By Michael Kappy, David Allen, Mitchell Geffner
Whole how-to-guidance at the assessment and remedy of endocrine problems in young ones "Edited and written through eminent pediatric endocrinologists, this is often at this time the simplest ebook for fellows in education and pediatricians in perform. It includes in eleven chapters a concise treatise of pediatric endocrine illnesses, good written, effortless readable, helped by means of titles and headings in colour. hugely illustrated in colour and with updated references, it's hugely recommended."--Pediatric Endocrinology experiences four superstar DOODY'S evaluation! "This is a really valuable ebook for all physicians who deal with younger sufferers with endocrine disorders....In making a how-to advisor whereas breaking down the molecular mechanisms of endocrine ailments, it fills a spot in at present to be had pediatric endocrinology literature....This very good booklet allows for busy first-year endocrinology fellows to achieve a large realizing of the pertinent subject matters during this field."--Doody's evaluation provider Pediatric perform: Endocrinology is an exceptional medical research and decision-making instrument for these treating endocrine difficulties in youngsters. that includes an cutting edge problem-oriented process, this well-illustrated, full-color advisor skillfully integrates pathophysiology with medical administration. a variety of figures illustrate the rules of standard and irregular body structure and therapy reason and results. No different source deals this concise but entire assessment of present wisdom, hyperlinks those thoughts with research of medical occasions, and gives such useful innovations for rational and effective review and therapy of youngsters with endocrine issues. Pediatric perform: Endocrinology opens with an introductory bankruptcy that clarifies the hyperlink among genetics, telephone biology, and body structure with pathophysiology to supply a transparent assessment of the endocrine method. next chapters conceal issues of progress, water metabolism, thyroid and adrenal glands, bone and mineral metabolism, puberty, intercourse improvement, weight problems, diabetes, and hypoglycemia. through the e-book emphasis is put on care of the sufferer, with the objective of optimizing care and bettering the scientific administration and results for those sufferers. greater than three hundred full-color photographs, figures, and tables increase the presentation. beneficial properties of the Pediatric perform sequence: counsel that let you know what you want to know--and what you want to do--at each level of care Diagnostic and remedy algorithms "When to Refer" containers study all of the proper scientific issues Diagnostic Tests--with a pragmatic emphasis at the correct checks to reserve clinical remedy assurance that incorporates medicinal drugs, dosages, and management in an easy-to-read tabular structure handy icons and a constant bankruptcy layout a variety of scientific colour pictures and didactic diagrams
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CHAPTER 1 General Concepts and Physiology ■ 17 Table 1-5. Patterns of Effector and Trophic Hormones in Endocrine Disease Concentration of Effector Hormone Concentration of Trophic Hormone Primary endocrine gland deficiency Central endocrine deficiency Hormone resistance Low High Low Low or normal High High Primary endocrine gland hyperfunction Central endocrine hyperfunction High Low High Normal or high Activating receptor mutation High Low Category of Disease Example Autoimmune thyroiditis (↓ T4, ↑ TSH) Growth hormone deficiency (↓ IGF-1, ↓ GH) Androgen insensitivity syndrome (↑ testosterone, ↑ LH) Graves disease (↑ T4, ↓ TSH) Cushing disease (↑cortisol, ↑ ACTH) FMPP (↑ testosterone, ↓ LH) ACTH, adrenocorticotrophic hormone; FMPP, familial male-limited precocious puberty; GH, growth hormone; IGF-1, insulin-like growth factor-1; LH, luteinizing hormone; T4, L-thyroxine; TSH, thyroid-stimulating hormone present.
120 Intact PTH (pg/mL) 100 Primary hypoparathyroidism Primary hyperparathyroidism Hypercalcemia of malignancy 80 Reference interval 60 40 20 8 11 12 9 10 Serum calcium (mg/dL) 13 14 FIGURE 1-13 ■ Distinguishing primary hypoparathyroidism, primary hyperparathyroidism, and hypercalcemia of malignancy. The concentration of parathyroid hormone (PTH) may be normal in each of these conditions. They can only be distinguished from each other by comparing simultaneously obtained PTH and calcium concentrations.
Table 1-7 summarizes many of these. Clinical optimization of testing Many endocrine diseases are relatively rare, and symptoms of many endocrine diseases may also exist in other nonendocrine conditions. Because of the low prevalence of some endocrine disorders (low pretest probability), laboratory tests often have high false positive rates and low positive predictive values. This may easily result in an Table 1-7. Preanalytical Factors Influencing Hormone Measurement Patient Related Variables Nonpatient Related Variables Age Sex Pubertal status Diurnal variation Pulsatile secretion Episodic secretion Nutritional status Posture Exercise Pain/stress Medications Menstrual cycle Seasonal changes Body size Plasma vs serum vs whole blood Storage temperature Storage duration Number of freeze/thaw cycles Time before processing EDTA vs heparin plasma Erroneous collection of timed specimens EDTA, Ethylenediaminetetraacetic acid 20 ■ Pediatric Practice: Endocrinology erroneous diagnosis.