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13.7.1 Normal growth and its disorders 2416 CONTENTS 13.7.1 Normal growth and its disorders  2416 Gary Butler 13.7.2 Normal puberty and its disorders  2428 Fiona Ryan and Sejal Patel 13.7.3 Normal and abnormal sexual differentiation  2435 S. Faisal Ahmed an...

13.7.2 Normal puberty and its disorders 2428 section 13  Endocrine disorders 2428 Constitutionally advanced growth and puberty Just as growth delay is a variant of growth at one end of the normal range, so is constitutional tall stature. Assessments such as bo...

13.7.3 Normal and abnormal sexual differentiation 2435 13.7.3  Normal and abnormal sexual differentiation 2435 to trigger puberty and ensure its continuation after treatment is stopped. Permanent hypogonadism however needs continuation of treatment to ensure p...

13.8 Pancreatic endocrine disorders and multiple endocrine neoplasia 2449 ESSENTIALS Pancreatic neuroendocrine tumours (islet-​cell tumours) are rare and usually sporadic, but they may be associated with complex familial endocrine cancer syndromes. Recognized ...

13.9 Diabetes and hypoglycaemia 2464

13.9.1 Diabetes 2464 CONTENTS 13.9.1 Diabetes  2464 Colin Dayan and Julia Platts 13.9.2 Hypoglycaemia  2531 Mark Evans and Ben Challis 13.9.1  Diabetes Colin Dayan and Julia Platts ESSENTIALS Diabetes mellitus can be defined as a state of chronic hyperglycae...

13.9.2 Hypoglycaemia 2531 13.9.2  Hypoglycaemia 2531 long-​term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ, 314, 1512–​15. Malmberg K, et al. (2005). Intense metabolic control by means of in- sulin in patients with diabe...

14.1 Physiological changes of normal pregnancy 2563 ESSENTIALS Almost every maternal organ system makes a physiological adapta- tion to pregnancy for optimal pregnancy outcome. An understanding of these adaptations brings insight into the aetiology of gestatio...

14.10 Diabetes in pregnancy 2627 ESSENTIALS Diabetes in pregnancy is predominantly either pre-​existing type 1 or type 2 diabetes mellitus, or gestational diabetes, the latter defined as diabetes or glucose intolerance first diagnosed during the preg- nancy. G...

14.11 Endocrine disease in pregnancy 2638 ESSENTIALS Thyroid Many pregnant women will develop goitre. Gestational thyrotoxi- cosis needs to be differentiated from Graves’ disease, which requires treatment with propylthiouracil in early pregnancy and carbimazol...

14.12 Neurological conditions in pregnancy 2642 ESSENTIALS Pregnancy can influence the clinical course of an underlying neuro- logical problem or precipitate the first presentation of a neurological disease. Epilepsy—​sodium valproate is associated with higher...

14.13 The skin in pregnancy 2648 ESSENTIALS Dermatoses in pregnancy are common, they may be very itchy and may impact the life of a pregnant woman dramatically. There are four classical dermatoses of pregnancy. It is particularly important to recognize these a...

14.14 Autoimmune rheumatic disorders and vasculitis in pregnancy 2655 ESSENTIALS Autoimmune diseases affect 5–​7% of people, are more common in women of childbearing age, and are frequently encountered in preg- nancy. They may remit or improve during pregnancy...

14.15 Maternal infection in pregnancy 2671 ESSENTIALS Human Immunodeficiency Virus—​the global roll-​out of antiretro- viral therapy has significantly improved survival for people living with HIV and reduced mother-​to-​child transmission, but HIV in- fection ...

14.16 Fetal effects of maternal infection 2678 ESSENTIALS The fetal effects of maternal infection in pregnancy can be broadly categorized as follows (these are not mutually exclusive): (1)  transplacental infection causing fetal malformation (e.g. syph- ilis, ...

14.17 Blood disorders in pregnancy 2687 ESSENTIALS Plasma volume increases by more during pregnancy than does red cell mass, leading to haemodilution and a fall in the haematocrit from about 40% to 33%, with a nadir usually reached at 24–​32 weeks’ gestation. ...

14.18 Malignant disease in pregnancy 2696 ESSENTIALS Cancer in pregnancy is rare, affecting less than 1 in 1000 live births. It may be specific to pregnancy (gestational trophoblastic disease) or incidental to it, the less infrequent conditions being melanoma,...

14.19 Maternal critical care 2701 ESSENTIALS Critical illness during pregnancy or after giving birth is rare: in the United Kingdom 0.29% of maternities involve admission to a critical care unit, and the maternal death rate is 0.01%. Over 80% of obstetric admi...