Handbook of Diagnostic Endocrinology - part 1 pptx

HUMANA PRESS Handbook of Diagnostic Endocrinology Edited by Janet E. Hall, MD Lynnette K. Nieman, MD CONTEMPORARY ENDOCRINOLOGY ™ Handbook of Diagnostic Endocrinology Edited by Janet E. Hall, MD Lynnette K. Nieman, MD HUMANA PRESS HANDBOOK OF DIAGNOSTIC ENDOCRINOLOGY 00/FM/CE/Hall/F 12/4/02, 8:48 AM1 Androgens in Health and Disease, edited by C ARRIE BAGATELL AND WILLIAM J. B REMNER, 2003 Endocrine Replacement Therapy in Clinical Practice, edited by A. W AYNE MEIKLE, 2003 Early Diagnosis and Treatment of Endocrine Disorders, edited by R OBERT S. BAR, 2003 Type I Diabetes: Etiology and Treatment, edited by M ARK A. SPERLING, 2003 Handbook of Diagnostic Endocrinology, edited by J ANET E. HALL AND LYNNETTE K. NIEMAN, 2003 Pediatric Endocrinology: A Practical Clinical Guide, edited by S ALLY RADOVICK AND MARGARET H. M ACGILLIVRAY, 2003 Diseases of the Thyroid, 2nd ed., edited by L EWIS E. BRAVERMAN, 2003 Developmental Endocrinology: From Research to Clinical Practice, edited by E RICA A. EUGSTER AND ORA HIRSCH PESCOVITZ, 2002 Osteoporosis: Pathophysiology and Clinical Management, edited by E RIC S. O RWOLL AND MICHAEL BLIZIOTES, 2002 Challenging Cases in Endocrinology, edited by M ARK E. MOLITCH, 2002 Selective Estrogen Receptor Modulators: Research and Clinical Applications, edited by A NDREA MANNI AND MICHAEL F. VERDERAME, 2002 Transgenics in Endocrinology, edited by M ARTIN MATZUK, CHESTER W. BROWN, AND T. RAJENDRA KUMAR, 2001 Assisted Fertilization and Nuclear Transfer in Mammals, edited by D ON P. WOLF AND MARY ZELINSKI-WOOTEN, 2001 Adrenal Disorders, edited by A NDREW N. M ARGIORIS AND GEORGE P. CHROUSOS, 2001 Endocrine Oncology, edited by S TEPHEN P. E THIER, 2000 Endocrinology of the Lung: Development and Surfactant Synthesis, edited by C AROLE R. MENDELSON, 2000 Sports Endocrinology, edited by M ICHELLE P. WARREN AND NAAMA W. CONSTANTINI, 2000 Gene Engineering in Endocrinology, edited by M ARGARET A. SHUPNIK, 2000 Endocrinology of Aging, edited by J OHN E. M ORLEY AND LUCRETIA VAN DEN BERG, 2000 Human Growth Hormone: Research and Clinical Practice, edited by R OY G. S MITH AND MICHAEL O. THORNER, 2000 Hormones and the Heart in Health and Disease, edited by L EONARD SHARE, 1999 Menopause: Endocrinology and Manage- ment, edited by D AVID B. SEIFER AND ELIZABETH A. KENNARD, 1999 The IGF System: Molecular Biology, Physiology, and Clinical Applica- tions, edited by R ON G. ROSENFELD AND CHARLES T. ROBERTS, JR., 1999 Neurosteroids: A New Regulatory Function in the Nervous System, edited by E TIENNE-EMILE BAULIEU, PAUL ROBEL, AND MICHAEL SCHUMACHER, 1999 Autoimmune Endocrinopathies, edited by R OBERT VOLPÉ, 1999 Hormone Resistance Syndromes, edited by J. L ARRY JAMESON, 1999 Hormone Replacement Therapy, edited by A. W AYNE MEIKLE, 1999 Insulin Resistance: The Metabolic Syndrome X, edited by G ERALD M. REAVEN AND AMI LAWS, 1999 Endocrinology of Breast Cancer, edited by A NDREA MANNI, 1999 Molecular and Cellular Pediatric Endocrinology, edited by S TUART HANDWERGER, 1999 Gastrointestinal Endocrinology, edited by G EORGE H. GREELEY, JR., 1999 CONTEMPORARY ENDOCRINOLOGY P. Michael Conn, SERIES EDITOR 00/FM/CE/Hall/F 12/4/02, 8:48 AM2 HANDBOOK OF DIAGNOSTIC ENDOCRINOLOGY Edited by JANET E. HALL, MD Massachusetts General Hospital, Boston, MA and LYNNETTE K. NIEMAN, MD National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD HUMANA PRESS TOTOWA, NEW JERSEY 00/FM/CE/Hall/F 12/4/02, 8:48 AM3 © 2003 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel: 973-256-1699; Fax: 973-256-8341; E-mail: humana@humanapr.com.com or visit our website at humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. 