In this sweeping exploration of the relatively recent obesity epidemic, Michael L. Power and Jay Schulkin probe evolutionary biology, history, physiology, and medical science to uncover the causes of our growing girth. The unexpected answer? Our own evolutionary success. For most of the past few million years, our evolutionary ancestors' survival depended on being able to consume as much as possible when food was available and to store the excess energy for periods when it was scarce. In the developed world today, high-calorie foods are readily obtainable, yet the propensity to store fat is part of our species' heritage, leaving an increasing number of the world's people vulnerable to obesity. In an environment of abundant food, we are anatomically, physiologically, metabolically, and behaviorally programmed in a way that makes it difficult for us to avoid gaining weight. Power and Schulkin's engagingly argued book draws on popular examples and sound science to explain our expanding waistlines and to discuss the consequences of being overweight for different demographic groups. They review the various studies of human and animal fat use and storage, including those that examine fat deposition and metabolism in men and women; chronicle cultural differences in food procurement, preparation, and consumption; and consider the influence of sedentary occupations and lifestyles. A compelling and comprehensive examination of the causes and consequences of the obesity epidemic, "The Evolution of Obesity" offers fascinating insights into the question, Why are we getting fatter?

 

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The book is in question and answer format, very easy and comfortable to read. It incorporates objective structures practical examination (OSPE) and other format on Endocrinology questions. Contents of the book have been updated as per the latest guidelines by various endocrine organizations all over the world, especially American Association of Clinical Endocrinology (AACE) guidelines, American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), American Thyroid Association (ATA) guidelines, and other organizations of the world.

 

Description:

Recognising a need to promote and enhance teaching of clinical endocrinology and diabetes in UK medical schools, the Society for Endocrinology, in collaboration with Diabetes UK and the Association of British Clinical Diabetologists, created a national curriculum that sets out the minimum recommended standards for undergraduate medical education.

Clinical Endocrinology and Diabetes at a Glance corresponds to the curriculum and covers all important areas of diabetes and endocrinology in a clinically relevant and concise manner, with complementary figures to ensure principles are explained clearly. It highlights key practical skills for undergraduates in line with the GMC recommendations that medical graduates should be well prepared for their Foundation posts. There is also emphasis on the importance of multidisciplinary teams in the management of endocrine diseases and diabetes. These include sections on structured education programmes, psychosocial aspects, and patient self-management and monitoring.

Clinical Endocrinology and Diabetes at a Glance will serve as a valuable resource for medical students and junior doctors treating patients with these conditions.

 

Table of Contents:

 

