Endocrine and Metabolic Disorders: Merck Manual Professional

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Endocrine and Metabolic Disorders

Overview of the Endocrine System
	Hypothalamic-Pituitary Relationships
	Hypothalamic Controls
	Anterior Pituitary Function
		Adrenocorticotropic hormone (ACTH)
		Thyroid-stimulating hormone (TSH)
		Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
		Growth hormone (GH)
		Prolactin
		Other hormones
	Posterior Pituitary Function
		Antidiuretic hormone (ADH, vasopressin)
		Oxytocin
Endocrine Disorders
		Hyperfunction
		Hypofunction
	Laboratory Testing
	Treatment
	Aging and Endocrinology

Pituitary Disorders

Pituitary Lesions
		Empty sella syndrome
		Anterior lobe lesions
		Posterior lobe lesions
Generalized Hypopituitarism
	Symptoms and Signs
	Diagnosis
		Imaging tests
		Laboratory testing
	Treatment
Selective Pituitary Hormone Deficiencies
Hypopituitarism in Children Resulting in Short Stature
	Symptoms and Signs
	Diagnosis
	Treatment
Gigantism and Acromegaly
	Symptoms and Signs
		Pituitary gigantism
		Acromegaly
	Diagnosis
	Treatment
Galactorrhea
	Etiology
	Symptoms and Signs
	Diagnosis
	Treatment
Central Diabetes Insipidus
	Pathophysiology
	Etiology
		Primary CDI
		Secondary CDI
	Symptoms and Signs
	Diagnosis
		Psychogenic polydipsia
	Treatment

Thyroid Disorders

Overview of Thyroid Function
		Synthesis and Release of Thyroid Hormones
		Laboratory Testing of Thyroid Function
			Screening
Approach to the Patient With a Thyroid Nodule
		Etiology
		Evaluation
			History
			Physical examination
			Testing
		Treatment
Euthyroid Sick Syndrome
		Diagnosis
		Treatment
		Key Points
Hashimoto's Thyroiditis
		Symptoms and Signs
		Diagnosis
		Treatment
		Key Points
Hyperthyroidism
		Etiology
		Pathophysiology
		Symptoms and Signs
			Thyroid storm
		Diagnosis
		Treatment
			Methimazole and Propylthiouracil
			β-Blockers
			Iodine
			Radioactive sodium iodine (¹³¹I, radioiodine)
			Surgery
			Treatment of thyroid storm
			Treatment of infiltrative dermopathy and ophthalmopathy
		Key Points
	Subclinical Hyperthyroidism
Hypothyroidism
			Primary hypothyroidism
			Secondary hypothyroidism
		Symptoms and Signs
			Myxedema coma
		Diagnosis
		Treatment
			Myxedema coma
		Key Points
	Subclinical Hypothyroidism
Silent Lymphocytic Thyroiditis
		Symptoms and Signs
		Diagnosis
		Treatment
		Key Points
Subacute Thyroiditis
		Symptoms and Signs
		Diagnosis
		Prognosis
		Treatment
		Key Points
Simple Nontoxic Goiter
		Symptoms and Signs
		Diagnosis
		Treatment
		Key Points
Thyroid Cancers
	Papillary Carcinoma
		Treatment
	Follicular Carcinoma
	Medullary Carcinoma
		Symptoms and Signs
		Diagnosis
		Treatment
	Anaplastic Carcinoma
	Radiation-Induced Thyroid Cancer

Adrenal Disorders

Overview of Adrenal Function
		Cortex
		Medulla
		Clinical syndromes
Addison Disease
	Etiology
	Pathophysiology
		Mineralocorticoid deficiency
		Glucocorticoid deficiency
	Symptoms and Signs
		Adrenal crisis
	Diagnosis
		Differential diagnosis
		Testing
	Treatment
		Adrenal crisis
		Treatment of complications
	Key Points
Secondary Adrenal Insufficiency
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Adrenal Virilism
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Cushing Syndrome
	Etiology
	Symptoms and Signs
	Diagnosis
	Treatment
		Nelson syndrome
	Key Points
Primary Aldosteronism
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Secondary Aldosteronism
Pheochromocytoma
	Symptoms and Signs
	Diagnosis
		Blood tests
		Urine tests
		Other tests
	Treatment
	Key Points
Nonfunctional Adrenal Masses
	Symptoms and Signs
	Diagnosis
	Treatment

