections/pregnancy/) - Christopher Kovacs, MD, FRCPC, FACP, FACE
- [Endocrine Testing Protocols](https://www.endotext.org/sections/protocols/) - Christian Koch, MD, PhD
- [Endocrinology of Aging](https://www.endotext.org/sections/aging/) - Emiliano Corpas, MD, PhD and Marc R. Blackman, MD
- [Endocrine Emergencies](https://www.endotext.org/sections/emergencies/) - Kenneth Feingold, MD and Matthew Kim, MD
- [Diagnosis and Treatment of Diseases of Lipid and Lipoprotein Metabolism in Adults and Children](https://www.endotext.org/sections/lipids/) - Kenneth Feingold, MD, Don P Wilson, MD and Amy Sanghavi Shah MD, MS, NLA
- [Disorders that Affect Multiple Organs](https://www.endotext.org/sections/organs/) - George Chrousos, MD
- [Thyroid Disease Manager](https://www.endotext.org/sections/thyroiddiseasemanager/) - Peter Kopp, MD
- [Tropical Endocrinology](https://www.endotext.org/sections/tropical-endocrinology/) - Sanjay Kalra, MD, DM, (AIIMS) and Rakesh Sahay, MD, DNB, DM (Endo), FICP, FACE