Part 1: Introduction

1: Introduction to endocrinology

Synthesis, release and transport

Mechanisms of hormone action

Control and feedback

Patterns of hormone secretion

Measurement of hormones

Dynamic endocrine tests

Part 2: Disorders of the hypothalamic–pituitary axis

2: The hypothalamic–pituitary axis and its assessment

Physiology

Assessment of the pituitary gland

Imaging

3: Acromegaly

Clinical features

Investigation

Management

4: Cushing’s syndrome

Clinical features

Investigation

Differential diagnosis

Management

Follow-up and monitoring

5: Hypopituitarism and non-functioning pituitary adenomas

Non-functioning pituitary adenomas

Hypopituitarism

6: Prolactinoma and hyperprolactinaemia

Hyperprolactinaemia

Prolactinoma

Pituitary incidentaloma

Part 3: Disorders of thirst and fluid balance

7: Hypernatraemia and diabetes insipidus

Posterior pituitary function and sodium homeostasis

Hypernatraemia

Diabetes insipidus

Acute severe hypernatraemia

8: Hyponatraemia and SIADH

Hyponatraemia

Syndrome of inappropriate ADH

Acute severe hyponatraemia

Part 4: Thyroid disorders

9: Thyroid function

Anatomy

Physiology

Actions of thyroid hormones

Interpreting thyroid function tests

Primary and secondary hypothyroidism

Hyperthyroidism

Factors affecting thyroid results

10: Hyperthyroidism: clinical presentation and investigation

Causes

Clinical presentation

Investigation

11: Hyperthyroidism: management and ophthalmopathy

Medical treatment

Definitive treatments

Thyroid ophthalmopathy

12: Hyperthyroidism: special circumstances

Hyperthyroidism and pregnancy

Subclinical hyperthyroidism

Elevated fT4 with unsuppressed TSH

Assay interference

TSHoma and thyroid hormone resistance

13: Hypothyroidism

Causes

Clinical features

Investigations

Treatment

Subclinical hypothyroidism

Hypothyroidism and pregnancy

Polyglandular autoimmune disease

14: Goitre, thyroid nodules and cancer

Goitre

Multinodular goitre

Solitary thyroid nodule

Thyroid cancer

Management of differentiated thyroid cancer

Part 5: Disorders of calcium homeostasis

15: Physiology of calcium, PTH and vitamin D metabolism

Parathyroid hormone

Vitamin D

Vitamin D deficiency

16: Hypercalcaemia

Hypercalcaemia with suppressed PTH

Hypercalcaemia with non-suppressed PTH

Acute severe hypercalcaemia

17: Hypocalcaemia

Causes

Clinical features

Investigation

Treatment

Pseudo-hypoparathyroidism

18: Osteoporosis

Causes

Clinical features

Investigation

Assessing fracture risk

Treatment

Part 6: Disorders of the adrenal gland

19: Steroid physiology and biochemical assessment

Steroid synthesis

Glucocorticoids

Adrenal androgens

Mineralocorticoids

Biochemical assessment of the adrenal axis

20: Adrenal insufficiency

Primary adrenal insufficiency

Secondary adrenal insufficiency

Steroid-induced hypoadrenalism

21: Adrenocortical tumours

Adrenal Cushing’s syndrome

Primary hyperaldosteronism

Adrenal incidentalomas

22: Disorders of the adrenal medulla

Phaeochromocytoma and paraganglioma

Part 7: Disorders of the reproductive system

23: Physiology of the reproductive system

Physiology of female reproduction

Physiology of male reproduction

24: Growth, puberty and sexual differentiation

Normal growth

Normal puberty

Short stature

Precocious puberty

Delayed puberty

Sexual differentiation

Transition of young people into the adult service

25: Menstrual disturbance

Definition

Causes

Assessment

Treatment

Premature ovarian failure

Turner’s syndrome

26: Hyperandrogenism

Hirsutism

Polycystic ovary syndrome

Congenital adrenal hyperplasia

27: Menopause and HRT

Definition

Clinical presentation

Assessment

Treatment

Long-term risks and benefits

Pre-menopausal oestrogen replacement

28: Male hypogonadism

Definition

Primary hypogonadism

Secondary hypogonadism

Late onset hypogonadism

Assessment

Treatment

29: Gynaecomastia

Definition

Causes

Assessment

Treatment

30: Infertility

Definition and aetiology

Evaluation of the infertile couple

Investigations

Management

Part 8: Neuroendocrine tumours

31: Neuroendocrine tumours

Definition

Aetiology

Symptoms and signs

Diagnosis

32: Neuroendocrine tumours: management

Treatment

Carcinoid heart disease

Prognosis

33: Inherited endocrine tumour syndromes

Multiple endocrine neoplasia type 1

Multiple endocrine neoplasia type 2

Carney complex

McCune–Albright syndrome

34: Spontaneous hypoglycaemia

Fasting hypoglycaemia

Postprandial hypoglycaemia

Assessment

Management

Part 9: Endocrine emergencies

35: Adrenal crisis

Clinical presentation

Management

36: Pituitary apoplexy

Clinical presentation

Management

37: Myxoedema coma

Clinical presentation

Management

38: Thyroid storm

Clinical presentation

Investigations

Management

39: Acute hyponatraemia

Clinical presentation

Management

40: Severe hypercalcaemia

Clinical presentation

Management

41: Acute hypocalcaemia

Clinical presentation

Management

Part 10: Diabetes mellitus

42: Overview

History

Landmark studies

Advances in care

Diabetes support organisations

Awareness

43: Diagnosis and monitoring

Diagnosis of diabetes

Oral glucose tolerance test

Impaired fasting glycaemia and impaired glucose tolerance

Screening

Monitoring diabetes

44: Classification

Type 1 diabetes

Type 2 diabetes

Maturity-onset diabetes of the young

Other genetic defects in β-cell function

Genetic defects in insulin action

Pancreatic diseases

Endocrine disorders

Drugs

Gestational diabetes

Other associations with diabetes

45: Type 1 diabetes: aetiology and clinical presentation

Aetiology

Pathophysiology

Clinical presentation

46: Type 1 diabetes: insulin and other therapies

Lifestyle

Insulin

Continuous subcutaneous insulin infusion

Pancreatic transplantation

The artificial pancreas

Immunotherapy

47: Type 2 diabetes: aetiology and clinical presentation

Aetiology

Pathophysiology

Clinical presentation

48: Type 2 diabetes: treatment

Diet and exercise

Metformin

Sulphonylureas

Meglitinides

Acarbose

Glitazones

DPP-4 inhibitors

GLP-1 receptor agonists

SGLT-2 inhibitors

Insulin

49: Macrovascular complications

Epidemiology

Aetiology

Clinical presentation

Management

50: Microvascular complications

Background

Aetiology

Neuropathy

Nephropathy

Retinopathy

51: Diabetic foot disease

Epidemiology

Aetiology

Clinical presentation

Management

Prognosis

52: Diabetic ketoacidosis

Definition and epidemiology

Aetiology

Symptoms and signs

Investigations

Management

Prognosis

53: Hyperglycaemic hyperosmolar state

Definition and epidemiology

Aetiology

Symptoms and signs

Investigations

Management

Prognosis

54: Hypoglycaemia

Definition and epidemiology

Aetiology

Symptoms and signs

Investigations

Management

Prognosis

55: Peri-operative management

Pathophysiological factors

Pre-operative management

Intra-operative management

Postoperative management

56: Management of acute illness

Aims of management

Monitoring

Drug management

Calorie and fluid intake

Special groups for consideration

57: Insulin infusions

Variable-rate intravenous insulin infusion

Fixed-rate intravenous insulin infusion

58: Pregnancy and diabetes

Epidemiology

Pathophysiology

Complications

Pre-conception care

Screening for GDM

Antenatal care

Peri- and postnatal care

Postnatal diabetes screening

59: Genetics of diabetes

Type 1 diabetes

Type 2 diabetes

Maturity onset diabetes of the young

Mitochondrial diabetes

Neonatal diabetes

Monogenic disorders of insulin resistance

60: The multidisciplinary team

Diagnosis and surveillance

Life stages

Disease stages

Setting

61: Lipid disorders

Primary hyperlipidaemias

Secondary hyperlipidaemias

62: Appetite and weight

Central regulation

Gut regulation

Long-term regulation

Clinical assessment

63: Obesity and anorexia

Obesity

Anorexia

Index

EULA

 

Osteoporosis is a common, underdiagnosed, and undertreated condition, complicated by fractures which lead to significant mortality and morbidity. The prevalence of osteoporotic fractures in postmenopausal women exceeds the combined prevalence of breast cancer, stroke, heart failure, and myocardial infarction. Often called "the silent disease," it does not reveal itself with obvious symptoms until a fracture occurs. In the first year after sustaining a hip fracture, mortality is increased by almost 24% in women and is even higher in men. About half of those who sustain an osteoporotic hip fracture become so disabled that they are no longer able to resume their daily activities, and as many as 20% require long-term institutional care. Effective treatments for osteoporosis are now available if it is diagnosed and addressed in a timely manner. Unfortunately, this disease remains shockingly underdiagnosed and undertreated, even in patients who sustain low-trauma hip fractures.
The past two decades have witnessed radical changes in the diagnosis and management of osteoporosis. The densitometric diagnosis of osteoporosis is noninvasive, quick, and relatively simple. Tools are now available to predict the patient's probability of sustaining fractures, to identify patients who are particularly vulnerable, and to determine which patients will benefit from further investigation and treatment. Various associations have developed guidelines to help clinicians reach a diagnosis and initiate treatment. Due to better understanding of the basic pathophysiology of bone turnover, potent and relatively safe medications that significantly reduce the risk of fractures are now widely available. It is of paramount importance that this disease be diagnosed and treated as early as possible in order to take advantage of these developments and reduce the enormous socioeconomic and psychological impact of osteoporosis.
Given the burden of osteoporotic fractures, all clinicians should have a working knowledge of e diagnosis, treatment, and prevention of the disease. Clinicians should feel comfortable diagnosing and initiating treatment for the majority of patients with osteoporosis. Only complicated cases or patients who are unresponsive to treatment should be referred to specialists. The aim of this book is to distill the available information on osteoporosis into an easily comprehensible format that will serve as a practical guide for busy clinicians. Numerous boxes, tables, diagrams, and figures present the information in an accessible manner. This book will be of particular use to general practitioners, endocrinologists, rheumatologists, gynecologists, internists, geriatricians, and orthopedic surgeons.

 

 

Description:

 

 

Description:

Providing summaries of the latest and best publications, clinical trials, and evidence in endocrinology, this portable handbook is a time-saving addition to your professional library. In a concise, easy-to-read format, it offers evidence-based recommendations for the diagnosis and treatment of endocrine disorders and provides a comprehensive summary of pertinent clinical studies supporting the practice recommendations

 

Table of Contents:

 

Chapter 1 Hypothalamic Pituitary Disease

Introduction of the Hypothalamic–Pituitary Axis

Pituitary Adenomas and Sellar Masses

Hypopituitarism

Imaging of the Hypothalamic–Pituitary System

Disorders of the Prolactin System

Acromegaly

Thyroid-Stimulating Hormone Secreting Pituitary Adenomas

Cushing Disease

Diabetes Insipidus

SIADH

References

Chapter 2 Thyroid Disorders

Evaluation of Thyroid Function

Thyroid Imaging

Hyperthyroidism

Hypothyroidism

Thyroid Nodules

Thyroid Cancer

Euthyroid Sick Syndrome

References

Chapter 3 Adrenal Disorders

Evaluation of Adrenal Function

Adrenal Imaging

Primary Hyperaldosteronism

Cushing Syndrome

Adrenal Incidentaloma

Adrenal Insufficiency

Pheochromocytoma

References

Chapter 4 Metabolic Bone Disorders

Evaluation of Metabolic Bone Disorders

Bone Imaging

Osteoporosis

Paget Disease of the Bone

Primary Hyperparathyroidism

Parathyroid Carcinoma

Hypercalcemia

Hypocalcemia

Osteomalacia

Vitamin D Deficiency

References

Chapter 5 Reproductive Disorders

Amenorrhea

Precocious Puberty

Hyperandrogenism

Polycystic Ovary Syndrome

Menopause

Infertility

Male Hypogonadism

References

Chapter 6 Diabetes Mellitus

Epidemiology and Prevalence

Types of Diabetes Mellitus

Clinical Presentation

Screening for Diabetes

Assessing Glycemic Control

Treatment of Diabetes

Inpatient Diabetes Management

Macrovascular Complications of Diabetes

The Impact of Multifactorial Intervention

The Cardiovascular Impact of Treatment of Hyperglycemia

The Cardiovascular Impact of Treatment of Hypertension

The Cardiovascular Impact of Treatment of Hyperlipidemia

The Cardiovascular Impact of Antiplatelet Therapy

Microvascular Complications of Diabetes

Hypoglycemia

Prevention of Diabetes Mellitus

References

Chapter 7 Lipid Disorders

Introduction

Treatment Options for Lowering LDL Cholesterol

Clinical Outcomes Data with PCSK9 Inhibition

Future Studies with PCSK9 Inhibitors

High-Density-Lipoprotein Cholesterol and Triglycerides

Treatment Options for Triglycerides

Summary

References

Chapter 8 Obesity

Definition

Epidemiology

Etiology

Pathophysiology

Evaluation

Treatment

Pharmacotherapy

Bariatric/Metabolic Surgery

References

Chapter 9 Multiple Endocrine Neoplasia

MEN Type 1

MEN Type 2

References

Chapter 10 Carcinoid Tumors

Definition

Pathology

Biology

Epidemiology

Diagnosis

Treatment

Summary

References

Chapter 11 Paraneoplastic Endocrine Syndromes

Hypercalcemia of Malignancy

Hypocalcemia

Tumor-Induced Osteomalacia

Ectopic Adrenocorticotropic Hormone Syndrome

Non–Islet Cell Tumor–Induced Hypoglycemia

Acromegaly

Hyperthyroidism

References

Chapter 12 Genetics

Definition

Etiology

Epidemiology

Pathophysiology

Diagnosis

References

Chapter 13 Transgender Care

Introduction

Definitions

Mental Health

Gender-Affirming Hormone Therapy in Adults

Special Considerations in Management of Gender Nonconforming Children and Transgender Youth

Gender-Affirming Surgery

Conclusion

References

Index

 

 

Description:

Diabetes: Epidemiology, Pathophysiology and Clinical Management aims to be the one-stop diabetes book for researchers, scientists and clinicians. It details the epidemiology, causes, molecular mechanisms, molecular markers, available drugs, experimental drugs, treatment modalities, and dietary and lifestyle approaches related to diabetes. It focuses on various molecular aspects of diabetes, and its related co-morbidities. Apart from the drug-based treatment approach based on international guidelines, this book also describes various surgical treatments available for cases of uncontrolled symptomatic diabetes. It also lays emphasis on the future possibilities of different approaches for diabetes management. Key Features Includes treatment guidelines and approaches to diabetes provided by major global diabetes associations Provides a thorough and comprehensive assimilation of detailed information and updates in the field of diabetes, helpful for researchers, scientists and clinicians Contains a chapter on anti-diabetic drugs, that covers both the commercially approved drugs as well as those that are in various phases of experimental, pre-clinical, and clinical trials

 

Table of Contents:

 

Chapter 1 Diabetes Epidemiology – 1980 and Beyond

Face-to-Face with the Global Diabetes Epidemiology

References

Chapter 2 Diabetes and Inflammation

Introduction

General Mechanism of Inflammation-Induced Insulin Resistance

Macrophage Activation and Insulin Resistance in Obesity

Role of Pro-Inflammatory Cytokines in Diabetes

Tumour Necrosis Factor – α

Interleukins

C – Reactive Protein (CRP)

Toll-Like Receptors

Conclusions

References

Chapter 3 Insulin Resistance and Glucose Regulation

Introduction to Insulin Resistance

Obesity as a Cause of Insulin Resistance

Free Fatty Acids

Adiponectin

TNF-α

Resistin and Interleukin-6

Leptin

Fibroblast Growth Factor 21

Dietary Effect on Insulin Resistance

Fatty Acid Mediated Insulin Resistance

Fructose-Induced Insulin Resistance

Conclusions

References

Chapter 4 Diabetes : A Leading Contributor to Other Disease Complications

Introduction

Pathophysiology of T2DM

Diabetes-Related Complications

Diabetic Retinopathy

Cardiovascular Disorders

Diabetic Nephropathy

Diabetic Neuropathy

Pulmonary Dysfunctions

Hepatic Dysfunction

Other Complications

Periodontitis

Genito-Urinary Infections

Tuberculosis

Gastroparesis

Conclusions

References

Chapter 5 Biomarkers of Diabetes

Biomarkers

Biomarkers for T1DM

Biomarkers for T2DM

Glycated Haemoglobin (HbA1c)

1, 5-Anhydroglucitol (1,5-AG)

Uric Acid

Chromogranin A

Skin and Lens Autofluorescence

References

Chapter 6 Anti-Diabetic Drugs

Introduction

Parenteral Anti-Diabetic Drugs (Insulin)

Oral Anti-Diabetic Drugs

Drugs for Diabetes Insipidus

Drugs from the Labs: The Story of Possibilities

GK Activators

FGF21 Mimetics

PTP-1B Inhibitors

RAGE Inhibitors

References

Chapter 7 Diagnosis and Treatment

Diagnosis of Diabetes

Pharmacological Treatment of Diabetes

Surgical Treatment of Diabetes

References

Chapter 8 Dietary and Lifestyle Management of Diabetes

Importance of Dietary and Lifestyle Management in Diabetes

Metabolic Effects of Exercise

Gut Microbiome and Diabetes: Old Companion with a New Angle

References

Chapter 9 Future Prospects and Recommendations

Index

 

