By Anil Bhansali, Yashpal Gogate
This booklet covers fascinating and but usually tough instances between grownup sufferers in a distinct Question-Answer structure. Simulating the bed-side case discussions through the ward rounds, one query logically results in one other query thereby producing interest and selling evidence-based medication. Taking the readers during the complete spectrum ranging from etiology and pathophysiology to scientific presentation to administration rules, each one query addresses one key element of the disease. defined in a very easy and lucid narrative, this booklet guarantees sound conceptual figuring out whereas protecting each one subject comprehensively. This quantity covers very important themes akin to acromegaly, Cushing syndrome, osteoporosis, hypercalcemia, pheochromocytoma, hyperaldosteronism, thyroid issues and diabetes in grownup sufferers. those instances are usually not basically noticeable by way of endocrinologists, yet also are controlled by way of internists, orthopedic surgeons, obstetricians and gynecologists. much less universal issues comparable to adrenal problems and androgen extra have additionally been coated.
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Extra info for Clinical Rounds in Endocrinology: Volume I - Adult Endocrinology
Goiter is present in 70–80% of patients with acromegaly. Thyroid enlargement may be diffuse or multinodular and is usually associated with normal thyroid function; however, 4–14% of patients may have hyperthyroidism. The causes of goiter in acromegaly include GH–IGF1-mediated growth and proliferation of thyroid follicular cells, McCune–Albright Syndrome, GH and TSH co-secreting adenoma, and medullary thyroid carcinoma with ectopic GHRH secretion. Solitary nodule in a patient with acromegaly should raise the suspicion of papillary thyroid cancer as it is one of the common cancers associated with acromegaly.
GH also decreases the expression of insulin-sensitizing adipokines like adiponectin and visfatin. In addition, GH promotes lipolysis and increases the serum levels of non-esterified fatty acids, resulting in worsening of insulin resistance. 30. What are the cardiovascular manifestations in acromegaly? Cardiovascular manifestations in acromegaly include cardiomyopathy, heart failure, asymmetrical septal hypertrophy, arrhythmias, and coronary artery disease. Diastolic dysfunction is the earliest abnormality in acromegalic cardiomyopathy, followed by systolic dysfunction and eventually heart failure which is characteristically associated with increased left ventricular muscle mass.
Hirsutism is present in nearly half of the patients with acromegaly. It is due to direct effect of GH–IGF1 on pilosebaceous units and GH-mediated hyperandrogenemia. Hyperandrogenemia is due to decreased SHBG, insulin resistance/ hyperinsulinemia, and increased ovarian steroidogenesis. In addition, hyperprolactinemia which is present in 30% of patients with acromegaly can also result in increased androgen production. Hirsutism in these patients is invariably accompanied with menstrual irregularities.