Endocrinology and diabetes : a problem oriented approach

✍ Scribed by Hossein Gharib (editor); Francisco Bandeira (editor); Luiz Griz (editor); Manuel Faria (editor)

• Year: 2022
• Tongue: English
• Leaves: 487
• Edition: Second
• Category: Library

✦ Table of Contents

Preface to Second Edition
Contents
Contributors
Part I: Endocrinology
1: Hyperthyroidism and Thyrotoxicosis
Introduction
Presentation of Thyrotoxicosis State
Clinical Presentations of Thyrotoxicosis Mimicking Other Conditions
Thyrotoxicosis Syndromes (Table 1.1)
Hyperthyroidism Associated with High Thyroid RAIU [5]
Hyperthyroidism Associated with Normal RAIU
Thyrotoxicosis Associated with Very Low or Near-Zero (Table 1.2) Neck RAIU [2, 5]
Thyrotoxicosis with Low Thyroid RAIU and Low Serum Thyroglobulin
Thyrotoxicosis Presenting with Neck Pain
Drug-Induced Thyrotoxicosis and Hyperthyroidism
Amiodarone-Induced Thyrotoxicosis
Subclinical Hyperthyroidism
Hyperthyroidism Associated with Pregnancy
Fetal and Neonatal Hyperthyroidism
Hyperthyroidism in Pediatric Age Group
Hyperthyroidism in Trophoblastic Disease
Hyperthyroidism with Inappropriately Normal Serum TSH in TSH-Producing Pituitary Adenoma
Hyperthyroidism in Thyroid Hormone Resistance
Thyrotoxicosis Associated with “Café au Lait” Pigmentation and Fibrous Dysplasia (McCune–Albright Syndrome)
Non-autoimmune Hyperthyroidism Caused by Genetic Mutation of TSH Receptor
Metastatic Follicular Cancer and Hyperthyroidism
Hyperthyroidism Associated with Normal T4 but Elevated T3 (T3 Toxicosis)
Laboratory Investigation of Thyrotoxicosis and Hyperthyroidism
Management of Thyrotoxicosis and Hyperthyroidism
Management of Graves’ Hyperthyroidism
Pros and Cons of Antithyroid Therapy
How to Manage Recurrence of Hyperthyroidism After 18 Months of Antithyroid Therapy?
Radioactive Iodine Therapy (RAI) for Graves’ Hyperthyroidism
Management Before and Immediately After RAI Therapy
Surgical Management of Graves’ Hyperthyroidism
Preparing Patients with Graves’ Hyperthyroidism for Surgery
Management of Severe Hyperthyroidism and Thyroid Storm
Management of Toxic Adenoma and Toxic Multinodular Goiter
Management of Hyperthyroidism Associated with Ophthalmopathy and Thyroid Dermopathy
Conclusions
References
2: Hypothyroidism
Introduction
Epidemiology
Clinical Presentation and Physical Examination
Etiology
Primary Hypothyroidism
Medication-Induced Thyroid Dysfunction
Central (Secondary and Tertiary) Hypothyroidism
Generalized Thyroid Hormone Resistance
Evaluation
Treatment
Therapeutic Target
Persistent Complaints Despite Normal TSH
Combination Therapy
Special Populations
Subclinical Hypothyroidism (SCH)
Hypothyroidism and Pregnancy
Myxedema Coma
References
3: Thyroid Nodules and Cancer
Introduction and Clinical Importance
History and Physical Examination
Diagnostic Evaluation
Serum Markers
Thyroid Ultrasound and Indication for Fine-Needle Aspiration (FNA)
Other Imaging
Cytology
Management, Therapy, and Follow-Up
Benign Thyroid Nodule
Malignant Thyroid Nodule
Suspicious for Malignancy
Indeterminate Thyroid Nodule (AUS/FLUS and FN/SFN)
