Table Of ContentENDOCRINE
Te ENDOCRINE ESSENTIALS: Endocrine Update For General Medicine is
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vignettes focus on established knowledge gaps identifed in the diagnosis and
management of bone and mineral homeostasis, diabetes melitus, cardiovascular ENDOCRINE UPDATE
endocrinology, men’s and women’s health, and thyroid disorder.
FOR GENERAL MEDICINE
Bone and Mineral
Homeostasis
■
Diabetes Mellitus
■
Cardiovascular
Endocrinology
Te Endocrine Society
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Men’s and Women’s
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is dedicated to advancing excellence in
endocrinology and promoting its essential ■
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Tyroid
ISBN 1-879225-76-X Disorders
EndocrinE EssEntials EndocrinE UpdatE for GEnEral MEdicinE
ENDOCRINE
ESSENTIALS
ENDOCRINE UPDATE
FOR GENERAL MEDICINE
Bradley D. Anawalt, MD
Editor
8401 Connecticut Avenue, Suite 900
Chevy Chase, Maryland 20815
To receive a CME certifcate, please visit
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Founded in 1916
8401 Connecticut Ave., Suite 900
Chevy Chase, MD 20815
www.endo-society.org
Editor
Bradley D. Anawalt, MD
Endocrine Essentials: Endocrine Update for General Medicine
Director, Education: Robert Bartel
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Coordinator, Education: Dalia Golchan
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Copyright © February 2012 by Te Endocrine Society, 8401 Connecticut Avenue, Suite
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contributors
Bradley D. Anawalt, MD Frances Hayes, MB, FRCPI
University of Washington Medical Center St. Vincent’s University Hospital
Hormone Foundation of Endocrine Society Department of Endocrinology
Robert A. Adler, MD Irl B. Hirsch, MD
McGuire Veterans Afairs Medical Center, Richmond University of Washington
Virginia Commonwealth University School of Medicine Medical Center
Richard Auchus, MD, PhD Mara J. Horwitz, MD
University of Michigan, Department of Medicine
Division of Metabolism, Endocrinology, & Diabetes University of Pittsburgh
Graeme I. Bell, PhD Mary Korytkowski, MD
Te University of Chicago University of Pittsburgh
Departments of Medicine and Pediatrics Department of Medical-Endocrinology
Section of Endocrinology, Diabetes and Metabolism
Michael A. Levine, MD
Daniel D Bikle, MD, PhD Te Children’s Hospital of Philadelphia
Medicine and Dermatology University of Pennsylvania
Veterans Afairs Medical Center and University of California, School of Medicine
San Francisco
Alvin M. Matsumoto, MD
Glenn D. Braunstein, MD Geriatric Research, Education and Clinical Center, VA
Department of Medicine Puget Sound Health Care System and
Cedars-Sinai Medical Center Department of Medicine
University of Washington
Gregory A. Brent, MD School of Medicine
Chair, Department of Medicine, VA Greater Los Angeles
Healthcare System; Medicine and Physiology, David Gefen Anthony L. McCall, MD, PhD, FACP
School of Medicine at UCLA University of Virginia
School of Medicine
Kenneth D. Burman, MD
Endocrine Section, Washington Hospital Center Alastair R. McLellan, MD, FRCP
Department of Medicine, Georgetown University Gardiner Institute
Western Infrmary
Luiza Caramori, MD MS PhD
Division of Endocrinology and Diabetes Graham T. McMahon, MD, MMSc
University of Minnesota Division of Endocrinology, Diabetes & Hypertension
Brigham and Women’s Hospital
Alan Chait, MD Department of Medicine, Harvard Medical School
Division of Metabolism, Endocrinology and Nutrition
University of Washington Rochelle Naylor, MD
Te University of Chicago
Samuel Dagogo-Jack, MD Departments of Medicine and Pediatrics
Division of Endocrinology, Diabetes & Metabolism Section of Endocrinology, Diabetes and Metabolism
University of Tennessee Health Science Center
Catherine B. Niewoehner, MD
Anthony DeSantis, MD Virginia Medical Center