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For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [0-89603-757-6/03 $20.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 Handbook of diagnostic endocrinology /edited by Janet E. Hall and Lynnette K. Nieman. p. ; cm.—(Contemporary endocrinology) Includes bibliographical references and index. ISBN 0-89603-757-6 (alk. paper); 1-59259-293-7 (e-book) 1. Endocrine glands—Diseases—Diagnosis—Handbooks, manuals, etc. I. Hall, Janet E. II. Nieman, Lynnette, K. III. Contemporary endocrinology (Totowa, NJ). [DNLM: 1. Endocrine Diseases—diagnosis. 2. Diagnostic Techniques, Endocrine. WK 140 H236 2003 ] RC649 .H298 2003 616.4’075—dc21 2002032870 00/FM/CE/Hall/F 12/4/02, 8:48 AM4 v PREFACE The aim of the Handbook of Diagnostic Endocrinology is to provide a com- prehensive overview of current approaches to the diagnosis of endocrine disor- ders. Our ability to diagnose patients with diseases of the endocrine systems is expanding exponentially with the development of new and more reliable assay methods and the incorporation of both molecular and genetic approaches into our understanding of the pathophysiology of these diseases. Although the pri- mary focus of this volume is on the diagnosis of endocrine disease, the vast majority of endocrine diseases require long-term management; therefore, many of the chapters also discuss approaches to follow-up in these patients. The Handbook of Diagnostic Endocrinology comprises 16 chapters. Immu- noassays have long been the cornerstones of endocrine diagnoses. As an impor- tant background, Sabrina Gill, Frances Hayes, and Patrick Sluss discuss the many methodological advances that have expanded our repertoire of diagnostic tests. With the increased number of tests available for endocrine evaluation, it is incumbent that we understand the factors that affect assay performance and their impact on our ability to use these tools to aid in clinical diagnosis. Joseph Verbalis reviews the regulatory mechanisms underlying water and sodium metabolism and presents a comprehensive approach to disorders of body fluids, which are among the most commonly encountered problems in clinical medi- cine. Mary Lee Vance outlines the diagnosis and long-term followup of patients presenting with pituitary tumors, and Lynnette Nieman provides an approach to the diagnosis and differential diagnosis of Cushing’s syndrome that includes a critical appraisal of available tests. Although endocrine causes of hypertension occur in only 10% of hypertensive subjects, this small fraction represents a large number of patients. Jennifer Lawrence and Robert Dluhy present a thoughtful and efficient approach to the diagnosis of these disorders. Anastassios Pittas and Stephanie Lee then update the approach to the diagnosis of thyroid disease, including an important discussion of currently available assays. Regina Castro and Hossein Gharib present a cost-effective approach to evaluation of the com- mon problem of thyroid nodules and