Primer on the Metabolic Bone Diseases and Disorders of

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Publisher: Lippincott Raven; Third Edition First Printing edition (1996)

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In addition to his research priorities, Professor Williams is Director of Education within the Department of Medicine and Head of Education for Clinical Programme Group 1 (Medicine) in the Academic Health Sciences Centre. Duncan Bassett is a Professor of Endocrinology at Imperial College and is a Consultant Physician at the Academic Health Sciences Centre specialising in Metabolic Bone Disease The gaseous metabolism of infants with special reference to its relation to pulse-rate and muscular activity http://projectbaseline.org/books/the-gaseous-metabolism-of-infants-with-special-reference-to-its-relation-to-pulse-rate-and-muscular. If you fail to notify our office in time, your account will be charged $50.00. 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Diseases/Specialties/Treatments: Internal Medicine; Endocrinology, Diabetes and Metabolism; Congenital Adrenal Hyperplasia; Diabetes; Excessive Hair Growth or Hirsutism; High Blood Sugar; more Associations/Memberships: Endocrine Society; College of Physicians and Surgeons, Mumbai, India; American Association of Clinical Endocrinologists; American Diabetes Association (ADA); Association of Physicians of India; National Board of Medicine, New Delhi, India In addition, she is on the editorial boards of the Journal of Clinical Endocrinology and Metabolism and Thyroid. Baloch Zubair W, Seethala Raja R, Faquin William C, Papotti Mauro G, Basolo Fulvio, Fadda Guido, Randolph Gregory W, Hodak Steven P, Nikiforov Yuri E, Mandel Susan J: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): A changing paradigm in thyroid surgical pathology and implications for thyroid cytopathology Hypothyroidism Type 2: Epidemic by Starr, Mark (2005) http://projectbaseline.org/books/hypothyroidism-type-2-epidemic-by-starr-mark-2005. See urine Ca, lithium levels Can be either hypo or hyperthyroidHyperthyroid first 2-4 wks, then hypothyroid 4-12 wks, then recoverExam- diffuse painless goiter50% go on to have anti-TPO abs and Hashimoto's maintain FPG<100, A1C<7require 50%+ more insulin due to resistence from placental hormones, resolves at delivery (watch for, reduce insulin dose)Avoid in pregnancy: Statins, ACEs, ARBs (cat C 1st trimester, D later); most oral hypoglycemics are C 90% have some autoantibodyanti-islet cell, -GAD (glutamic acid decarboxylase), -tyrosine phosphateAnti-GAD is most clinically usefulCan be assc with other autoimmune dz- thyroid, adrenal, sprue, vitiligo, B12 deficiency, myasthenia AACE:A1C 6-7: one drug- MET, TZD, insulin, secretogogueA1C 7-8: combo orals +/- insulinA1C 8-10: intensive orals + insulinA1C 10+: intensive insulinADA:lifestyle modification + MET, intensify tx q3 mo if A1C>7 Suppressed - hyperglycemia, somatastatin, chronic steroidsStimulated by - hypoglycemia, estrogensGH -> liver -> IGF-1 ->effects Diabetic Control and Complications Trial (DCCT): reduced microvasc complic with tight control, slowing of macrovasc reduced, but not statistically significant IN DM1UKPDS (UK prospective DM study): same as DCCT, in DM2ADVANCE, VADT - no improvement with intensive controlACCORD: increased mortality with intensive control more frequent in womenEuthyroid, nl labsFound by large gland or compression sxsDo US to look for dominant nodules, suspicious of maliganancyTreat if symptomatic compression or cosmetic issuesTreat with iodine ablation or surgery; thyroxine doesn't help Most common cause- DM pt with mild renal failure, decreased renin production; see HyperK, acidosis out of proportion to renal dzUnable to retain Na-> postural HoTNWU- ACTH stim test, measure renin, aldo levels while upright and salt restrictedRx- fludrocortisoneDrugs suppresssing aldo- ACE-I, NSAIDs, chronic heparin Insidious onset, usually 10+yr to dxEnlarged hands, feet, coarse facial features, deepened voice, carpal tunnel, acanthosis nigricans, skin tags; jaw growth causing dental abnormalitiesCardiac - ischemic HD, cardiomyopathy, diastolic HF, HTN, LVH; increased risk of CVA, DM, OSA, colon polyps, malignancyUntreated, lifespan reduced 10+ yrs Most likely to least:1 , e.g. Imaging Endocrine Diseases in Children (Medical Radiology / Diagnostic Imaging) projectbaseline.org.

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