University of Washington Department of Endocrinology and Metabolism
School of Medicine
Louis H. Philipson, MD, PhD
Richard Eastell, MD, FRCP, FRCPath, FMedSci Te University of Chicago
Northern General Hospital Departments of Medicine and Pediatrics
Centre for Biomedical Research Section of Endocrinology, Diabetes and Metabolism
Kenneth Feingold, MD Cliford J. Rosen, MD
University of California, San Francisco Maine Medical Center Research Institute
Department of Medicine Center for Clinical & Translational Research
James Findling, MD Douglas S. Ross, MD
Medical College of Wisconsin Department of Medicine, Harvard Medical School
Endocrinology Center at North Hills
Lisa Tannock, MD
Hossein Gharib, MD, MACP, MACE University of Kentucky
Mayo Clinic College of Medicine Department of Endocrinology
Department of Endocrinology
Tomas Weber, MD
Catherine M. Gordon, MD, MSc Division of Endocrinology, Metabolism & Nutrition
Children’s Hospital Boston Duke University Medical Center
Division of Adolescent Medicine
Bu B. Yeap, MBBS, FRACP
SiriAtma Greeley, MD, PhD School of Medicine and Pharmacology
Te University of Chicago University of Western Australia
Departments of Medicine and Pediatrics Fremantle Hospital
Section of Endocrinology, Diabetes and Metabolism
contents
Continuing Medical Education (CME) ......................................... vi
Preface ...........................................................................................viii
bone and Mineral HoMeostasis
1. Vitamin D: When and How to Use ........................................... 2
Daniel D. Bikle, MD, PhD
2. Risk Assessment for Osteoporotic Fracture .......................... 10
Richard Eastell, MD, FRCP, FRCPath, FMedSci
Tomas Weber, MD
3. Drug Terapies for Osteoporosis:
When, Which & How Long to Use? ........................................ 15
Anthony DeSantis, MD
4. Gauging Response to Osteoporosis Terapy ........................ 24
Cliford J. Rosen, MD
Catherine B. Niewoehner, MD
5. New Options for Vertebral Fracture....................................... 31
Alastair R. McLellan, MD, FRCP
6. Investigation & Management of Hypocalcemia ................... 38
Michael A. Levine, MD
7. Normocalcemic Hyperparathyroidism ................................. 48
Robert A. Adler, MD
8. Medical Options for Primary Hyperparathyroidism ............ 54
Mara J. Horwitz, MD
diabetes Mellitus
9. Monogenic Diabetes: Who Needs MODY Screening? ......... 62
Louis H. Philipson, MD, PhD
Rochelle Naylor, MD; SiriAtma Greeley, MD, PhD
Graeme I. Bell, PhD
10. Difcult Diabetes Cases ......................................................... 71
Graham T. McMahon MD, MMSc
11. Management of CVD Risk in Diabetes .................................. 80
Samuel Dagogo-Jack, MD
12. Prevention of Diabetic Nephropathy .................................... 88
Luiza Caramori, MD, MS, PhD
13. Insulin Management of Diabetes .......................................... 98
Mary Korytkowski, MD
14. Insulin Pumps ....................................................................... 109
Anthony L. McCall, MD, PhD, FACP
15. CGM and Its Role in Diabetes Management ...................... 120
Irl B. Hirsch, MD
cardiovascular endocrinology
16. Dyslipidemia Beyond the Statin .......................................... 127
Kenneth Feingold, MD & Lisa Tannock, MD
17. M anagement of the Abnormal C’s: Coronary Calcium
Scores, CIMT, CRP & Other Cryptic Markers of CAD ......... 137
Alan Chait, MD
18. Primary Hyperaldosteronism .............................................. 141
Richard Auchus, MD, PhD & James Findling, MD
Men’s and WoMen’s HealtH
19. D iagnosis & Management of Male Hypogonadism:
In the Older Man ................................................................... 150
Frances Hayes, MB, FRCPI
20. Erectile Dysfunction: Who, When and What Treatment? .. 155
Alvin M. Matsumoto, MD
21. Investigation and Management of Gynecomastia .............. 167
Bu B. Yeap, MBBS, FRACP & Glenn D. Braunstein, MD
22. Contraception in Adolescents .............................................. 178
Catherine M. Gordon, MD, MSc
tHyroid disorders
23. Clinical Approach to Subclinical Hypothyroidism ............. 186
Hossein Gharib, MD, MACP, MACE
Douglas S. Ross, MD
24. Management of Subclinical Hyperthyroidism ................... 193
Gregory A. Brent, MD & Kenneth D. Burman, MD
Index ............................................................................................. 202
CME Post Test .............................................................................. 207
vi
continuing Medical education
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Te Endocrine Society is accredited by evaluation and diagnosis of common
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Te Endocrine Society designates this activity should be of substantial interest
enduring material for a maximum of 12.0 to endocrinologists, internists and family
AMA PRA Category 1 Credits™. Physicians practitioners who care for patients with
should claim only the credit commensurate endocrine disorders.
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Learning Objectives with relevant fnancial relationships from
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• Identify and diferentiate endocrine MD, Richard Auchus, MD, PhD, Daniel D.
cases that can be treated in a primary Bikle, MD, PhD, Glenn D. Braunstein, MD,
care setting and those that are in need of Gregory Brent, MD, Luiza Caramori, MD,
referral to an endocrinologist for treatment MS, PhD, Anthony DeSantis, MD, Richard
vii
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MD, Hossein Gharib, MD, MACP, MACE, Society requires that any discussions of
SiriAtma Greeley, MD, PhD, Francis such “of-label” use be based on scientifc
Hayes, MB, FRCPI, Mara J. Horwitz, research that conforms to generally
MD, Mary Korytkowski, MD, Michael A. accepted standards of experimental
Levine, MD, Alvin M. Matsumoto, MD, design, data collection, and data analysis.
Anthony L. McCall, MD, PhD, FACP, Before recommending or prescribing
Alastair R. McLellan, MD, FRCP, Graham any therapeutic agent or device, learners
T. McMahon, MD, MMSc, Rochelle Naylor, should review the complete prescribing
MD, Catherine B. Niewoehner, MD, Louis information, including indications,
H. Philipson, MD, PhD, Cliford Rosen, contraindications, warnings, precautions,
MD, Lisa Tannock, MD, Bu B. Yeap, MBBS, and adverse events.
FRACP, Tomas Weber, MD
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viii
preface
I am pleased to present this second volume of Endocrine Essentials,
a work that reviews the recent clinical research on some of the
most common clinical endocrinology topics that primary care
clinicians, endocrinologists and other clinicians grapple with in
the clinic. Tese topics include osteoporosis, calcium disorders,
diabetes management, subclinical thyroid dysfunction, lipid
disorders and selected areas in men’s and women’s health.
Each chapter is based on a talk given at the Endocrine Society’s
Annual Scientifc Meeting in 2010 or 2011. Te chapter synthesizes
the most recent clinical research into practical approaches to the
management of common endocrinology disorders. Te chapters
contain a succinct review of a topic and case-based questions and
answers. Each chapter also includes a multiple choice question
written in the format of questions used in the American Board of
Internal Medicine exam. Te content of each chapter will be useful
for busy clinicians who want a rational, evidence-based approach
to the clinical dilemmas that they face in the clinic and for those
clinicians preparing for board examinations in internal medicine
or endocrinology.
I hope that you enjoy reading this book and applying the principles
in it to the care of your patients!
Bradley D. Anawalt, MD
Clinical Science Chair, ENDO 2011
Bone
and Mineral
HoMeostasis