 

Description:

This practical guide presents a concise approach to exploring endocrine pathophysiology through the physical exam, emphasizing common clinical signs in endocrinology that can be elicited through inspection, palpation, percussion or auscultation. The established and proposed mechanisms underlying these physical signs are highlighted, allowing students, residents and trainees to better appreciate endocrine pathophysiology at the bedside.   The text is organized sensibly to facilitate quick and efficient review by medical trainees. Major diseases in endocrinology are grouped by organ systems - pituitary, thyroid, adrenal, and so on. Specific physical examination findings in each primary endocrine disease are reviewed and grouped under the categories of clinical features and pathophysiology, followed by related clinical and pathophysiology pearls. A brief description of the clinical finding is followed by a summary of the pathophysiologic mechanisms underlying the stated clinical finding. Relevant normal physiology and pathophysiology are reviewed where applicable, to facilitate learning.   There are numerous texts on the pathophysiologic basis of diagnostic and laboratory findings in endocrinology. There is, however, no dedicated text to address questions that might be asked by trainees. Endocrine Pathophysiology satisfies this need in the literature. 

 

Table of Contents:

 

1. Pituitary Gland Signs

2. Thyroid Gland Signs

3. Adrenal Gland Signs

4. Pancreatic Gland Signs

5. Parathyroid Gland and Musculoskeletal Signs

6. Reproductive Organ Signs

7. Signs in Disorders of Lipid Metabolism and Obesity

8. Eponymous Terms and Selected Historical Figures in Endocrinology

 

 

 

 

Description:

Ideal for all health care professionals who evaluate, diagnose, treat, or refer patients with endocrine disease or disorders, Manual of Endocrinology and Metabolism, Fifth Edition, brings together nearly 150 global authorities who share their knowledge and expertise on endocrine disorders in children, adolescents, and adults. Using a concise outline format, this thoroughly updated manual presents clinical information and protocols needed in everyday practice, with an emphasis on diagnosis and treatment. Succinct chapters and an abundance of tables and diagrams make complex information easy to find and understand.

 

 

Table of Contents:

 

Section 1 Basic Science of Clinical Endocrinology

1 Clinical Molecular Endocrinology Laboratory Testing

2 Hormone-Resistant States

3 Genetics of Endocrinology

4 The Growth Plate

Section 2 Hypothalamic-Pituitary Dysfunction

5 Anterior Pituitary Diseases

6 Hypopituitarism after Traumatic Brain Injury

7 Prolactin

8 Nipple Discharge/Galactorrhea

9 Acromegaly/Gigantism

10 Clinical Disorders of Vasopressin

11 Preoperative, Intraoperative, and Postoperative Management Following Pituitary Surgery

12 Growth Hormone in Adults

13 Pituitary Disorders and Tall Stature in Children

14 Short Stature and Growth Hormone Therapy

15 Laron Syndrome

16 Prader–Willi Syndrome

Section 3 Adrenal Disorders

17 The Adrenal Cortex and Mineralocorticoid Hypertension

18 Pheochromocytoma and Paraganglioma

19 Hormonal Hypertension

20 Use of Salivary Cortisol Assay to Screen for Cushing Syndrome/Disease

21 Adrenal Hormones during Acute and Chronic Illness: Evaluation and Treatment

22 Congenital Adrenal Hyperplasia

23 Adrenal Steroid Excess in Childhood

24 Adrenal Insufficiency in Childhood

Section 4 Disorders of the Reproductive System

25 Female Reproductive Endocrinology in Adults

26 Polycystic Ovary Syndrome

27 Male Reproductive Disorders in Adults

28 Disorders of Sexual Development in the Pediatric and Adolescent Male

29 Early, Precocious, and Delayed Female Pubertal Development

30 Ambiguous Genitalia

Section 5 Mineral Disorders

31 Disorders of Calciotropic Hormones in Adults

32 Hypercalcemic Crisis

33 Metabolic Bone Disease

34 Parathyroid Hormone-Related Protein

35 Common Bone and Mineral Disorders of Childhood

Section 6 Thyroid Disorders

36 Evaluation of Thyroid Function

37 Thyroiditis

38 Hypothyroidism and Hyperthyroidism

39 Thyroid Tumors in Adults

40 Newborn Thyroid Disorders and Screening

41 Thyroid Nodules and Thyroid Cancer in Children and Adolescents

42 Thyroid Disorders in Children and Adolescents

Section 7 Metabolic Disorders

43 Obesity

44 Disorders of Lipid Metabolism

45 Hypoglycemia in Adults

46 Hypoglycemia in Infants and Children

47 Congenital Hyperinsulinism

Section 8 Inborn Errors of Metabolism

48 Introduction to Inborn Errors of Metabolism

49 Glycogen Storage Diseases

50 Hypokalemic Paralysis

Section 9 Diabetes Mellitus

51 Etiology, Pathogenesis, and Therapy of Type 1 Diabetes Mellitus

52 Diagnosis and Management of Type 1 Diabetes Mellitus in Children, Adolescents and Young Adults

53 Hypoglycemia-Associated Autonomic Failure (HAAF) in Diabetes Mellitus

54 Diabetic Ketoacidosis

55 Type 2 Diabetes Mellitus

56 Glucose Control in Glucocorticoid-Induced Hyperglycemia

57 Bariatric Surgery in Adults with Type 2 Diabetes

58 Diabetes Mellitus and the Geriatric Patient

59 Diabetes Mellitus Type 2, Obesity, Dyslipidemia, and the Metabolic Syndrome in Children

60 Type 1.5 Diabetes: Overlay between Type 1 and Type 2 Diabetes

61 C-Peptide

62 Cystic Fibrosis Related Diabetes

63 Diabetes in Pregnancy

64 Management of Diabetes Mellitus in the Perioperative Period

65 Diabetes Mellitus: Recent Developments and Clinical Implications

66 Artificial Pancreas

67 Glycated Proteins in the Diagnosis and Management of Type I and Type II Diabetes Mellitus

68 Inhaled Insulin

69 The Application of Stem Cells in Diabetes Mellitus

Section 10 Sex Hormone Treatments

70 The Care of Gender-nonconforming and Transgender Youth

71 Hormone Therapy in Transgender Adults

72 How to Manage Men with Low Testosterone

73 The Use of Hormones in Female Sexual Dysfunction

74 Menopausal Hormone Therapy

Section 11 Special Topics in Clinical Endocrinology

75 Endocrine Diseases in Pregnancy

76 Fetal Endocrinology and Neonatal Emergencies

77 Hormones and Aging

78 Neuroendocrine (APUD) Syndromes

79 Multiple Endocrine Neoplasia Syndromes

80 Radiology, Nuclear Medicine, and Endocrinology

81 Surgery for Endocrine Disorders

82 Surgical Management of Pediatric Endocrine Diseases

83 Biomarkers Used in the Screening, Diagnosis, Management, and Surveillance of Endocrine Cancers

84 Autoimmune Endocrine Syndromes

85 Management of Some Hormone-Dependent Cancers with Analogs of Hypothalamic Hormones

86 Endocrine-Disrupting Chemicals

87 Flushing and Sweating

88 Intranasal Hormones

89 The Female Athlete

Appendix A Protocols for Stimulation and Suppression Tests Commonly Used in Clinical Endocrinology

Index

 

 

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Description:

Developed from time-tested material utilized in endocrinology courses for medical students, this comprehensive and practical guide draws together a number of related disciplines to create a straightforward and accessible approach to the study of endocrine and metabolic diseases. Designed with the student in mind, each of the main endocrine organs and disorders are covered in thematic sections on diabetes, thyroid disorders, calcium disorders, adrenal disorders, and hypothalamus and pituitary disorders. Opening with clear learning objectives, chapters within each section discuss core concepts, anatomy, embryology, histology, testing, diagnosis and pharmacology, and include clinical case scenarios and multiple choice review questions. Full-color figures and diagrams enhance and extend the content.  Perfect for in-class reference or board licensing review, Essentials of Endocrinology and Metabolism is an indispensable resource for medical and nursing students alike.

 

Table of Contents:

 

1. Introduction to Endocrinology Concepts

Part I. Diabetes

2. Getting Prepared Series for Diabetes

3. Diabetes Types and Diagnosis

4. Diabetes Complications

5. Diabetes Pharmacology

6. Diabetes Cases

Part II. Thyroid

7. Getting Prepared Series for Thyroid

8. Abnormal Thyroid Function

9. Thyroid Testing

10. Thyroid Pharmacology

11. Thyroid Nodules and Cancer

12. Thyroid Cases

Part III. Calcium

13. Getting Prepared Series for Calcium

14. Hypercalcemia

15. Hypocalcemia

16. Calcium Pharmacology

17. Calcium Cases

Part IV. Adrenal

18. Getting Prepared Series for Adrenal

19. Adrenal Cortex

20. Adrenal Testing

21. Adrenal Pharmacology

22. Secondary Hypertension

23. Adrenal Cases

Part V. Hypothalamus and Pituitary

24. Getting Prepared Series for Pituitary

25. Prolactin

26. Growth Hormone

27. Reproductive Function

28. Posterior Pituitary

29. Pituitary Cases

30. Puberty Cases

Back Matter

 

Description:

Offering current guidelines on the relatively new practice of puberty suppression for gender-dysphoric adolescents, Pubertal Suppression in Transgender Youth provides a succinct, easy-to-digest overview of this timely topic. This concise, clinically-focused resource by Dr. Courtney Finlayson covers all relevant topics, from a brief history of medical care of transgender youth to emerging developments in the field.

 

 Table of Contents

 

·  Copyright

·  List of Contributors

·  Chapter 1. History of Care of Transgender Youth

·  Dedication

·  Chapter 2. Models of Care and Current Guidelines for Care of Transgender Individuals

·  Gender-Affirming Care

·  Multidisciplinary Care

·  Practice Guidelines

·  Mental Healthcare

·  Medical Care

·  Adjunctive Services

·  Barriers to Care

·  Summary

·  Chapter 3. Puberty

·  Physical Changes Associated With Puberty

·  Physiology of Puberty

·  Delayed Puberty or Absent Puberty (Sexual Infantilism)

·  Precocious Puberty (Sexual Precocity)

·  Chapter 4. GnRH Analogs (Mechanism, Past Studies, Drug Options, Use in Precocious Puberty, Use in Gender-Nonconforming Youth)

·  Historical Perspective

·  Physiology and Mechanism of Action

·  Use in Central Precocious Puberty

·  Outcomes in Central Precocious Puberty

·  Use in Gender-Nonconforming Youth

·  Options for Treatment

·  Outcomes in Gender-Nonconforming Youth

·  Challenges in Care

·  Conclusion

·  Chapter 5. Rationale for the Initiation, Use, and Monitoring of GnRHa in Gender Non-conforming Youth

·  Introduction

·  Rationale

·  Initiation

·  Monitoring

·  Conclusion

·  Chapter 6. Psychosocial Considerations in Pubertal Suppression Treatment

·  Introduction

·  Possible Effects of Gonadotropin-Releasing Hormone Analogues on Gender Identity and/or Sexuality Development

·  Unknown Neurocognitive Sequelae of Pubertal Suppression Treatment

·  Psychosocial Implications of Known Medical Side Effects of Gonadotropin-Releasing Hormone Analogue Treatment

·  Family Factors

·  Conclusion

·  Chapter 7. Medical Side Effects of GnRH Agonists

·  Bone Health

·  Brain

·  Fertility

·  Body Mass Index and Body Composition

·  Summary

·  Chapter 8. Surgical Side Effects of GnRHa

·  Introduction

·  Goals of Surgery

·  Timing of Surgery

·  Surgical Considerations for Individuals on GnRHa

·  Areas of Uncertainty

·  Conclusion

·  Chapter 9. Fertility Preservation: Considerations for Gender-Diverse Youth

·  Risk of Infertility due to Hormonal Therapies

·  Fertility Preservation Options in Birth-Assigned Males

·  Fertility Preservation Options in Birth-Assigned Females

·  Attitudes Toward FP and Other Psychological Considerations

·  Ethical Considerations

·  Financial Considerations

·  Future Directions

·  Conclusions

·  Chapter 10. Duration of Pubertal Suppression and Initiation of Gender-Affirming Hormone Treatment in Youth

·  Pubertal Suppression and Gender-Affirming Hormone Therapies

·  Relevant Time Points in Clinical Guidelines and Protocols

·  Unresolved Questions

·  Case Examples

·  Initiation of Gender-Affirming Hormones

·  Testosterone

·  Estrogen

·  Conclusions

·  Chapter 11. Ethical Considerations of GnRHa Treatment and Consent Process

·  Introduction

·  Pubertal Suppression

·  Benefits of Pubertal Suppression

·  Ethical Issues

·  Conclusion

·  Chapter 12. Emerging Developments in Pubertal Suppression for Gender Incongruent/Gender Dysphoric Youth

·  Triptorelin, a New Gonadotropin-Releasing Hormone Agonist

·  Prolonged Use of Histrelin acetate implant in Transgender Youth

·  Gonadotropin-Releasing Hormone Agonist Use in Nonbinary Youth

·  Gonadotropin-Releasing Hormone and Gonadotropin Antagonists

·  Kisspeptin and Neurokinin B Antagonists

·  Oxandrolone as an Alternative Gender-Affirming Masculinizing Hormone

·  Low-Dose Estrogen and Testosterone

·  Antiandrogens and Androgen Receptor Inhibitors

·  Antiandrogens

·  Conclusion

 

 

Imaging in Endocrinology will provide endocrinologists and radiologists of all levels with an outstanding diagnostic imaging atlas to aid them in the diagnosis and management of all the major endocrine diseases they are likely to encounter. In full colour throughout, the 300 high–quality images consist of CT scans, MRI, NMR and histopathology slides, and are arranged by each specific endocrine condition, resulting in a visually outstanding and easily accessible tool that guides the user through exactly what to look out for and provides a practical and extremely useful aid in helping them formulate a diagnosis.