Non-diagnostic
Special Situations
Thyroid Nodule During Pregnancy
Thyroid Nodules in Children
Thyroid Cancer
American Thyroid Association Risk Stratification System
ATA Low Risk
ATA Intermediate Risk
ATA High Risk
Summary
Appendix
References
4: Evaluation of Sellar Masses
Introduction
Key Points to the Diagnosis
Radiologic Findings
History, Physical Examination, and Laboratory Findings
Evaluation of the Incidentally Found Pituitary Mass
Differential Diagnosis
Present and Future Therapies
Transsphenoidal Surgery
Radiation
Medical Therapy
References
5: Hyperprolactinemia
Pathophysiology
Key Points for Diagnosis
Differential Diagnosis
Current Therapies and Future Perspectives
Medical Treatment
Surgical Treatment
Radiotherapy
Fertility and Pregnancy
Addressing Prolactinomas Resistant and/or Aggressive
Summary: Diagnosis and Treatment
References
6: Acromegaly
Epidemiology
Etiology
Pathophysiology
Clinical Features
Cardiovascular System
Endocrine and Metabolic Features
Musculoskeletal Features
Neoplastic Features
Respiratory System
Diagnosis
Treatment
Transsphenoidal Surgery
Medical Treatment
Somatostatin Analogues
Dopaminergic Agonists
GH Receptor Antagonists
Combination Therapy
Radiotherapy
Treatment in Pregnancy
Pasireotide LAR
Somatoprim
Subcutaneous Octreotide
Oral Octreotide
Temozolomide
References
7: Hypopituitarism
Causes
Diagnosis
Clinical Presentation
Somatotropin Deficiency
Children
Adults
Gonadotropin Deficiency
Thyrotropin Deficiency
Corticotropin Deficiency
Antidiuretic Hormone (ADH) Deficiency
Diagnostic Testing
Somatotropin Deficiency
Children
GH Stimulation Testing in Children
Adults
GH Stimulation Testing in Adults
Transitional Period
Gonadotropin Deficiency
Thyrotropin Deficiency
Corticotropin Deficiency
ADH Deficiency
Imaging
Neuro-ophthalmic Exam
Management
Hormone Replacement Therapy
Hyposomatotropism
Children
Adults
Transitional Period
Hypogonadism (in the Adult Female)
Pubertal Development
Fertility Treatment
Hypogonadism (in the Adult Male)
Oral Testosterone
Intramuscular Depot
Transdermal Systems
Buccal Tablet
Pellets
Other
Monitoring During Androgen Therapy
Infants/Pubertal Development
Fertility Treatment
Thyrotropin Deficiency
ACTH Deficiency
ADH Deficiency
Hormone Replacement Therapy Interactions
Long-Term Management
Potential Future Therapy
References
8: Cushing’s Syndrome
Introduction
Aetiology
Epidemiology
Key Points to the Diagnosis and to the Differential Diagnosis (Fig. 8.1)
Present and Future Therapies (Fig. 8.2)
Conclusions
References
9: Adrenal Failure
Introduction
Presentation of Adrenal Insufficiency
Biochemical Findings in Adrenal Insufficiency
Pathophysiology
Diagnostic Tests (Tables 9.2 and 9.3) [12]
Investigations to Establish the Underlying Cause of Adrenal Insufficiency
Other Investigations
Differential Diagnosis
Treatment
Management of Adrenal Crisis
Management of Chronic or Insidious Onset of Adrenal Insufficiency
Glucocorticoid Replacements
Mineralocorticoid Replacement
DHEA Replacement [17]
Modified Release Hydrocortisone
Follow-Up
