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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.

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 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 ...

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