Polyglandular Deficiency Syndromes

Polyglandular Deficiency Syndromes
		Etiology
		Pathophysiology
		Classification
			Type I
			Type II (Schmidt's syndrome)
			Type III
		Symptoms and Signs
		Diagnosis
		Treatment
	IPEX Syndrome
	POEMS Syndrome

Porphyrias

Overview of Porphyrias
	Etiology
	Pathophysiology
	Diagnosis
	Secondary porphyrinuria
Acute Porphyrias
	Precipitating Factors
	Symptoms and Signs
		The acute porphyric attack
		Subacute or subchronic symptoms
		Skin symptoms in VP and HCP
		Late manifestations
	Diagnosis
		Acute attack
		Determination of type
		Family studies
	Prognosis
	Treatment
	Prevention
	Key Points
Overview of Cutaneous Porphyrias
Porphyria Cutanea Tarda
	Pathophysiology
		Pseudoporphyria
	Symptoms and Signs
	Diagnosis
	Treatment
	Prevention
	Key Points
Erythropoietic Protoporphyria
	Etiology
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points

Fluid Metabolism

Water and Sodium Balance
			Osmotic forces
			Water intake and excretion
Disorders of Fluid Volume
			Renin-angiotensin-aldosterone axis
			Other natriuretic factors
			Na depletion and excess
	Volume Depletion
		Symptoms and Signs
		Diagnosis
		Treatment
	Volume Overload

Electrolyte Disorders

Hyponatremia
	Etiology
		Hypovolemic hyponatremia
		Euvolemic hyponatremia
		Hypervolemic hyponatremia
		Hyponatremia in AIDS
	Symptoms and Signs
	Diagnosis
		Identification of the cause
	Treatment
		Mild hyponatremia
		Severe hyponatremia
		Osmotic demyelination syndrome
	Key Points
Hypernatremia
	Etiology
		Hypovolemic hypernatremia
		Euvolemic hypernatremia
		Hypervolemic hypernatremia
		Hypernatremia in the elderly
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Overview of Disorders of Potassium Concentration
		K shifts
		K metabolism
		False K concentrations
Hypokalemia
	Etiology
		GI tract losses
		Intracellular shift
		Renal losses
		Drugs
	Symptoms and Signs
	Diagnosis
		ECG
		Diagnosis of cause
	Treatment
	Prevention
	Key Points
Hyperkalemia
	Etiology
	Symptoms and Signs
	Diagnosis
		ECG
		Diagnosis of cause
	Treatment
		Mild hyperkalemia
		Moderate to severe hyperkalemia
	Key Points
Overview of Disorders of Calcium Concentration
	Regulation of Calcium Metabolism
Hypocalcemia
	Etiology
		Hypoparathyroidism
		Pseudohypoparathyroidism
		Vitamin D deficiency and dependency
		Renal disease
		Other causes
	Symptoms and Signs
		Neurologic manifestations
		Other manifestations
	Diagnosis
	Treatment
	Key Points
Hypercalcemia
	Etiology
	Pathophysiology
	Symptoms and Signs
	Diagnosis
		Initial evaluation
		Hyperparathyroidism
		Cancer
		FHH
		Milk-alkali syndrome
		Other causes
	Treatment
		Mild hypercalcemia
		Moderate hypercalcemia
		Severe hypercalcemia
		Hyperparathyroidism
		FHH
	Key Points
Overview of Disorders of Phosphate Concentration
Hypophosphatemia
	Etiology
	Symptoms and Signs
	Diagnosis
	Treatment
		Oral treatment
		Parenteral treatment
	Key Points
Hyperphosphatemia
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Overview of Disorders of Magnesium Concentration
Hypomagnesemia
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Hypermagnesemia
	Diagnosis
	Treatment