Every major endocrine condition is covered in a specific section, including diseases of the thyroid, pituitary, reproductive and adrenal glands, the pancreas, bone metabolism problems, and the various forms of endocrine cancers. Each disease covered will offer a comparison of the normal findings so as to further assist in diagnosis.
An accompanying website contains an online slide–atlas of all the figures in the book, to allow users to download all figures for use in presentations. Led by Paolo Pozzilli, an internationally–recognised expert in this field, the authors have assembled a wonderful collection of images that will be greatly valued by endocrinologists and radiologists alike, ensuring this is the perfect tool to consult when assessing patients with endocrine disease.

The revised and updated fourth edition of Practical Endocrinology and Diabetes in Children offers a practical, highly clinical and up-to-date handbook of paediatric endocrinology and diabetes. The book is written in clear terms and offers a user-friendly format that is designed to be concise, yet comprehensive.. The international panel of expert contributors explore the range of endocrine disorders in children including growth, thyroid, adrenal and problems related to puberty.

 

About this Textbook

 Diabetes has become a worldwide health problem, the global estimated prevalence approaches ten percent and the burden of this disease in terms of morbidity and mortality is unprecedented. The advances acquired through the knowledge of the mechanisms of the disease and the variety of therapeutic approaches contrast with the inability of private and public health systems in underdeveloped and even developed countries to achieve the goals of treatment. This paradox has been described in many sources: the surge of scientific advances contrast with an unprecedented amount of human suffering. Thus, a patient centered and an evidence-based approach with the capacity to produce measurable clinical and economic outcomes is required.

The purpose of this textbook is multiple: to offer a comprehensive resource covering all aspects of outpatient management; to address diabetes as a health problem from an epidemiological, economic and clinical perspective; to discuss the role of social determinants of health on the worldwide increase in diabetes; to highlight the challenges and obstacles in providing adequate care; and to outline a multidisciplinary approach to management in which medical visits retain their importance as part of a team comprising the patient, his or her family and a multidisciplinary group of health professionals who are able to move beyond the traditional approach of diabetes as a disease and greatly improve outcomes.

 

Table of contents (64 chapters)

 

Preface: A New Disease?

Pages 1-8

Rodriguez-Saldana, Joel

The Dynamics of Diabetes Prevalence, Morbidity, and Mortality

Pages 11-21

Gregg, Edward W. (et al.)

Economic Costs, from Individuals to Health Systems: Evidence from a Middle-Income Country

Pages 23-32

Arredondo, Armando (et al.)

The Ecological Approach to Self-Management in Diabetes

Pages 33-59

Fisher, Edwin B. (et al.)

Social Determinants of Health and Diabetes Outcomes

Pages 61-69

Hashimoto, Hideki

Definition, Diagnostic Criteria, Screening, Diagnosis, and Classification of Diabetes and Categories of Glucose Intolerance

Pages 71-85

Nandhini, Lakshmana Perumal (et al.)

Pathophysiology of Type 1 Diabetes

Pages 89-99

Gómez-Díaz, Rita A.

Pathophysiology of Type 2 Diabetes

Pages 101-116

Kesavadev, Jothydev (et al.)

Genetic Determinants of Type 2 Diabetes

Pages 117-125

Cruz, Miguel (et al.)

Gene Expression Modifications in Type 2 Diabetes

Pages 127-144

Suarez-Sanchez, Fernando (et al.)

The Immune System and Inflammation in Type 2 Diabetes

Pages 145-167

Macedo, Rebeca García

Dysfunction and Death of Pancreatic Beta Cells in Type 2 Diabetes

Pages 169-184

Ortega-Camarillo, Clara

Obesity in the Pathophysiology of Diabetes

Pages 185-213

Paniagua González, Juan Antonio (et al.)

Pathogenesis of Gestational Diabetes Mellitus

Pages 215-225

Kintiraki, Evangelia (et al.)

Non-alcoholic Fatty Liver in the Pathogenesis of Diabetes

Pages 227-235

Villela Nogueira, Cristiane A. (et al.)

Diabetes Management in Asia

Pages 239-253

Shivashankar, Roopa (et al.)

Diabetes Management in the United States

Pages 255-271

Ali, Mohammed K. (et al.)

Diabetes Management in Africa

Pages 273-288

Choukem, Simeon Pierre (et al.)

The Patient-Centered Medical Home, Primary Care, and Diabetes

Pages 291-304

Rodriguez-Saldana, Joel

Outpatient Diabetes Management and the Chronic Care Model

Pages 305-332

Rodriguez-Saldana, Joel

Clinical Practice Guidelines, Evidence-Based Medicine, and Diabetes

Pages 333-355

Rodriguez-Saldana, Joel

Measuring Diabetes Quality of Care: Clinical Outcomes, Cost-Effectiveness, and Patient Experience of Care

Pages 357-365

O’Connor, Patrick J. (et al.)

Clinical Inertia: The Role of Physicians in Diabetes Outcomes

Pages 367-380

Rodriguez-Saldana, Joel

Patient Adherence: Challenges, Myths, and Realities

Pages 381-400

Rodriguez-Saldana, Joel

Challenges and Opportunities in Diabetes Education

Pages 403-416

Dickinson, Jane K. (et al.)

Diabetes and Mental Health: From Distress to Depression

Pages 417-428

Heinze, Gerhard (et al.)

Tools of Self-Care: Self-Monitoring of Blood Glucose and Tele-Health Resources

Pages 429-450

Ginsberg, Barry H.

Continuous Glucose Monitoring in Clinical Practice: Ambulatory Glucose Profile and the Application of Advanced Glucose Sensing Technologies to Clinical Decision-Making

Pages 451-462

Mazze, Roger S.

Type 2 Diabetes and Lifestyle Medicine

Pages 463-476

Galaviz, Karla I. (et al.)

Evidence and Implementation of Medical Nutrition Therapy in Persons with Diabetes

Pages 477-483

Maryniuk, Melinda Downie (et al.)

