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392 Pituitary Tumor Syndromes is associated with decreased libido and potency, infertility, decreased muscle mass with weakness, reduced beard and body hair growth, soft testes, and characteristic fine facial wrinkles. Osteoporosis occurs in both untreated hyp...

393 Disorders of the Neurohypophysis Diagnosis is based on demonstrating elevated serum free T4 levels, inappropriately normal or high TSH secretion, and MRI evidence of a pituitary adenoma. Elevated free glycoprotein hormone α subunits are seen in many patien...

394 Thyroid Gland Physiology and Testing as pseudohyponatremia (due to raised lipids or protein) or translo­ cational hyponatremia (due to raised glucose or exogenous effective osmolytes [e.g., mannitol]). SIAD must then be differentiated from other types of h...

395 Hypothyroidism hormone (“cold” nodules, see Chap. 397, Fig 397-3A), and these are more likely to be malignant (~5–10%). Whole-body and thyroid scanning is also used in the treatment and, now less frequently, in the surveillance of thyroid cancer. After thy...

396 Hyperthyroidism and Other Causes of Thyrotoxicosis be approximated by decreasing the upper limit of the nonpregnant reference range by 0.5 mIU/L (~4.0 mIU/L) and the lower limit by 0.4 mIU/L (~0.1 mIU/L). However, it is important to recognize that the norm...

397 Thyroid Nodular Disease and Thyroid Cancer suppression of the thyroid (Wolff-Chaikoff effect), and the inhibitory effects on deiodinase activity and thyroid hormone receptor action become predominant. These events lead to the following pattern of thyroid f...

398 Disorders of the Adrenal Cortex on a negative result. Assuming a 25–30% ROM for nodules with indeterminate cytology, the negative predictive values for the cur­ rently validated molecular tests are >95%. The evaluation of a thyroid nodule is stressful for ...

399 Pheochromocytoma Fleseriu M et al: Consensus on diagnosis and management of Cushing’s disease: A guideline update. Lancet Diabetes Endocrinol 9:847, 2021. Hahner S et al: Adrenal insufficiency. Nat Rev Dis Primers 7:19, 2021. Merke DP et al: Modified-relea...

400 Multiple Endocrine Neoplasia Syndromes TABLE 399-3  Patterns of Occurrence in Inherited Pheochromocytoma and Paraganglioma–Associated Syndromes EXTRA-ADRENAL RETROPERITONEAL OR PELVIC TUMORS MUTATED GENE ADRENAL TUMORS HEAD AND NECK TUMORS MAX +++++ <x + <...

401 Autoimmune Polyendocrine Syndromes Peter A. Gottlieb, Aaron W. Michels Autoimmune Polyendocrine Syndromes Polyglandular deficiency syndromes have been given many differ­ ent names, reflecting the wide spectrum of disorders that have been associated with th...

SECTION 2 Sex- and Gender-Based Medicine Section 2 Sex- and Gender-Based Medicine Courtney Finlayson, J. Larry Jameson, John C. Achermann Sex Development PART 12 Endocrinology and Metabolism Sex development begins in utero but continues into young adulthood w...

402 Sex Development Section 2 Sex- and Gender-Based Medicine Courtney Finlayson, J. Larry Jameson, John C. Achermann Sex Development PART 12 Endocrinology and Metabolism Sex development begins in utero but continues into young adulthood with the achievement o...

403 Disorders of the Testes and Male Reproductive System increased risk for germ cell cancer, requiring monitoring and potential gonadectomy. Long-term urogynecologic follow-up may be needed. Psychosocial and psychosexual evaluation and management are also imp...

404 Disorders of the Female Reproductive System detecting AAS use. Illicit testosterone use is detected generally by the measurement of urinary testosterone-to-epitestosterone ratio and further confirmed by the 13C:12C ratio in testosterone using iso­ tope rat...

405 Menstrual Disorders and Pelvic Pain Approximately 50% of girls with congenital hypogonadotropic hypo­ gonadism, with or without anosmia, have a history of some degree of breast development, and 10% report one to two episodes of vaginal bleeding. Family stu...

406 Hirsutism as appropriate. Neuromuscular and psychosomatic etiologies should also be considered. Some women experience discomfort at the time of ovulation (mit­ telschmerz or ovulation pain). The pain can be quite intense but is generally of short duration....

407 Menopause and Postmenopausal Hormone Therapy JoAnn E. Manson, Shari S. Bassuk Menopause and Postmenopausal Hormone Therapy Menopause is the permanent cessation of menstruation due to loss of ovarian follicular function. It is diagnosed retrospectively afte...

408 Infertility and Contraception family history of breast cancer in a first-degree relative or other contraindications, and who have a strong personal preference for therapy. Poor candidates are women with elevated cardiovascular risk, those at increased risk...