Criteria to Initiate Evaluation for Growth Hormone Deficiency (GHD)

Tools for the diagnosis of GHD include auxology, radiographic assessment of bone age, measurement of insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 (IGFBP-3), provocative growth hormone (GH) testing, cranial magnetic resonance imaging (MRI), and, in certain cases, genetic testing. Growth velocity and the degree of short stature are primary considerations in the decision to pursue evaluation for GHD. Continue reading

Diagnosis of Diabetes Insipidus (DI)

Diabetes insipidus is a disease in which large volumes of dilute urine (polyuria) are excreted due to vasopressin (AVP) deficiency [central diabetes insipidus (CDI)], AVP resistance [nephrogenic diabetes insipidus (NDI)], or excessive water intake (primary polydipsia). Polyuria is characterized by a urine volume in excess of 2 l/m2/24 h or approximately 150 ml/kg/24 h at birth, 100–110 ml/kg/24 h until the age of 2 years and 40–50 ml/kg/24 h in the older child and adult. Continue reading

Diagnosis of Subclinical Hyperthyroidism

In overt hyperthyroidism, serum levels of free T4 and triiodothyronine (T3) or levels of T3 alone are elevated, and serum thyrotropin (TSH) levels are suppressed. In subclinical hyperthyroidism, levels of free T4 and T3 are normal, thyrotropin levels are suppressed, and thyroid hormone levels are usually in the middle to upper range of normal. Continue reading

Summary of the ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD

The updated American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol (GTBC) has been long-awaited since the latest update of the Adult Treatment Panel III (ATP III) guidelines in 2004. The updated GTBC recommends a significant paradigm shift in lipid-loweringdrug therapy for atherosclerotic cardiovascular disease (ASCVD) risk reduction, which has led to questions regarding their content and their implementation.

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Diagnosis of Paget’s Disease of Bone

Paget’s disease of bone (also known as osteitis deformans) is a nonmalignant disease involving accelerated bone resorption followed by deposition of dense, chaotic, and ineffectively mineralized bone matrix.

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Management Guidelines for Patients with Thyroid Nodules

As defined by the American Thyroid Association’s task force on the management of thyroid nodules and differentiated thyroid cancer, a thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding thyroid parenchyma.

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Guidelines for the Treatment of Asymptomatic Primary Hyperparathyroidism

The finding of hypercalcemia on routine biochemical testing or in the evaluation of postmenopausal women with osteoporosis is typically the initial clue to the diagnosis of primary hyperparathyroidism. The total serum calcium level, which combines both the free and albumin-bound components of circulating calcium, should be adjusted for the level of albumin. Measurement of ionized calcium may be useful in selected cases, such as in patients with hyperalbuminemia, thrombocytosis, Waldenström’s macroglobulinemia, and myeloma; these patients may have elevated levels of total serum calcium, but normal levels of ionized serum calcium (artifactual hypercalcemia).

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Algorithm for Diagnosing Hyperthyroidism

Clinical hyperthyroidism, also called thyrotoxicosis, is caused by the effects of excess thyroid hormone and can be triggered by different disorders. Etiologic diagnosis influences prognosis and therapy.

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Criteria for Diagnosis of Cushing’s Syndrome (CS)

The evaluation of patients with suspected Cushing’s syndrome (CS) is complex and expensive, and the diagnosis is often a challenge for clinicians. Most patients initially suspected of having CS will not have this condition, and therefore efficient screening procedures are needed to identify the few patients who will need additional investigation in specialized centers.

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