discuss the preoperative evaluation and postoperative followup of patients with thyroid cancer. Allison Goldfine pro- vides an overview of the diagnosis of the various forms of diabetes and a com- prehensive discussion of long-term monitoring of the primary disease and its complications. Robert Ratner reviews the important area of gestational diabetes, both its diagnosis and consequences, and John Service presents a clear approach to the diagnosis of hypoglycemia. William Donahoo, Elizabeth Stephens, and 00/FM/CE/Hall/F 12/4/02, 8:48 AM5 vi Preface Robert Eckel provide a thorough discussion of the modalities that are currently available for the assessment of dyslipidemia and obesity. Benjamin Leder and Joel Finkelstein then review calcium metabolism and present a logical approach to the diagnosis of hyper- and hypocalcemia. Patrick Doran and Sundeep Khosla discuss the spectrum of osteoporosis and an approach to diagnosis and long-term followup based on the currently available tools. Margaret Wierman reviews the normal physiology of the hypothalamic–pituitary–testicular axis and the physi- ology of erection, both of which are critical to the approach to evaluation of hypogonadism and erectile dysfunction. Drew Tortoriello and Janet Hall then discuss the physiology of normal menstrual function as a backdrop to their approach to the evaluation and long-term followup of women with disorders of menstrual function. Ricardo Azziz completes this volume with a practical and focused discussion of the evaluation of androgen excess in women. In Handbook of Diagnostic Endocrinology we provide the reader with a concise approach to the diagnosis of endocrine disorders that is based on an understanding of their pathophysiology and includes both clinical manifesta- tions and the most current laboratory tests available. This work will serve as a reference for students and fellows in training as well as an update for practicing endocrinologists and internists. We thank the contributors to this volume, without whose expertise and efforts this work would not be possible. Janet E. Hall, MD Lynnette K. Nieman, MD 00/FM/CE/Hall/F 12/4/02, 8:48 AM6 vii CONTENTS Preface v Contributors ix 1 Issues in Endocrine Immunoassay 1 Sabrina Gill, Frances J. Hayes, and Patrick M. Sluss 2 Disorders of Water Metabolism 23 Joseph G. Verbalis 3 Pituitary Tumors: Prolactinomas, Acromegaly, Gonadotropin-Producing, Nonfunctioning 55 Mary Lee Vance 4 Cushing’s Syndrome 67 Lynnette K. Nieman 5 Endocrine Hypertension 85 Jennifer E. Lawrence and Robert G. Dluhy 6 Evaluation of Thyroid Function 107 Anastassios G. Pittas and Stephanie L. Lee 7 Thyroid Nodules and Thyroid Cancer 131 M. Regina Castro and Hossein Gharib 8 Diagnosis and Management of Diabetes 157 Allison B. Goldfine 9 Gestational Diabetes: Where Do We Look for It and How Do We Find It? 179 Robert E. Ratner 10 Hypoglycemic Disorders 193 F. John Service 11 The Evaluation of Dyslipidemia and Obesity 213 William T. Donahoo, Elizabeth Stephens, and Robert H. Eckel 12 Hyper- and Hypocalcemia 239 Benjamin Z. Leder and Joel S. Finkelstein 00/FM/CE/Hall/F 12/4/02, 8:48 AM7 viii Contents 13 Osteoporosis 257 Patrick M. Doran and Sundeep Khosla 14 Hypogonadism and Erectile Dysfunction 277 Margaret E. Wierman 15 Menstrual Dysfunction 295 Drew V. Tortoriello and Janet E. Hall 16 Differential Diagnosis and Evaluation of Hyperandrogenism 323 Ricardo Azziz Index 331 00/FM/CE/Hall/F 12/4/02, 8:48 AM8 ix CONTRIBUTORS RICARDO AZZIZ, MD, MPH, MBA, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA M. R EGINA CASTRO, MD, Department of Medicine and Endocrinology, Albany Medical College, Stratton VA Medical Center, Albany, NY R OBERT G. DLUHY, MD, Division of Endocrinology-Hypertension, Brigham and Women’s Hospital, Boston, MA W ILLIAM T. DONAHOO, MD, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Health Sciences Center, Denver, CO P ATRICK M. DORAN, MD, Division of Endocrinology, McGill University Health Center, Montreal, Canada R OBERT H. ECKEL, MD, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Health Sciences Center, Denver, CO J OEL S. FINKELSTEIN, MD, Division of Endocrinology, Massachusetts General Hospital, Boston, MA H OSSEIN GHARIB, MD, FACE, Division of Endocrinology and Metabolism, Mayo Clinic and Mayo Foundation, Rochester, MN S ABRINA GILL, MD, Division of Endocrinology and Metabolism, St. Paul’s Hospital, Vancouver BC, Canada A LLISON B. GOLDFINE, MD, Research Division, Joslin Diabetes Center, Boston, MA J ANET E. HALL, MD, Reproductive Endocrine Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA F RANCES J. HAYES, MD, Reproductive Endocrine Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA S UNDEEP KHOSLA, MD, Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN J ENNIFER E. LAWRENCE, MD, Valdosta Specialty Clinic, Valdosta, GA B ENJAMIN Z. LEDER, MD, Division of Endocrinology, Massachusetts General Hospital, Boston, MA S TEPHANIE L. LEE, MD, Division of Endocrinology, Diabetes and Metabolism, Boston Medical Center, Boston, MA L YNNETTE K. NIEMAN, MD, Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD A NASTASSIOS G. PITTAS, MD, Division of Endocrinology, Diabetes, Metabolism and Molecular Medicine, New England Medical Center, Boston, MA 00/FM/CE/Hall/F 12/4/02, 8:48 AM9 [...]... Wallac 32 5 61 28 219 12 3 98 10 2 10 6 37 14 49 45 5 28.5 26.9 30.4 38.2 37.6 33.4 32.0 33.4 31. 3 33.9 32.8 23.8 26.5 35.9 38.9 35.8 52.5 51. 0 39.4 43 .1 44.4 41. 3 39.8 47.0 28.7 31. 2 33.05 32.63 32.82 45. 81 44.46 36 .18 38.02 38. 51 36.39 36 .12 38. 91 25.69 — 1. 69 2.09 1. 57 2.66 2. 31 1.30 2 .19 2.23 2.39 1. 70 3.60 1. 22 — 5 .1% 6.4% 4.8% 5.8% 5.2% 3.6% 5.8% 5.8% 6.6% 4.7% 9.3% 4.7% the LH and hCG β-subunits can... Vitros 263 53 66 78 63 46 12 9 44 64 41 30 Low High Mean SD CV 318 .0 906.0 628 .10 13 8.00 22.0% 614 .0 13 90.0 885.90 18 3.90 20.8% 345.0 499.0 408.40 31. 10 7.6% 340.0 495.0 419 .90 30.70 7.3% 7 01. 0 9 81. 0 844.30 50.50 6.0% 744.0 994.0 897 .10 54.60 6 .1% 732.0 997.0 842.30 56.90 6.8% 698.0 920.0 815 .10 49.20 6.0% 508.0 796.0 650.30 58.50 9.0% 826.0 11 27.0 972.60 77.20 7.9% 737.0 9 91. 0 843.20 55.30 6.6% which... least 10 ) of a “zero” dose standard (Fig 3) For competitive immunoassays that 11 01/ Sluss/ 1- 2 2/F 11 12 /2/02, 8:53 AM 12 Gill et al Fig 2 Effect of pre-analytical hemolysis on insulin measurements have a negative dose–response curve, the lower 95% confidence limit is used Alternatively, the minimum detectable concentration of hormone can be defined based upon the variance of repeated measurements of unknown... appropriate pathophysiological settings The ease and precision of modern automated analyzers has made these powerful tools widely available However, the methods 