Assess Glucocorticoid Replacement
Assess Mineralocorticoid Replacement
Patient Education
References
10: Adrenal Incidentalomas
Epidemiology
Imaging Procedures
Fine Needle Aspiration (FNA)
Hormonal Evaluation
Patient Follow-Up
Treatment
References
11: Endocrine Hypertension
Introduction
Primary Aldosteronism
Etiology
Clinical Presentation
Diagnosis
Screening
Confirmatory Tests
Imaging Tests
Adrenal Vein Sampling
Postural Test
Genetic Tests
Treatment
Pheochromocytoma and Paraganglioma
Epidemiology and Pathophysiology
Clinical Presentation
Laboratory Tests
Imaging Tests
Genetic Tests
Treatment
Preoperative Clinical Management
Perioperative Management
Follow-Up
Treatment of Malignant Pheochromocytoma
References
12: Hirsutism and Virilization
Epidemiology of Hirsutism and Virilization
Etiology of Hirsutism and Virilization
Pathophysiology of Hirsutism and Virilization
Key Points to the Diagnosis of Hirsutism and Virilization
Physical Examination
Hormone Profile
Genetic Analysis
Differential Diagnosis
Management of Hirsutism and of Virilization
References
13: Menopause
Epidemiology
Clinical Manifestations
Diagnosis
Hormone Therapy
Vasomotor Symptoms
Genitourinary Tract
Sexual Function
Quality of Life
Osteoporosis
Cardiovascular Effect
Diabetes Mellitus
Endometrial Cancer
Breast Cancer
Ovarian Cancer
Cognition and Dementia
Principles of Treatment
Patient Selection
Preparations
Dose and Route of Administration
Duration of Treatment
Discontinuation of Treatment
Complementary and Alternative Therapies
Nonhormonal Therapy for Vasomotor Symptoms
Other Hormone Therapies
Phytohormones
Botanicals
Tibolone
Ospemifene
Others
The Future
References
14: Male Hypogonadism
Pathophysiology
Causes of Hypogonadism
Primary Hypogonadism (Hypergonadotropic)
Congenital Causes
Klinefelter Syndrome
Other Chromosomal Abnormalities
Disorders of Androgen Synthesis
Mutation in FSH and LH Genes
Cryptorchidism
Congenital Anorchia
Acquired Causes
Varicocele
Orchitis
Chronic Diseases
HIV Infection
Irradiation
Gonadal Toxicity of Cancer Chemotherapy
Trauma and Torsion of Testes
Medications
Autoimmune Testicular Failure
Secondary Hypogonadism (Hypogonadotropic)
Congenital Causes
Isolated Hypogonadotropic Hypogonadism
Kallmann Syndrome
Laurence–Moon and Bardet–Biedl Syndrome
Deficiencies of Transcription Factors
Acquired Causes
Disorders of Gonadotropin Secretion
Hyperprolactinemia
Drugs
Chronic Diseases
Critical Conditions
Anorexia Nervosa
Diabetes Mellitus
Obesity
Disorders of Direct Gonadotroph
Benign Tumors and Cysts
Neoplasms
Infiltrative Diseases
Infections
Traumatic Brain Injury
Endocrine Disruptors and the Gonadotropic Axis
Quality of Semen
Testes Dysgenesis Syndrome
Male Urogenital Tract Malformation
Testicular Germ Cell Cancer
Gynecomastia
Diagnosis
Treatment
Oral Androgens
Transdermal Androgens
Testosterone Gel (1%)
Testosterone Topical Solution (2%) Applied to the Axillae
Transdermal Patches
Injectable Androgens
Subcutaneous Implants
Other forms of treatment
Male Hypogonadism Associated with T2DM and Obesity: To Treat or Not to Treat?
