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121. Myxedema Coma

Related Chapters II. Epidemiology : Rare (0.22 per Million persons in U.S.) III. Pathophysiology Severe IV. Predisposing factors Cold exposure Infection s V. Signs See Hypothermic stuporous state Respiratory depression with hypercarbia Percardial effusion Hemodynamic instability VI. Labs See VII. Management Medical emergency with high mortality Endocrinology ICU admission y and hemodynamic support Anticipate electrolyte abnormalities (e.g. ) Consider s VIII. References Images: Related links (...) ( ) Related Topics in Thyroid Disease About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific

2018 FP Notebook

122. Hypothyroidism

is the primary screening and monitoring test Most sensitive marker for function Protocol Screening: TSH with reflex to Monitoring after diagnosis: TSH alone is sufficient Interpretation increased low Primary Hypothyroidism normal Overt Hypothyroidism unlikely if 6-10 Consider checking is low in congenital absence of T4 to T3 converting enzyme may also be low due to blocking T4 to T3 conversion decreased low Central Hypothyroidism (secondary Hypothyroidism) Urgent endocrinology Obtain head imaging (MRI Brain (...) for treatment indications In general, avoid and desiccated (no evidence of benefit, and cardiovascular risk) Elderly: Consider withdrawing Indication: Elderly in Community and nursing-home May have been diagnosed prior to sensitive TSH Trial at decreased dose or off for 6 weeks Recheck TSH after trial Pregnancy See Maintaining a euthyroid state throughout pregnancy is critical XIV. Management: Endocrinology referral indications Age <18 years old Cardiac disorders Concurrent other endocrine disorders

2018 FP Notebook

123. Gynecomastia

Dihydrotestosterone Clomiphene ( ) Surgical management Indicated in prolonged, severe, refractory to medication cases X. References Wilson (1998) Williams Endocrinology, Saunders, 885-92 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Gynecomastia." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Gynecomastia (C0018418) Definition (NCI_CTCAE) A disorder (...) -of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 4/7

2018 FP Notebook

124. Precocious Puberty

Puberty Girls under age 6 years old Neurologic findings ( , , vision changes) Peripheral Precocious Puberty (prepubertal LH and gonad size) , cortisol excess, adrenal tumor Consider , adrenal imaging, Endocrinology referral Exogenous sex steroid exposure Ovarian tumor Elevated estradiol level and low LH level seen with -secreting tumors Testicular tumor McCune-Albright Syndrome Further evaluation Further laboratory testing (see above) Additional lab testing (esp. , hyperandrogenic effects in girls) 17 (...) Development About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns

2018 FP Notebook

125. Kallmann's Syndrome

Cerebellar VI. References Wilson (1998) Williams Endocrinology, p. 1555-6 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Kallmanns Syndrome." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Kallmann Syndrome (C0162809) Definition (MSHCZE) Syndrom charakterizovaný anosmií a deficitem gonadotropinů s nedostatečným vývojem pohlavních žláz (...) UMLS ( ) Related Topics in Sexual Development About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address

2018 FP Notebook

126. Turner's Syndrome

in teens Genitourinary evaluation Renal to assess for anomalies Dental evaluation Orthodontist evaluation for malocclusion XI. Management: Women Fertility and Consult with gynecologic specialists Manage comorbid s Calcium and supplementation XII. References Behrman (2000) Nelson Pediatrics, Saunders, p. 1753-4 Wilson (1998) Williams Endocrinology, p. 1337-52 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Turners Syndrome." Click (...) Norwegian Turners syndrom , Turner-syndrom Derived from the NIH UMLS ( ) Related Topics in Sexual Development About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here

2018 FP Notebook

127. Pubertal Delay

Obtain karyotype Refer to pediatric endocrinology Pubertal range LH or FSH Constitutional delay of growth and (see above) Repeat measurements in 1-3 months Prepubertal range LH or FSH Persistent (10% of boys, 20% of girls) Dysmorphic features (e.g. Turner Syndrome) Radiation exposure Constitutional delay of growth and (60% of boys, 30% of girls) Most common cause of Delayed Puberty (diagnosis of exclusion) Consistent findings Delayed of Delayed Puberty (75% have parental Pubertal Delay) Consider Jump (...) Start Therapy Indications Girls over age 13 years and boys over 14 years No spontaneous after 6 months of observation Example protocol for boys Testosterone cypionate or enanthate 50 -100 mg IM per month Example protocol for girls Estradiol 6.2 mcg (25% of 25 mcg patch) applied to skin overnight for 3-6 months Consider referral to pediatric endocrinology No pubertal progression after 4-6 months after jump start therapy Functional (20% of boys, 20% of girls) or chronic disease (e.g. , , disease) X

2018 FP Notebook

128. Journal Abbreviations

Throat J Emerg Infect Dis Emerg Med Emerg Med Clin North Am Emerg Med J Emerg Med Rep Endocrinol Metab Clin North Am Endocrinology Environ Health Perspect Epilepsia Res Eur Arch Otorhinolaryngol Eur J Appl Physiol Eur J Appl Physiol Occup Physiol Eur J Cancer Eur J Clin Nutr Eur J Dermatol Eur J Gastroenterol Hepatol Eur J Med Res Eur J Ophthalmol Eur J Vasc Surg Eur Radiol Evid Based Oncol (not indexed) Expert Opin Drug Saf Eye VIII. Journals: F Fam Pract Recert (not indexed) Federal Practitioner (...) Bing) These images are a random sampling from a Bing search on the term "Journal Abbreviations." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Clinical Research About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728

2018 FP Notebook

129. Cachexia in Cancer

de Emaciação Derived from the NIH UMLS ( ) Related Topics in Endocrinology About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical

2018 FP Notebook

130. Primary Ovarian Insufficiency

sampling from a Bing search on the term "Primary Ovarian Insufficiency." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Endocrinology About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic

2018 FP Notebook

131. Prader-Willi Syndrome

features Morbid (onset after 12 months) and learning disabilities (e.g. , small ) Skin V. Labs: Genetic Testing Indications: All suspected cases of Prader-Willi : 100% Tests (both are done) High resolution karyotype Methylation analysis (specific for PWS) VI. Associated conditions VII. Management s Ophthalmology for and Pediatric endocrinology for possible Developmental pediatrician Speech therapy Physical therapy and occupational therapy Conditions to observe for and manage as infant Hypoventilation (...) Prader-Willi Syndrom , Prader-Labhart-Willi-Fanconi-Syndrom , Prader-Willi-Syndrom , Labhart-Willi-Syndrom Portuguese Síndrome de Labhart-Willi , Síndrome de Prader-Willi Derived from the NIH UMLS ( ) Related Topics in Pediatrics About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content

2018 FP Notebook

132. Adrenal Mass

(see above) Consider evaluating endocrine labs above (especially to rule out ) Repeat unenhanced in 12 months to confirm no change Adrenal Mass 1-4 cm and not a lipid containing lesion Evaluate endocrine labs above (especially to rule out ) Perform with IV contrast and delayed phase (or MRI as alternative) If CT or MRI non-diagnostic, consider FDG-PET Referral Endocrinology for functional adenomas ral surgery for suspicious or non-diagnostic imaging IX. References Images: Related links to external (...) reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 12/3/2014 and last

2018 FP Notebook

133. Diabetes Mellitus

endocrinology later Give prescriptions today Meter, strips, lancets, , syringes X. Management: Initial Education Key Topics See See Type specific Diabetes Information See See Adjunctive Management See See See See See See See See Weight loss (Guidelines as of 2012) Historically considered in all diabetic patients Previously started by age 45 years in men and age 55 years in women does not increase risk of l Indications for low dose 81 mg daily Based on Framingham risk >10% (and no vascular disease (...) reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 7/31/2018 and last

2018 FP Notebook

134. Tall Stature

Chapters II. Differential Diagnosis Normal variants Constitutional Tall Stature Familial Tall Stature Endocrine disorders excess (GH secreting tumors, pituitary , or or ) (Untreated, pubertal) ( ) tic disorders - disproportionate overgrowth Beckwith-Wiedemann Syndrome tic disorders - proportionate overgrowth (Sotos Syndrome) Weaver Syndrome III. Evaluation Assess parental heights See See IV. Labs: Specific (IGF-1) - consult local endocrinology ( ) Amino acid screen ( ) Karyotype ( , XXY in males (...) , Stature tall , Large stature , Tall stature , Tall stature (finding) , stature; tall , tall; stature Hungarian Termet magas Derived from the NIH UMLS ( ) Related Topics in Growth Disorders About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences

2018 FP Notebook

135. Short Stature

Chemistry panel (Chem8) and and (ESR) Tissue transglutaminase antibodies Endocrine ( , ) (IGF-1) - consult local endocrinology Turner Syndrome Karyotype (FSH) VII. Differential Diagnosis (with specific related evaluation) Normal tests, evaluation and s Idiopathic Short Stature Normal tests and evaluation with a minimally delayed Medication causes Chronic s s for Anticonvulsants Abnormal tests or evaluation with a normal (requires further evaluation) Inflammatory conditions Dysmorphic features present (...) for age (or <3rd percentile) <5 cm (2 in) per year Projected height <2 SD (10 cm) below Approach Determine if growth is truly delayed (see indications above) See Determine when growth delay began (in-utero, perinatal or childhood) See Determine cause if possible Only 5% of Short Stature referrals have an identifiable pathologic cause Most common identifiable causes Turner Syndrome (girls) Gastrointestinal symptoms Consider or Pediatric Gastroenterology Referral Endocrinology symptoms Consider cortisol

2018 FP Notebook

136. Waist-to-Hip Ratio

Circumference Males >= 40 inches (102 cm) confers increased risk Females >= 35 inches (88 cm) confers increased risk IV. References Flier in Wilson (1998) Williams Endocrinology, p. 1063 (1998) Treatment of Adult , AOA, p. 63-4 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Waist-to-Hip Ratio." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology (...) interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 10/21/2007 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

137. Contraceptive Selection in Diabetes Mellitus

to external sites (from Bing) These images are a random sampling from a Bing search on the term "Contraceptive Selection in Diabetes Mellitus." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Endocrinology About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree (...) of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 2/6/2013 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

138. Androgen Decline in the Aging Male

: Male Menopause (C1456659) Concepts Physiologic Function ( T039 ) English Menopause, Male , Male Menopause Derived from the NIH UMLS ( ) Related Topics in Endocrinology About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access (...) Total <300 ng/dl (in the morning, or 2 within 2 hours of awakening) Ruled out if testosterone >400 ng/dl Recheck a second value to confirm low testosterone ( ) testing indications Most accurate measure Low ( , , ) High (Older age) Wide variation in accuracy among labs Consider evaluation for secondary cause See Always obtain serum pituitary markers when is <150 ng/dl (expert endocrinology opinion) Indications to evaluate for pituitary tumor high low low Consider other conditions causing low

2018 FP Notebook

139. Testicular Failure

from the NIH UMLS ( ) Related Topics in Endocrinology About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should

2018 FP Notebook

140. Male Infertility

Croatian NEPLODNOST MUŠKARCA Polish Niepłodność męska Hungarian Férfi infertilitas , Nem meghatározott férfi infertilitas Norwegian Mannlig infertilitet Derived from the NIH UMLS ( ) Related Topics in Endocrinology About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature

2018 FP Notebook

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