01/ Sluss/ 1- 2 2/F 18 12 /2/02, 8:53 AM 01/ Sluss/ 1- 2 2/F Chapter 1/ Endocrine Immunoassay 19 19 12 /2/02, 8:53 AM Fig 5 Mechanism of the “hook effect” in a one-step immunometric assay 19 20 Gill et al remain highly complex, and it is essential to... Enzymol 19 81; 73:224–239 10 Nye L, Forrest GC, Greenwood H Solid-phase magnetic particle radioimmunoassay Clin Chem Acta 19 76;69:387–392 11 Van Vunakis H, Langone JJ Immunochemical Methods Methods Enzymol 19 80;70 :1 525 12 Price CP, Newman DJ Principles and Practice of Immunoassay Stockton Press, New York, 19 91 13 Diamandis EP Detection techniques for immunoassay and DNA probing applications Clin Biochem 19 90;23:443... underlying most cases of serum interference are still unknown 01/ Sluss/ 1- 2 2/F 16 12 /2/02, 8:53 AM Chapter 1/ Endocrine Immunoassay 17 Fig 4 Comparison of the analytical recovery of two estradiol immunoassays demonstrating nonuniformity of bias between assays The degree to which immunoassay measurements differ from the absolute amount of hormone is often referred to as the bias of the assay Because the... J Physiol 19 88;255:E696–7 01 01/ Sluss/ 1- 2 2/F 20 12 /2/02, 8:53 AM Chapter 1/ Endocrine Immunoassay 21 21 Veldhuis JD, Beitins IZ, Johnson ML, Serabian MA, Dufau ML Biologically active luteinizing hormone is secreted in episodic pulsations that vary in relation to stage of the menstrual cycle J Clin Endocrinol Metab 19 84;58 :10 50 10 58 22 Filicori M, Butler JP, Crowley WF Jr Hypothalamic control of goandotropin... Press, New York, 19 87 39 Ekins RP, Edwards P Point on the meaning of sensitivity Clin Chem 19 97;43 :18 24 18 31 40 Fraser CG, Petersen PH Desirable standards for laboratory tests if they are to fulfill medical needs Clinical Chemistry 39: 14 4 7 -1 455, 19 93 41 Spencer CA, Takeuchi M, Kazarosyan M Current status and performance goals for serum thyrotropin [TSH] assays Clin Chem 19 96;42 :14 0 14 5 42 De los Santos... Accuracy of luteinizing hormone immunoassay is improved by changing epitope specificity of the labeled monoclonal antibody Clin Chem 19 95; 41: 953–955 45 Pettersson K, Ding YQ, Huhtaniemi I Monoclonal antibody-based discrepancies between two-site immunometric tests for lutropin Clin Chem 19 91; 37 :17 45 17 48 01/ Sluss/ 1- 2 2/F 21 12/2/02, 8:53 AM 22 Gill et al 46 Pettersson K, Ding YQ, Huhtaniemi I An immunologically... Division of Endocrinology, University of Virginia Health Services Center, Charlottesville, VA JOSEPH G VERBALIS, MD, Division of Endocrinology and Metabolism, Georgetown University School of Medicine, Washington, DC MARGARET E WIERMAN, MD, Division of Endocrinology, Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO 00/FM/CE/Hall/F 10 12 /4/02, 8:48 AM Chapter 1/ Endocrine . 39.4 36 .18 1. 30 3.6% Access Beckman 10 2 32.0 43 .1 38.02 2 .19 5.8% Immulite DPC 10 6 33.4 44.4 38. 51 2.23 5.8% Immulite 2000 DPC 37 31. 3 41. 3 36.39 2.39 6.6% IRMA (CAC) DPC 14 33.9 39.8 36 .12 1. 70. 33.05 1. 69 5 .1% AxSYM Abbott 5 61 26.9 38.9 32.63 2.09 6.4% Imx Abbott 28 30.4 35.8 32.82 1. 57 4.8% ACS180 Bayer 219 38.2 52.5 45. 81 2.66 5.8% Centaur Bayer 12 3 37.6 51. 0 44.46 2. 31 5.2% Immuno 1. index. ISBN 0-8 960 3-7 5 7-6 (alk. paper); 1- 5 925 9-2 9 3-7 (e-book) 1. Endocrine glands—Diseases—Diagnosis—Handbooks, manuals, etc. I. Hall, Janet E. II. Nieman, Lynnette, K. III. Contemporary endocrinology