By Shlomo Melmed MBChB MACP, Kenneth S. Polonsky MD, P. Reed Larsen MD FRCP, Henry M. Kronenberg MD
The newest variation of Williams Textbook of Endocrinology edited by way of Drs. Shlomo Melmed, Kenneth S. Polonsky, P. Reed Larsen, and Henry M. Kronenberg, is helping you diagnose and deal with your sufferers successfully with up-to-the minute, functional knowledge on all endocrine procedure issues. complete but available, this generally revised twelfth variation updates you on diabetes, metabolic syndrome, weight problems, thyroid affliction, testicular problems, and masses extra so that you promises your sufferers with the main winning remedies. locate clinical perception and medical info interwoven in each bankruptcy, reflecting advances in either components of this always altering self-discipline, and provided in a very available structure. You’ll additionally entry useful contributions from a dynamic record of professional authors and approximately 2.000 full-color photographs that can assist you with each analysis. in addition to handy on-line entry at www.expertconsult.com, this name has every thing you want to deal with any and all of the scientific endocrinopathies you could encounter.
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Example text
Likewise, common sense and judgment should lead to treating many nodules more conservatively in the aged. Whereas larger nodules in older patients may be aggressive malignancies, it is reasonable to tell octogenarians who present with five or six thyroid nodules of modest size that even if the risk of malignancy is about 10%, the risk of death from such malignancies is quite remote. These older patients can then decide for themselves whether to undergo one or more biopsies. Choosing not to have a biopsy seems particularly appropriate in this age group, especially when other potentially life-threatening illnesses are present.
Some of these patients with benign adrenal tumors are appropriately referred to surgeons based solely on tumor size. ” Most of these lesions turn out to be benign, but all of them require careful follow-up, and some may require surgery. There is an unfortunate misconception among many endocrinologists that needle biopsy can distinguish a benign from a malignant adrenal cortical tumor. In fact, a needle biopsy can diagnose metastasis to the adrenals but only rarely distinguishes adrenocortical adenoma from ACCs.
The increasing recognition of subclinical Cushing’s syndrome is a consequence of the radiologic detection of adrenal incidentalomas. A diagnosis of subclinical Cushing’s syndrome in a patient with an adrenal adenoma is most commonly based on the failure to suppress cortisol after overnight administration of dexamethasone, but the actual criteria for diagnosis vary considerably. There is no consensus about which dose of dexamethasone to use, which dexamethasone-suppressed cortisol value is diagnostic, or, more importantly, when surgical removal of the adrenal is advisable.