Testosterone and Cardiovascular Disease
Monitoring and Follow-Up
References
15: Hormone Therapy in the Transgender Patient
Introduction and Terminology
Diagnosis and Guidelines
Gender-Affirming Hormone Therapy in Children
Transfeminine Hormone Therapy and Long-Term Monitoring
Transmasculine Hormone Therapy and Long-Term Monitoring
Surgical Considerations
Conclusions
References
16: Idiopathic Short Stature: Diagnostic and Therapeutic Approach
Case Report
Introduction
Short Stature Diagnosis
Criteria for Investigation of Short Stature
Diagnostic Approach
Case Report Evolution and the Diagnosis of Idiopathic Short Stature (ISS)
Present Therapies for Short Stature
References
17: Delayed Puberty
Introduction
Key Points to the Diagnosis
Hypogonadotropic Hypogonadism (HH)
Constitutional Delay of Growth and Puberty (CDGP)
Functional Hypogonadotropic Hypogonadism (FHH)
Isolated Gonadotropin Deficiency
Multiple Pituitary Hormone Deficiencies
Genetic Syndromes
Hypergonadotropic Hypogonadism (HHG)
Gonadal Dysgenesis
Disorders of Sex Development
Gonadal Injury or Loss
Eugonadotropic Hypogonadism (EH)
Diagnostic Tests
Present and Future Therapies
Future Therapies
References
18: Precocious Puberty
Introduction
Hypothalamic–Pituitary–Gonadal Axis
Normal Puberty
Girls
Boys
Precocious Puberty
Definition
Normal Variants
Differential Diagnosis
Gonadotropin-Dependent Precocious Puberty
Gonadotropin-Independent Precocious Puberty
Key Points to the Diagnosis
Evaluation
Medical History
Physical Examination
Imaging Studies
Biochemical Studies
Present and Future Therapies
Treatment of Gonadotropin-Dependent Precocious Puberty
GnRHa Dosing and Monitoring
Safety
Treatment of Gonadotropin-Independent Precocious Puberty
Conclusions
References
19: Ambiguous Genitalia
Epidemiology and Classification
Differentiation of Genitalia and Hormonal Control
Genetics
Causes of Ambiguous Genitalia
Sex Chromosome DSD
Ovotesticular DSD
46,XX DSD
21-Hydroxylase (21-OH) Deficiency
11β-Hydroxylase (11-OH) Deficiency
P450 Oxidoreductase (POR) Deficiency
P450 Aromatase Deficiency
Androgens and Progestogens of Maternal Origin
46,XY DSD
Androgen Insensitivity Syndrome (CAIS and PAIS)
46,XY Partial or Total Gonadal Dysgenesis
17-OH Deficiency
3βHSD2 Deficiency
StAR Deficiency (Lipoid CAH)
SCC Deficiency
Smith-Lemli-Opitz Syndrome
5α-Reductase Deficiency
17β-Hydroxysteroid-Dehydrogenase Type 3 Deficiency
Initial Approach of Newborns with Ambiguous Genitalia
Physical Exam
Diagnostic Tests
Hormonal Treatment
Monitoring
Surgical Treatment
Affirmation of Gender
References
20: Non-parathyroid Hypercalcemia
Non-parathyroid Hypercalcemia
Etiology
Bone Resorption
Primary Hyperparathyroidism
Secondary and Tertiary Hyperparathyroidism
Malignant Neoplasms
Thyrotoxicosis
Increase in Intestinal Calcium Absorption
Alkaline Milk Syndrome
Hypervitaminosis D
Granulomatous Diseases
Decrease of Calcium Excretion
Chronic Renal Insufficiency
Rhabdomyolysis and Acute Renal Failure
Thiazide Diuretics
Downregulation of Calcium-Sensing Receptor
Familial Hypocalciuric Hypercalcemia (FHH)
Medicines
Lithium
Hypervitaminosis A
Other Endocrinopathies
Pheochromocytoma
Adrenal Insufficiency
Uncommon Causes of Hypercalcemia
Hypercalcemia Mediated by Elevated Levels of Calcitriol
Hypercalcemia Caused by PTHrp
Hypercalcemia of Unknown Mechanism
Clinical Manifestations
Gastrointestinal
Renal
Cardiovascular
Neuropsychiatric
Physical Findings
Diagnostic Evaluation/Laboratory Diagnosis
Treatment
Increase in Calcium Urinary Excretion
Decrease in Intestinal Calcium Absorption
Inhibition of Bone Resorption
Denosumab
Other Therapies
Calcimimetics
Dialysis
References
21: Hypocalcemia
Key Points to the Diagnosis
Signs and Symptoms
Differential Diagnosis
PTH-Mediated Hypocalcemia
Hypoparathyroidism
Illustration: Case 1
Illustration: Case 2
PTH Resistance
Vitamin D-Related Hypocalcemia
Vitamin D Deficiency
Illustration: Case 3
Vitamin D-Resistant Rickets
Other Causes of Hypocalcemia
Laboratory Tests and Interpretation
Management
References
22: Primary Hyperparathyroidism
Epidemiology
Etiology
Diagnosis
Differential Diagnosis
Normocalcemic Primary Hyperparathyroidism
Skeletal Manifestations
Extraskeletal Manifestations
Neuropsychiatric Symptoms
Cardiovascular Symptoms
Renal Manifestations
Localization of Parathyroid Lesions
Indications for Parathyroidectomy in PHPT
Surgical Techniques
Intraoperative PTH Monitoring
Medical Therapy
Calcimimetic Agents
Hormone Replacement Therapy
Selective Modulators of Estrogen Receptors (SERMs)
Bisphosphonates
References
23: Vitamin D Deficiency
Introduction
Key Points
Definition of Vitamin D Deficiency (Fig. 23.1)
Measuring 25OHD
Defining Vitamin D Status and Intake Requirements (Fig. 23.1)
Secondary Indices of Vitamin D Deficiency (Fig. 23.3)
Differential Diagnosis (Table 23.2)
Intestinal, Hepatic, and Renal Diseases
Hypophosphatemic Bone Disease (Table 23.2)
Rare Conditions
Present and Future Therapies
Vitamin D and Calcium Supplementation
High-Dose Vitamin D Therapy: 25OHD Dose Response and Outcome Response
Future Therapies
Conclusion
References
24: Postmenopausal Osteoporosis
Epidemiology
Risk Factors
FRAX
Diagnosis
Clinical History and Physical Examination
Laboratory Evaluation
Bone Markers
Imaging
Plain Radiography
Bone Densitometry
Quantitative Computerized Tomography
Ultrasonography
Bone Quality
Treatment
Indication
Non-pharmacological Treatment
Calcium/Vitamin D
Physical Exercise
Pharmacological Treatment
Estrogens
Tibolone
Calcitonin
SERMs (Selective Modulators of Estrogen Receptors)
Bisphosphonates
Denosumab
Parathyroid Hormone
Strontium
Romosozumab
Transdermal Abaloparatide
Oral Calcitonin
References
25: Osteoporosis in Men
Introduction
Clinical Case
Key Points to the Diagnosis of Bone Loss in Men
Medical History and Physical Examination
Laboratory Tests
Bone Mineral Density (BMD)
Fracture Risk Algorithms
Differential Diagnosis of Bone Loss in Men
Selection of Men for Pharmacological Treatment
Approved Treatments for Male Osteoporosis
Antiresorptive Agents
Bisphosphonates
Denosumab
Osteoanabolic Agents
Testosterone Replacement
Future Therapeutic Approaches
Selective Estrogen Receptor Modulators (SERMs)
Selective Androgen Receptor Modulators (SARMs)
Abaloparatide
Sclerostin Antibody
Monitoring Therapy
References
26: Glucocorticoid-Induced Osteoporosis
Introduction
Patient Case Report
Epidemiology
Pathophysiology
Assessment of Fracture Risk
Management
Guidelines
Lessons from the Patient Case Report
Summary
References
27: Metabolic Bone Diseases Other Than Osteoporosis
Osteogenesis Imperfecta
Pathophysiology
Clinical Manifestations
Diagnosis
Differential Diagnosis
Treatment
Osteomalacia
Clinical Manifestations
Diagnosis
Treatment
Paget’s Disease of Bone
Pathogenesis
Histopathology
Epidemiology
Clinical Manifestations
Diagnosis
Treatment
References
Part II: Diabetes Mellitus
28: Classification and Laboratory Diagnosis of Diabetes Mellitus
Introduction
Part II: Classification of Diabetes Mellitus
Historical Perspective on Diabetes Nomenclature
Case Examples Illustrating Different Classifications of Diabetes
Case 1
Case 2
Case 3
Case 4
Case 5
Part II: Clinical Stages of Diabetes
Part III: Laboratory Diagnosis of Diabetes Mellitus
Determining Diagnostic Thresholds
Tests of Glycemia for Diabetes Diagnosis
Serum Glucose and OGTT
Glycated Hemoglobin (HbA1c)
Case 6
Case 7
Tests to Aid Determination of Diabetes Type
C-Peptide
Autoantibodies
Conclusion
References
29: Gestational Diabetes
Diagnosis of Gestational Diabetes
Differential Diagnosis/Other Considerations
Current and Future Therapies
Summary and Conclusions
References
30: Oral Therapies for Type 2 Diabetes
Introduction