Acid-Base Regulation and Disorders Diabetes Mellitus and Disorders of Carbohydrate Metabolism

Diabetes Mellitus (DM)
	Etiology
		Type 1
		Type 2
		Miscellaneous types
	Symptoms and Signs
	Complications
		Diabetic retinopathy
		Diabetic nephropathy
		Diabetic neuropathy
		Macrovascular disease
		Cardiomyopathy
		Infection
		Other complications
	Diagnosis
		Screening for disease
		Screening for complications
	Treatment
		Goals and methods
		Patient education
		Diet
		Exercise
		Monitoring
		Insulin
		Complications of insulin treatment
		Insulin regimens for type 1 DM
		Insulin regimens for type 2 DM
		Oral antihyperglycemic drugs
		Injectable antihyperglycemic drugs
		Other antihyperglycemic treatments
		Adjunctive treatments
	Special Populations and Settings
		Children
		Adolescents
		Hospitalization
		Surgery
	Prevention
		Type 1
		Type 2
		Complications
	Key Points
Diabetic Ketoacidosis (DKA)
	Pathophysiology
	Symptoms and Signs
	Diagnosis
	Prognosis
	Treatment
	Key Points
Nonketotic Hyperosmolar Syndrome (NKHS)
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points
Alcoholic Ketoacidosis
	Pathophysiology
	Symptoms and Signs
	Diagnosis
	Treatment
Hypoglycemia
	Etiology
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points

Lipid Disorders

Overview of Lipid Metabolism
		Physiology
			Exogenous (dietary) lipid metabolism
			Endogenous lipid metabolism
Dyslipidemia
		Classification
		Etiology
			Primary causes
			Secondary causes
		Symptoms and Signs
		Diagnosis
			Lipid profile measurement
			Other tests
			Secondary causes
			Screening
		Treatment
			General principles
			Elevated LDL cholesterol
			Elevated TGs
			Low HDL
			Elevated Lp(a)
			Homozygous familial hypercholesterolemia
			Secondary causes
			Monitoring treatment
	Elevated High-Density Lipoprotein Levels
Hypolipidemia
		Etiology
			Abetalipoproteinemia (Bassen-Kornzweig syndrome)
			Hypobetalipoproteinemia
			Chylomicron retention disease

Amyloidosis

Amyloidosis
	Etiology
		Primary amyloidosis (AL)
		Secondary amyloidosis (AA)
		Familial amyloidosis
		A β₂-microglobulin (dialysis-related) amyloidosis
		A β-protein amyloidosis
	Symptoms and Signs
	Diagnosis
	Prognosis
	Treatment

Carcinoid Tumors

	Overview of Carcinoid Tumors
	Carcinoid Syndrome
			Etiology
			Pathophysiology
			Symptoms and Signs
			Diagnosis
			Prognosis
			Treatment
			Key Points

Multiple Endocrine Neoplasia (MEN) Syndromes

Overview of Multiple Endocrine Neoplasias
Multiple Endocrine Neoplasia, Type 1 (MEN 1)
	Symptoms and Signs
		Parathyroid
		Pancreas
		Pituitary
		Other manifestations
	Diagnosis
		Screening
	Treatment
	Key Points
Multiple Endocrine Neoplasia, Type 2A (MEN 2A)
	Symptoms and Signs
		Thyroid
		Adrenal
		Parathyroid
		Other manifestations
	Diagnosis
		Screening
	Treatment
	Key Points
Multiple Endocrine Neoplasia, Type 2B (MEN 2B)
	Symptoms and Signs
	Diagnosis
	Treatment
	Key Points

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