Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ 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 ++ – https://www.aace.com/files/adrenal-guidelines.pdf +++ Comments ++ A 1-mg overnight dexamethasone suppression test can be used to screen for hypercortisolism. Measure plasma-fractionated metanephrines and normetanephrines to screen for pheochromocytoma. Measure plasma renin activity and aldosterone concentration to assess for primary or secondary aldosteronism. +++ 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 ++ – www.endocrine.org/guidelines-and-clinical-practice/clinical-practice-guidelines/treatment-of-cushing-syndrome +++ DIABETES MELLITUS (DM), TYPE 1 +++ Population ++ – Children and adults with Type I DM. +++ Recommendations +++ ADA 2020 ++ – A1c goal <7% appropriate for most, <6.5% if obtainable without hypoglycemia, or 7–8% if hypoglycemia unawareness. – 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. – Consider continuous glucose monitoring in both children and adults, as it 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 fundoscopic exam q 2 y after initial assessment. 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: Check TSH, thyroid peroxidase and thyroglobulin antibodies initially; routine screening thereafter. Pernicious anemia: Check B12 level if anemia or peripheral neuropathy is present. – 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 ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth