Endocrinology

372 Pages·2015·35.81 MB·English

by  Thomas Fox

eureka
Endocrinology

eureka
Endocrinology
Thomas Fox MBBS BSc MRCP Bijay Vaidya MBBS PhD FRCP (Lon &
(Endo) PGCert Med Ed Edin)
Consultant Endocrinologist Consultant Endocrinologist
The Royal Devon and Exeter NHS The Royal Devon and Exeter NHS
Foundation Trust Foundation Trust
Exeter, UK Exeter, UK
Antonia Brooke MBBS MD MA
MRCP
Consultant Endocrinologist
The Royal Devon and Exeter NHS
Foundation Trust
Exeter, UK
Series Editors
Janine Henderson MRCPsych Stephen Parker BSc MS DipMedEd
MClinEd FRCS
MB BS Programme Director Consultant Breast and General
Hull York Medical School Paediatric Surgeon
York, UK St Mary’s Hospital
Newport, UK
David Oliveira PhD FRCP
Professor of Renal Medicine
St George’s, University of London
London, UK
London • Philadelphia • New Delhi • Panama City
© 2015 JP Medical Ltd.
Published by JP Medical Ltd, 83 Victoria Street, London, SW1H 0HW, UK
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The rights of Thomas Fox, Antonia Brooke and Bijay Vaidya to be identified as authors of this work have been
asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
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ISBN: 978-1-907816-71-0
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Publisher: Richard Furn
Development Editors: Thomas Fletcher, Paul Mayhew, Alison Whitehouse
Editorial Assistants: Sophie Woolven, Katie Pattullo
Copy Editor: Kim Howell
Graphic narratives: James Pollitt
Cover design: Forbes Design
Page design: Designers Collective Ltd
v
eureka
Series Editors’ Foreword
Today’s medical students need to know a great deal to be effective as tomorrow’s doctors.
This knowledge includes core science and clinical skills, from understanding biochemical
pathways to communicating with patients. Modern medical school curricula integrate this
teaching, thereby emphasising how learning in one area can support and reinforce another.
At the same time students must acquire sound clinical reasoning skills, working with
complex information to understand each individual’s unique medical problems.
The Eureka series is designed to cover all aspects of today’s medical curricula and
reinforce this integrated approach. Each book can be used from first year through to
qualification. Core biomedical principles are introduced but given relevant clinical context:
the authors have always asked themselves, ‘why does the aspiring clinician need to know
this’?
Each clinical title in the series is grounded in the relevant core science, which is
introduced at the start of each book. Each core science title integrates and emphasises
clinical relevance throughout. Medical and surgical approaches are included to provide a
complete and integrated view of the patient management options available to the clinician.
Clinical insights highlight key facts and principles drawn from medical practice. Cases
featuring unique graphic narratives are presented with clear explanations that show how
experienced clinicians think, enabling students to develop their own clinical reasoning and
decision making. Clinical SBAs help with exam revision while starter questions are a unique
learning tool designed to stimulate interest in the subject.
Having biomedical principles and clinical applications together in one book will make
their connections more explicit and easier to remember. Alongside repeated exposure
to patients and practice of clinical and communication skills, we hope Eureka will equip
medical students for a lifetime of successful clinical practice.
Janine Henderson, David Oliveira, Stephen Parker
About the Series Editors
Janine Henderson is the MB BS undergraduate Programme Director at Hull York Medical School
(HYMS). After medical school at the University of Oxford and clinical training in psychiatry, she
combined her work as a consultant with postgraduate teaching roles, moving to the new Hull York
Medical School in 2004. She has a particular interest in modern educational methods, curriculum
design and clinical reasoning.
David Oliveira is Professor of Renal Medicine at St George’s, University of London (SGUL), where
he served as the MBBS Course Director between 2007 and 2013. Having trained at Cambridge
University and the Westminster Hospital he obtained a PhD in cellular immunology and worked as
a renal physician before being appointed as Foundation Chair of Renal Medicine at SGUL.
Stephen Parker is a Consultant Breast and General Paediatric Surgeon at St Mary’s Hospital, Isle
of Wight. He trained at St George’s, University of London, and after service in the Royal Navy was
appointed as Consultant Surgeon at University Hospital Coventry. He has a particular interest in
e-learning and the use of multimedia platforms in medical education.

vii
Preface
Endocrine disorders are common and becoming more prevalent, not just in the United
Kingdom but worldwide. The complications of endocrine disease cause significant
morbidity and mortality, so a sound understanding of their diagnosis and management is
of vital importance to all clinicians. Our goal in writing Eureka Endocrinology is to set out
this knowledge in the clearest manner possible.
The endocrine system is integral to the functioning of the human body. Chapter 1 of
Eureka Endocrinology therefore provides the reader with a detailed overview of normal
endocrine anatomy and physiology. Throughout the chapter, we have included correlating
clinical information to help students understand the relevance of the anatomy, physiology
and pathology to everyday practice.
In chapter 2 we explain how to take a history and examine the patient, exploring
and illustrating key symptoms and clinical signs, before discussing the most important
investigations and management options. In the subsequent chapters each endocrine
disease is described in depth, using illustrated cases to give the student a unique insight
into how patients present and how we manage their medical problems in real life.
The starter questions at the beginning of each chapter will help students consolidate
and apply their learning, and the clinical SBAs at the end of the book will provide them
with an invaluable revision aid.
We hope you enjoy reading and learning from Eureka Endocrinology.
Thomas Fox, Antonia Brooke, Bijay Vaidya
March 2015
About the Authors
Thomas Fox is lead for curriculum development in endocrinology at the University of
Exeter Medical School (UEMS). He has played an active role in teaching endocrinology and
clinical skills at UEMS both during specialist training and as a Consultant Endocrinologist.
He delivers a special study module in metabolic medicine.
Antonia Brooke is the clinical lead for endocrinology at the Royal Devon and Exeter
Hospital. She is Endocrinology Training Programme Director for the South West Peninsula,
supporting registrars as they work towards becoming consultants. In her role as tutor
for undergraduates and junior doctors she enjoys encouraging students into a career in
endocrinology.
Bijay Vaidya is a Consultant Physician and Honorary Associate Professor of
Endocrinology. As well as playing an active role in teaching endocrinology at UEMS, he
has co-authored clinical reviews and learning modules on endocrine disorders for several
journals, including The BMJ and BMJ Learning.
viii
Contents
Series Editors’ Foreword v Case 2 Recurrent thrush 148
About the Series Editors v
Type 1 diabetes mellitus 150
Preface vii
Type 2 diabetes mellitus 158
About the Authors vii
Monogenic diabetes mellitus 163
Glossary xi
Gestational diabetes 164
Acknowledgements xii
Obesity 165
Lipid disorders 168
Chapter 1 First principles
Overview of the endocrine system 1 Chapter 4 Complications of
diabetes
The thyroid gland 8
The parathyroid glands 15 Introduction 173
The hypothalamus 20 Case 3 Red swollen foot 174
The pituitary gland 27
Macrovascular complications 176
The adrenal glands 36
Microvascular disease 180
The pancreas 44
Diabetic foot disease 189
The gut 49
The male reproductive system 51
The female reproductive system 56 Chapter 5 Thyroid disease
The pineal gland 61
Introduction 193
Case 4 Tremor and irritability 194
Chapter 2 Clinical essentials
Hyperthyroidism 196
Introduction 67 Thyroid eye disease 202
Common symptoms and how to take a Hypothyroidism 204
history 67 Thyroiditis 207
Common signs and how to examine a Goitre 208
patient 80 Thyroid nodule 211
Investigations 98 Thyroid cancer 211
Management options 116
Chapter 6 Pituitary disease
Chapter 3 Diabetes mellitus,
Introduction 215
obesity and lipid
disorders Case 5 H eadaches and change in facial
appearance 216
Introduction 145
Case 6 Weight gain and easy bruising 217
Case 1 W eight loss, thirst and excessive
amounts of urine 146 Acromegaly 219
ix
Contents
Prolactinoma 223 Disorders of sex development 287
Cushing’s syndrome 226 Hypogonadism in men 288
Hypopituitarism 230 Klinefelter’s syndrome 290
Non-functioning pituitary tumours 233
Diabetes insipidus 234
Chapter 10 Other endocrine
disorders
Chapter 7 Adrenal disease
Introduction 293
Introduction 239 Case 12 Worsening vision and headache 294
Case 7 Headaches and profuse sweating 240 Multiple endocrine neoplasia syndromes 295
Addison’s disease 242 Autoimmune polyglandular syndromes 298
Conn’s syndrome 246 Ectopic hormone syndromes 299
Phaeochromocytoma 248 Carcinoid tumours and carcinoid syndrome 300
Congenital adrenal hyperplasia 250 Insulinomas 301
Cushing’s syndrome 252 Other neuroendocrine tumours:
Adrenal adenomas 252 gastrinoma, glucagonoma, vipoma and
somatostatinoma 302
Chapter 8 Calcium homeostasis
and metabolic bone Chapter 11 Endocrine
disease emergencies
Introduction 255 Introduction 305
Case 8 Sharp pain in the back and tiredness 256 Case 13 D iarrhoea, vomiting and lethargy
after a meal out 306
Case 9 Leg pain while walking 258
Diabetic ketoacidosis 307
Hypercalcaemia 259
Hyperosmolar hyperglycaemic state 308
Hyperparathyroidism 260
Severe hypoglycaemia 309
Hypocalcaemia 264
Case 14 Collapse and agitation 310
Hypoparathyroidism 265
Hyponatraemia 311
Osteoporosis 266
Paget’s disease 268 Case 15 A bdominal pain, vomiting and
Vitamin D deficiency 269 drowsiness 313
Addisonian crisis 315
Chapter 9 Reproductive system Case 16 Weight loss and anxiety 315
disorders
Thyroid storm 316
Introduction 273 Myxoedema coma 317
Case 10 C omplete absence of menstrual Case 17 W orsening palpitations,
periods in a 16-year-old 274 headaches and tremor 317
Case 11 Excessive hair growth 277 Hypertensive crisis 320
Polycystic ovary syndrome 279 Case 18 S evere headache and double
Primary ovarian insufficiency 282 vision 320
Turner’s syndrome 284
Pituitary apoplexy 321
Functional hypothalamic amenorrhoea 285