Evidence and Implementation of Physical Activity and Exercise

Pages 485-498

Jáuregui-Ulloa, Edtna (et al.)

The “Old” Oral Antidiabetics

Pages 501-513

Buhse, Susanne (et al.)

Incretin Therapies: Current Use and Emerging Possibilities

Pages 515-529

Schlögl, Haiko (et al.)

Sodium-Glucose Cotransporter 2 Inhibitors

Pages 531-539

Dailey, George, III (et al.)

Use of Insulin in Outpatient Diabetes Management

Pages 541-554

Faradji, Raquel N. (et al.)

Insulin Pump Therapy

Pages 555-570

Faradji, Raquel N. (et al.)

Diabetes and Hypertension

Pages 573-585

Khangura, D. (et al.)

Diabetes and Atherogenic Dyslipidemia

Pages 587-596

Mooradian, Arshag D.

Obesity and Diabetes

Pages 597-610

Wharton, Sean (et al.)

Diabetes and Smoking: The Burden of Evidence

Pages 611-616

Aggarwal, Sameer (et al.)

Diabetic Ketoacidosis

Pages 619-627

Umpierrez, Guillermo E.

Hypoglycemia: Diagnosis, Management, and Prevention

Pages 629-653

Faradji, Raquel N. (et al.)

Inpatient Management of Diabetes and Hyperglycemia

Pages 655-668

Horton, William B.

Diabetes and Infection

Pages 669-691

Atreja, Atulya (et al.)

Biochemical Mechanisms of Vascular Complications in Diabetes

Pages 695-707

Margarita Díaz-Flores, (et al.)

Diabetes and Cardiovascular Disease

Pages 709-730

Coutiño-Castelán, Daniel (et al.)

Diabetes and Stroke: The Role of Glucose Regulation

Pages 731-746

Lowe, Forrest (et al.)

Peripheral Arterial Disease and Diabetes Mellitus

Pages 747-763

Cheun, Tracy J. (et al.)

Ophthalmic Disease in Diabetes

Pages 765-775

Henriques, José (et al.)

Diabetes and Oral Health

Pages 777-790

Díaz-Romero, Rosa Maria (et al.)

Renal Disease in Diabetes

Pages 791-807

Garza-García, Carlos A. (et al.)

Peripheral Diabetic Neuropathies

Pages 809-823

Feher, Gergely

Diabetic Cardiac Autonomic Neuropathy

Pages 825-850

Serhiyenko, Viktoria (et al.)

Autonomic Visceral Neuropathy and Gastrointestinal Disorders

Pages 851-861

Drewes, Anne Mohr (et al.)

Urologic Complications in Patients with Diabetes

Pages 863-871

Casco, Stephania (et al.)

Musculoskeletal Complications of Diabetes Mellitus

Pages 873-881

Singla, Rajiv (et al.)

Diabetes and the Skin

Pages 883-898

Mestdagh, Justine (et al.)

Foot Complications

Pages 899-918

Harkless, Lawrence B. (et al.)

Diabetes and Cancer

Pages 919-937

Krajewska (Wojciechowska), Joanna (et al.)

Diabetes in Children and Adolescents

Pages 941-966

Miranda Lora, América Liliana (et al.)

Pregnancy: Pregestational and Gestational Management

Pages 967-976

García-Argueta, María Isabel (et al.)

The Elderly with Diabetes

Pages 977-989

Valencia-Rodrigo, Willy Marcos

The Artificial Pancreas

Pages 993-998

Ginsberg, Barry H. (et al.)

Unproven Therapies for Diabetes

Pages 999-1013

Kesavadev, Jothydev (et al.)

 

This timely and clinically oriented book uniquely addresses the entire spectrum of treatment for severe obesity and diabetes. It thoroughly examines all aspects from robotic surgery to cell therapy, from the latest antidiabetic drugs to endoscopic procedures and devices, from appetite-inhibiting signals and nutrients to gastric arterial embolization. It offers objective and authoritative information for practicing professionals; not only are successful interventions discussed and updated, but cutting-edge and experimental pathways are also anticipated.

Obesity is the foremost nutritional challenge worldwide. Its companion is type-2 diabetes, the most prevalent metabolic disease. Together they represent the diabesity epidemic, which is draining resources, overwhelming healthcare facilities, and impacting life expectancy and quality of life everywhere. No country has been spared, and most medical specialties have been affected. Many books focus on the surgical options for obesity and diabetes, namely bariatric and metabolic operations. Information on the clinical and pharmacological treatment is also available, conveyed by standard texts on internal medicine and endocrinology. Yet endoscopic maneuvers and prostheses, cell therapy for diabetes, and other innovative approaches are hard to come by, as conventional texts overlook such therapies. This timely publication bridges the gaps between all different therapeutic options, also covering advances in the conservative, surgical and parasurgical domains.

This book will appeal to seasoned specialists, students and healthcare professionals in training alike.

 

