Endocrinology Handbook Endocrine Unit Imperial College ...

1 Endocrinology Handbook Endocrine unit Imperial College Healthcare NHS. Trust Charing Cross, Hammersmith and St. Mary's Hospitals Updated: March 2010. First published 1988. Available as a 290 kB .pdf file since 1999 on: 1. INTRODUCTION .. 6. ANTERIOR PITUITARY .. 7. ANTERIOR PITUITARY FUNCTION ..7. insulin tolerance TEST (ITT) ..7. GLUCAGON TEST ..9. THYROTROPHIN RELEASING HORMONE (TRH) GONADOTROPHIN RELEASING HORMONE GNRH/LHRH COMBINED PITUITARY FUNCTION tests (CPT) ..12. VISUAL FIELD TESTING (GOLDMANN OR HUMPHREYS PERIMETRY).

2 14. SUSPECTED CUSHING'S LOW DOSE DEXAMETHASONE SUPPRESSION TEST (LDDST)..16. BILATERAL SIMULTANEOUS INFERIOR PETROSAL SINUS SAMPLING (IPSS) WITH CRF ..17. HIGH DOSE DEXAMETHASONE SUPPRESSION TEST (HDDST) ..19. PRE-OPERATIVE PREPARATION OF PATIENTS WITH CONFIRMED CUSHING'S. PERIPHERAL VENOUS SAMPLING FOR SOURCES OF ECTOPIC ACTH ..21. OVERNIGHT DEXAMETHASONE SUPPRESSION TEST ..21. CRH TESTING (WITHOUT DEXAMETHASONE)..22. CUSHING'S DAY CURVE ..23. PROLACTINOMAS AND NON FUNCTIONING PITUITARY ADENOMAS ..24. ASSAY PROBLEMS TO BE AWARE OF WITH DISTINGUISHING PITUITARY MACROADENOMAS SECRETING PROLACTIN FROM NON.

3 FUNCTIONING TUMOURS ..24. PROTOCOL FOR CABERGOLINE PREGNANCY AND THE DOPAMINE AGONIST TREATMENT OF PITUITARY TUMOURS ..27. OPERATIVE MANAGEMENT OF PITUITARY HYDROCORTISONE REPLACEMENT PRE- AND POST-PITUITARY POST OPERATIVE MANAGEMENT OF DIABETES IMMEDIATE POST-OPERATIVE ASSESSMENT OF GH BURDEN IN IMMEDIATE POST-OPERATIVE ASSESSMENT OF EARLY REMISSION IN CUSHING'S. DISEASE ..30. CUSHING'S DAY CURVE FOR ASSESSMENT OF EARLY REMISSION FOLLOWING TRANS- SPHENOIDAL SURGERY FOR CUSHING'S DISEASE ..33. FOLLOW UP OF PATIENTS WITH CUSHING'S DISEASE FOLLOWING BILATERAL.

4 POLICY ON SPERM STORAGE PRIOR TO PITUITARY HYDROCORTISONE DAY CURVE (HCDC) ..35. GROWTH 2. A WORD ON UNITS ..36. HUMAN GROWTH HORMONE (HGH) PRESCRIBING FOR ADULT ONSET GROWTH. HORMONE DEFICIENCY (AOGHD) ..36. EXERCISE TEST ..37. ARGININE STIMULATION ORAL GLUCOSE tolerance TEST FOR FOLLOW UP FOLLOWING PITUITARY SURGERY AND SCREENING COLONOSCOPY IN HISTORICAL METHODS OF ASSESSING EXCESS GROWTH FINGER SIZE MEASURING SKIN-FOLD THICKNESS ..41. POSTERIOR 43. DIABETES WATER DEPRIVATION TEST ..43. PROLONGED WATER DEPRIVATION TEST (MILLER AND MOSES).

5 46. THERAPEUTIC TRIAL OF ADRENAL INVESTIGATIONS .. 48. SHORT SYNACTHEN LONG SYNACTHEN ADRENAL TUMOURS ..52. OPERATIVE MANAGEMENT OF BILATERAL HYPERALDOSTERONISM ..54. PLASMA ALDOSTERONE, AND PLASMA RENIN ADRENAL VENOUS SAMPLING FOR SELENIUM CHOLESTEROL SCANNING FOR CONN'S TUMOURS ..60. PHAEOCHROMOCYTOMAS AND PARAGANGLIOMAS ..61. PLASMA/URINE CATECHOLAMINE MEASUREMENT ..61. PLASMA/URINE METANEPHRINE MEASUREMENT ..62. MANAGEMENT OF SUSPECTED PENTOLINIUM SUPPRESSION CLONIDINE SUPPRESSION GENETIC SCREENING FOR PHAEOCHROMOCYTOMAS.

