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ADRENAL INCIDENTALOMAS

Population

  • Adults.

Recommendations

AACE 2009

  • Evaluate clinically, biochemically, and radiographically for evidence of hypercortisolism, aldosteronism, the presence of pheochromocytoma or a malignant tumor.

  • Reevaluate patients who will be managed expectantly at 3–6 mo and then annually for 1–2 y.

Source

Comments

  1. A 1-mg overnight dexamethasone suppression test can be used to screen for hypercortisolism.

  2. Measure plasma-fractionated metanephrines and normetanephrines to screen for pheochromocytoma.

  3. Measure plasma renin activity and aldosterone concentration to assess for primary or secondary aldosteronism.

ANDROGEN DEFICIENCY SYNDROME (SEE HYPOGONADISM, MALE)

CUSHING’S SYNDROME (CS)

Population

  • Pediatric and adult patients with Cushing’s syndrome.

Recommendations

Endocrine Society 2015

  • Treatment goals for Cushing’s syndrome

    • Normalize cortisol levels to eliminate the signs and symptoms of CS.

    • Monitor and treat cortisol-dependent comorbidities.

  • Recommend vaccinations against influenza, herpes zoster, pneumococcus.

  • Recommend perioperative thromboprophylaxis for venous thromboembolism.

  • Recommend surgical resection of primary adrenal or ectopic focus underlying CS.

  • Assess postoperative serum cortisol levels.

Source

DIABETES MELLITUS (DM), TYPE 1

Population

  • Children and adults with Type I DM.

Recommendations

ADA 2019

  • Use intensive insulin therapy with >3 injections daily using either basal and prandial insulin or an insulin pump.

  • Patients using multiple insulin injections should self-monitor blood glucose at least 4 times daily.

  • Continuous glucose monitoring in both children and adults results in lower HbA1c levels.

  • Assess psychological and social situation.

  • Advise all patients not to smoke.

  • Begin screening at age 10, at onset of puberty, or after 5 y with Type 1 DM, whichever is earlier:

    • Urine albumin-to-creatinine ratio annually.

    • Dilated funduscopic exam q 1–2 y.

    • Monofilament screening for diabetic neuropathy annually.

    • Comprehensive foot examination at least annually.

  • Screen for other autoimmune conditions at time of diagnosis of Type 1 DM:

    • Celiac disease: IgA tissue transglutaminase antibodies. If negative, rescreen 2 and 5 y after DM diagnosis.

    • Thyroid dysfunction: TSH, thyroperoxidase and thyroglobulin antibodies.

  • Fasting lipid panel at age 10 or at onset of puberty, whichever is earlier (consider as early as age 2 y for a strong family history of hyperlipidemia).

    • Repeat annually if results are abnormal or every 5 y if results are acceptable (LDL <100 mg/dL).

  • Consider statin therapy if age ≥10 y and LDL ≥160 mg/dL, or LDL ≥130 mg/dL and one or more CVD risk factors.

  • Aspirin 75–162 mg/d for adults with:

    • 10-y risk of CVD >10% (primary prevention).

    • Pre-existing CVD (secondary prevention).

Source

Comment

  1. Glycemic control recommendations for children ...

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