Present and Future Therapies
Metformin
Sulfonylureas
Thiazolidinediones (TZD)
DPP-4 Inhibitors
α-Glucosidase Inhibitors
Glinides
Bromocriptine
Gliflozins
Conclusion
References
31: GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes
The Incretin Effect
Biological Effects of GLP-1
Pancreatic Effects
Extra-Pancreatic Effects
The Incretin Effect on Type 2 Diabetes
Exenatide
Side Effects
Exenatide Twice Daily and Extended Release
Liraglutide
Dulaglutide
Semaglutide
The Role of GLP1 RA in the Modern Treatment of T2DM
GLP-1 RA in the Treatment of Obesity
Lixisenatide
References
32: Insulin Therapy
Insulin Therapy in Type 1 Diabetes and Type 2 Diabetes Inpatient
Insulin Therapy in Type 1 Diabetes
Insulin Therapy in Type 2 Diabetes
Insulin Therapy Inpatient
Protocol for Insulin Therapy in Critically Ill Patients
Protocol for Insulin Therapy in Non-critically Ill Patients
References
33: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
Introduction
Pathophysiology
Diabetic Ketoacidosis
Hyperosmolar Hyperglycemic State
Diagnosis
Differential Diagnosis
Treatment
References
34: Hypoglycemia in the Non-diabetic Patient
Clinical Presentation
Pathophysiology
Differential Diagnosis
The Healthy Patient: Hyperinsulinemic Hypoglycemia
Insulinoma
Non-insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS)
Post-Bariatric Surgery Hypoglycemia
Insulin Antibody-Mediated Hypoglycemia
The Ill Patient
Genetic Causation and Predisposition to Hypoglycemia
Drug-Induced Hypoglycemia
Non-insulin-Mediated Hypoglycemia
Hypoglycemia Evaluation
Establishing a Diagnosis of Hypoglycemia
Seventy-Two-Hour Fast
Criteria for Hyperinsulinemia
Mixed Meal Test
Localizing Studies
Noninvasive Radiologic Studies
Invasive Techniques
Selective Arterial Calcium Stimulation
Treatment
Insulinomas
NIPHS and Post-Bariatric Surgery Hypoglycemia
Non-islet Cell Tumor Hypoglycemia
Iatrogenic
Future Therapies
Conclusion
References
35: Hypoglycaemia in Diabetes
Introduction
Definition
Morbidity and Mortality Associated with Hypoglycaemia
Acute Effects of Hypoglycaemia
Long-Term Effects of Hypoglycaemia
Presentation
Causes of Hypoglycaemia
Nocturnal Hypoglycaemia
Alcohol
Exercise
Risk Factors for Hypoglycaemia
Long Duration of Diabetes
Hypoglycaemia Unawareness
Renal Failure
Treatment Factors
Psychosocial Factors
Clinical Assessment
Management
Treatment of Acute Hypoglycaemia
Prevention of Hypoglycaemia
Education
Individualised Glycaemic Targets
Glucose-Lowering Agents with Lower Hypoglycaemic Potential
Continuous Subcutaneous Insulin Therapy
Continuous Glucose Monitoring
Sensor-Augmented Pumps and Closed-Loop Systems
Islet Cell and Pancreatic Transplant
Lifestyle Implications
Conclusion
References
36: The Diabetic Neuropathies
Introduction
Distal Symmetric Polyneuropathy
When to Suspect and Main Characteristics of Diabetic Polyneuropathy
Screening Tests
Differential Diagnosis
Acute Sensory Neuropathy and How to Distinguish from Chronic Sensorimotor Diabetic Polyneuropathy
Treatment
The Role of Glycemic Control
Lifestyle Modifications
Foot Care
Pathogenetic Therapies
Painful Diabetic Neuropathy
Antidepressants
Anticonvulsants
Other Agents
Nonpharmacological Therapy
Autonomic Neuropathy
Cardiovascular Autonomic Neuropathy
Gastrointestinal Autonomic Neuropathy
Genitourinary Autonomic Neuropathy
The Effect on Diabetes Control
Focal and Multifocal Neuropathies
General Recommendations
References
37: Diabetic Nephropathy
Introduction
Diagnosis
Differential Diagnosis
Treatment (Table 37.2)
Novel Therapies
References
38: The Diabetic Foot
Introduction
Diabetic Foot Ulcerations and Infections
Diabetic Foot Osteomyelitis and Amputations
Diabetic Charcot Neuroarthropathy
Conclusion
References
39: Diabetic Retinopathy
Introduction
Classification
Maculopathy
Treatment
References
40: Carbohydrate Counting
What Is Carbohydrate Counting?
Who Should Do Carbohydrate Counting?
Criteria for Prescribing the Counting of Carbohydrates
Choice of Nutritional Therapy
Action of Insulins
Exercises
What Is the Effect of Alcohol on Blood Glucose?
How Is the Amount of Carbohydrates in a Meal to Be Assessed?
Effects of Food on the Blood Sugar Level
Concluding Remarks
References
Part III: Obesity, Lipids and Nutrition
41: Pharmacological Treatment of Obesity
Introduction
Pathophysiology
Diagnosis
Pharmacological Treatment
Phentermine/Topiramate Association
Naltrexone/Bupropiona Association
Lorcaserin
Orlistat
Liraglutide
Future Perspectives
Cetilistat
Bupropion/Zonisamide
Beloranib
Tesofensine
Obesity and T2DM
Additional Pharmacotherapy for Obesity in DM2 (Not Approved by the FDA)
Metformin
Pramlintide
Semaglutide
Phentermine and SGLT2 Inhibitor Association
References
42: Nonalcoholic Fatty Liver Disease
Introduction
Pathogenesis
Screening
Diagnosis
Clinical Assessment
Laboratory Assessment
Imaging Exams
Invasive and Noninvasive Methods for Assessment of Inflammation and Fibrosis
Noninvasive Markers of NASH
Noninvasive Markers for Fibrosis
Treatment
Who Should Be Treated?
Nonpharmacological Treatment
Pharmacological Treatment of Liver Disease
Treatment of Dyslipidemia and Cardiovascular Risk Factors
Surgical Treatment
References
43: Treatment of Obesity in the Patient with Type 2 Diabetes
Introduction: Rising Prevalence of Obesity and Type 2 Diabetes Mellitus
Key Points to Be Discussed
Health Risks of Obesity
Treating the Patient with Obesity and Type 2 Diabetes
Lifestyle Modification
Outcomes of Medical Nutrition Therapy
Role of Medications in the Treatment of Obesity
Orlistat
Phentermine/Topiramate
Bupropion/Naltrexone
Liraglutide/Semaglutide
Bariatric Surgery
Impact of Bariatric Surgery on Type 2 Diabetes
Mechanisms of Improvement in Diabetes
Future Therapy Update
Summary
References
44: Dyslipidemia
Diagnosis
Lipid Profile
LDL-Cholesterol
HDL Cholesterol
Triglycerides
Non-HDL Cholesterol
Additional Tests
Lipoprotein (a)
C-Reactive Protein
Homocysteine
Apolipoproteins
Carotid Intima-Media Thickness and Coronary Calcium Score
In Whom Should Serum Lipids Be Measured?
Cardiovascular Risk Assessment
Treatment
Treatment Goals
Lifestyle Change (LSC)
Statins
Benefits in Secondary Prevention
Beneficial Effects on Atheromatous Plaque
Benefits of Primary Prevention
Fibrates
Niacin
Ezetimibe
Bile Acid Sequestrants
Combination Therapy
PCSK9 Inhibitors
Future Therapies
References
45: Dietary Approach for Cardiometabolic Disorders
Dietary Approach for Cardiometabolic Disorders
Nutritional Factors and Targets of MD
Mediterranean Diet
DASH
Low-Carb Diet
Vegetarian Diet
Quality of Fats
Micronutrients and Cardiovascular Health
Conclusion
References
46: Nutrition Supplements in Sports
Carbohydrates
Whey Protein
Creatine
Beta-Hydroxy-Beta-Methylbutyrate (HMB)
Caffeine
Buffering Agents
Sodium Bicarbonate (NaHCO3)
Beta Alanine
References
Index