6 66. MIBG SCAN ..67. THYROID AND PARATHYROID.. 69. PROTOCOL FOR THE POST-RADIOIODINE TREATMENT TELEPHONE INSTRUCTIONS FOR THOSE RUNNING THE PHONE CLINIC..71. PREPARATION OF THYROTOXIC PATIENTS FOR THYROIDECTOMY ..73. 3. PENTAGASTRIN TEST FOR MEDULLARY THYROID CARCINOMA ..74. CALCIUM INFUSION TEST FOR MEDULLARY CA THYROID ..75. FINE NEEDLE ASPIRATION OF A THYROID NODULE (FNA) ..76. 81. GLUCOSE tolerance TEST ..81. AUTONOMIC FUNCTION tests ..82. GUT HORMONE TUMOURS .. 84. INSULINOMAS ..84. GLUCOSE tolerance TEST.

7 84. PROLONGED SUPERVISED FAST ..84. MANAGEMENT OF STABLE INSULINOMAS PRIOR TO SURGERY ..86. GASTRIC ACID SECRETION ..87. INTRAVENOUS SECRETIN TEST ..88. LOCALIZATION OF GASTRINOMAS AND CARCINOID AND NEUROENDOCRINE FOODS TO AVOID DURING 24 HOUR URINE COLLECTION FOR 5-HIAA ..92. HEPATIC EMBOLIZATION OF CHEMOTHERAPY FOR NEUROENDOCRINE OVARY .. 96. SCREENING FOR OVULATION ..96. PROGESTERONE CLOMIPHENE TEST ..97. HYPOGONADOTROPHIC POLYCYSTIC OVARIAN DIAGNOSTIC CRITERIA ..99. APPROACH TO PCOS 101. FERTILITY INDUCTION IN HYPOGONADOTROPHIC NORMAL SEMEN ANALYSIS RESULTS.

8 102. OTHER MISCELLANEOUS CONDITIONS .. 103. SYSTEMIC ISCHAEMIC LACTATE 4. SURGICAL USEFUL NAMES AND ADDRESSES .. 111. 5. Introduction Diagnosis and appropriate treatment in clinical Endocrinology rely heavily on the accurate use and interpretation of diagnostic tests . This Handbook was devised as a means of guiding new junior staff (and refreshing the memories of their seniors!) when confronted by clinical problems and their investigation. This bible is meant to be brief and didactic with the inevitable costs as well as benefits of such an approach.

9 It is envisaged that it will be reprinted at 6 monthly intervals incorporating corrections and additions, any suggestions and comments from readers are welcome. Grateful acknowledgements are due to: Professor Stephen Bloom, Dr Simon Wallis, Professor Graham Joplin, Professor Kaye Ibbertson, Professor James Jackson, Dr Jacky Burrin, Mrs Sophie Barnes, Mrs Veronica Ferguson, Mr Stuart Lavery, Mr Paul Bains and all our colleagues for their help and encouragement. We are delighted to note that this bible is forming the basis of many Endocrine protocols on various website around the country.

10 The first version of this was written by the Registrars and Consultants in the Endocrine unit in 1988 and used as a Handbook for the junior doctors ever since. It has been available on the web since 1999 and it has since been widely used as the central source of Endocrine protocols ever since. Please feel free to use this information to educate your own staff, and please simply acknowledge the Imperial College Endocrine unit . Authors Andrew Hattersley Maria Barnard John Wilding Stephen Gilbey Peter Hammond Michela Rossi Duncan Bassett Arshia Panahloo Rachel Batterham Maha Barakat John Frank Bernard Khoo Jeannie Todd Sarah Stanley Elaine Murphy Carel LeRoux Waljit Dhillo Karim Meeran Niamh Martin Emma Hatfield Tricia Tan Jaideep Dhariwal Debbie Peters Jaimini Cegla Fausto Palazzo May 2010.