Chapter 3: Endocrine and Metabolic Disorders

ADRENAL INCIDENTALOMAS

Management

Adults

Recommendations from

► AACE 2009

• –In adults incidentally found to have an adrenal mass, 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://pro.aace.com/files/adrenal-guidelines.pdf

CUSHING SYNDROME

Management

Children and Adults

Recommendations from

► Endocrine Society 2015

• –Treatment goals:

  • Normalize cortisol levels to eliminate signs and symptoms.

  • Monitor and treat cortisol-dependent comorbidities.

• –Vaccinate against influenza, herpes zoster, pneumococcus.

• –Use perioperative thromboprophylaxis for venous thromboembolism.

• –Refer for surgical resection of primary adrenal or ectopic focus.

• –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 (T1DM)

Management

Children and Adolescents

Recommendations from

► ADA 2023, NICE 2023, Endocrine Society 2022

Evaluation

• –Screen for other autoimmune conditions at the time of diagnosis of T1DM:

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

  • Thyroid disease: check TSH, thyroid peroxidase, and thyroglobulin antibodies; screen q1–2 y thereafter.

  • Pernicious anemia: check B₁₂ level if anemia or peripheral neuropathy is present. (ADA)

  • Hypertension: check BP¹ at diagnosis and each follow-up visit.

  • Consider screening for sleep health, including sleep disorders and sleep disruptions due to diabetes symptoms or management needs. Refer to sleep medicine and/or behavioral health professional as indicated. (ADA)

Therapies

• –Use insulin therapy with multiple injections daily, either via basal plus prandial insulin or an insulin pump and ensure rotation of injection sites. (NICE)

• –Instruct patients using multiple insulin injections to self-monitor blood glucose at least 5 times daily. (NICE)

• –Offer diabetes self-management education and support. Consider social determinants of health of the target population to guide design and delivery of diabetes self-management education and support with the ultimate goal of health equity across all populations. (ADA)

• –Offer medical nutrition therapy, preferably with a registered dietitian nutritionist.

• –Encourage physical activity: 60 min/d of moderate-intensity aerobic activity, 3 d/wk of muscle and bone-strengthening activities.

• –Assess psychological and social situation. Screen/refer to specialist for anxiety, depression, disordered eating.

• –Encourage at least 4 clinic visits per year. (NICE)

• –Advise all patients not to smoke.

• –Consider statin therapy if ...