Description:   An ideal resource for both pediatricians and endocrinologists, Sperling’s Pediatric Endocrinology, 5th Edition, brings you fully up to date with accelerating research; new discoveries in metabolic, biochemical and molecular mechanisms; and the resulting advances in today’s clinical care. The editorial team of world-renowned pediatric endocrinologists led by Dr. Mark Sperling, as well as expert contributing authors, cover comprehensive and current aspects of both basic science and clinical practice. Whether you’re preparing for certification or have extensive clinical experience, this detailed, authoritative reference helps you increase your knowledge and determine the best possible course for every patient.   Key Features:   Delivers trusted guidance in every area of the field: including Endocrine Disorders of the Newborn, Endocrine Disorders of Childhood and Adolescence, and Laboratory Tests. Features new topics such as transgender issues in children and adolescents and endocrinology of pregnancy, the fetus and the placenta. Offers expert coverage of hot topics such as disorders of sexual development, molecular basis of endocrine disorders, hypoglycemia in newborns and infants; neonatal and other monogenic forms of diabetes; Type I and Type II diabetes and their treatment with new insulins together with the progress in an artificial pancreas and new medications for T2DM in adolescents; the obesity epidemic and role of bariatric surgery; and advances toward personalized medicine. Includes easy-to-follow algorithms and numerous quick-reference tables and boxes in every clinical chapter, plus interactive questions online for self-assessment. Offers state-of-the-art information and fresh perspectives from new and award-winning authors in such areas as disorders of growth, multiple endocrine tumors, and puberty and its disorders in girls and boys. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
Table Of Contents:
SECTION I Principles and Methods of Pediatric Endocrinology, 1 1. Overview and Principles of Pediatric Endocrinology, 1 Mark A. Sperling 2. Molecular Endocrinology, Endocrine Genetics, and Precision Medicine, 9 Ram K. Menon, Massimo Trucco, Joseph A. Majzoub, Constantine A. Stratakis 3. Receptor Transduction Pathways Mediating Hormone Action,   30 Bassil Kublaoui, Michael A. Levine 4. Endocrinology Laboratory Testing, 86 Jon Nakamoto SECTION II Endocrine Disorders in the Neonate, 106 5. Fetal-Maternal Endocrinology and Parturition, 106 Sam Mesiano, Helen N. Jones, Heide Aungst, Tani Malhotra, Louis J. Muglia 6. Ambiguous Genitalia, 123 Selma Feldman Witchel, Peter A. Lee 7. Hypoglycemia in the Newborn and Infant, 175 Diva D. De Leon, Paul Thornton, Charles A. Stanley, Mark A. Sperling 8. Disorders of the Thyroid in the Newborn and Infant, 202 Johnny Deladoey, Julia Elisabeth von Oettingen, Guy Van Vliet 9. Disorders of Mineral Metabolism: Normal Homeostasis, 220 Allen W. Root 10. Monogenic Diabetes Mellitus: Neonatal Diabetes and Maturity-Onset Diabetes of the Young, 279 Siri Atma W. Greeley*, Mary K. McCauley*, Louis H. Philipson, Mark A. Sperling *Authors contributed equally to this chapter SECTION III Childhood and Adolescent Endocrinology, 299 11. Disorders of Childhood Growth, 299 Alexander A.L. Jorge, Adda Grimberg, Mehul T. Dattani, Jeffrey Baron 12. Disorders of the Posterior Pituitary, 357 Abhinash Srivatsa, Joseph A. Majzoub 13. Thyroid Disorders in Children and Adolescents, 395 Scott Rivkees, Andrew J. Bauer 14. The Adrenal Cortex and Its Disorders, 425 Walter L. Miller, Christa E. Flück, David T. Breault, Brian J. Feldman 15. Pheochromocytoma/Paraganglioma, Medullary Thyroid Carcinoma, and Hereditary Endocrine Neoplasia Syndromes, 491 Steven G. Waguespack, Lauren Fishbein 16. Puberty in the Female and Its Disorders, 528 Robert L. Rosenfield, David W. Cooke, Sally Radovick 17. Turner Syndrome, 627 Philippe Backeljauw, Steven D. Chernausek, Claus Højbjerg Gravholt, Paul Kruszka 18. Puberty and Its Disorders in the Male, 661 Mark R. Palmert, Yee-Ming Chan, Leo Dunkel 19. Care of Transgender/Gender Nonconforming Youth, 695 Stephen M. Rosenthal, Amy B. Wisniewski 20. Disorders of Mineral Metabolism II. Abnormalities of Mineral Homeostasis in the Newborn, Infant, Child, and Adolescent, 705 Allen W. Root, Michael A. Levine 21. Diabetes Mellitus, 814 Mark A. Sperling, Joseph I. Wolfsdorf, Ram K. Menon, William V. Tamborlane, David Maahs, Tadej Battelino, Moshe Phillip 22. Autoimmune Polyglandular Syndromes, 884 Bimota Nambam, Michael J. Haller, William E. Winter, Desmond Schatz 23. Hypoglycemia in the Toddler and Child, 904 Joseph I. Wolfsdorf, Charles A. Stanley 24. Obesity, Metabolic Syndrome and Disorders of Energy Balance, 939 Joan C. Han, Ram Weiss 25. Lipid Disorders in Children and Adolescents, 1004 Stephen R. Daniels, Sarah C. Couch Index, 1022 Interactive questions for self-assessment can be found in the e-book; see inside front cover for details.

 

 

DESCRIPTION

The revised and updated third edition of the essential guide to the diagnosis and treatment of the diabetic foot

The revised third edition of the Atlas of the Diabetic Foot is an updated guide to the information needed for the prevention and treatment of diabetic foot problems with the aim of reducing amputations. In addition to offering the theoretical knowledge, the book is filled with more than 500 color photos from real-life cases. The cases explore a wide-variety of foot issues and the text includes information about differential diagnosis and treatment. The authors—noted experts in the field—describe the epidemiology, pathophysiology and classification of diabetic foot ulcers. In addition, the book highlights the diagnosis of the main risk factors for the diabetic foot, namely diabetic neuropathy, peripheral arterial disease and the anatomic deformities of the lower extremities.

The updated third edition, include 5 videos that clearly demonstrate the methods of examination for diabetic neuropathy and peripheral arterial disease. The text includes methods of callus removal and debridement as well as offloading. In addition, it contains information on how a total contact cast is constructed. This essential resource:

·         Contains a full color presentation of diabetic foot cases

·         Explains the prevention and treatment of diabetic foot problems in a revised and updated edition

·         Includes a larger format that allows for a better quality images

·         Offers a companion website with high-resolution digital files of photographs of the case studies presented

·         Presents a multidisciplinary approach appropriate for a wide audience foot and diabetic professionals

Written for diabetes specialists, endocrinologists and diabetic nurse specialists, podiatrists and podiatry nurse specialists, Atlas of the Diabetic Foot offers the information needed to help with the prevention, diagnosis and management of the diabetic foot.

TABLE OF CONTENTS

Preface to the Third Edition vii

Preface to the Second Edition ix

Preface to the First Edition xi

Acknowledgements xiii

About the Companion Website xv

1 Introduction 1

2 Diabetic Neuropathy 11

3 Anatomic Risk Factors for Diabetic Foot Ulceration 23

4 Other Foot-Related Risk Factors 49

5 Skin and Systemic Diseases with Manifestations in the Feet 63

6 Neuropathic Ulcers 75

7 Peripheral Vascular Disease 91

8 Ischemic and Neuro-Ischemic Ulcers and Gangrene 107

9 Heel Ulcers 135

10 Charcot Foot 147

11 Infections 169

12 Methods of Prevention 197

13 Methods of Ulcer Healing 205

14 Amputations 229

Appendix 237

Index 239

 

 

Description

The clinical laboratory plays a critical role in the diagnosis and management of endocrine and related metabolic disorders, which are leading causes of morbidity and mortality in children and adults. The Handbook of Diagnostic Endocrinology, Third Edition, provides a ready reference for the evaluation, diagnosis, and monitoring of such disorders. This revision incorporates translational medicine, connecting what clinicians need to know with those in research providing a clinical context to which they can relate their molecular findings. This book solves the needs of clinicians and researchers by bringing together in one book endocrinology at the molecular and clinical levels. As the intricacies of intracellular signaling have become better understood, states of hormone resistance are now increasingly recognized. The most common endocrinopathy in westernized countries, the metabolic syndrome, results, to a large extent, from insulin resistance. The complexity of the circulating forms of various hormones are acknowledged in this revision.

Key Features

Each chapter focuses on the biochemical tests that are required, either in the basal state or following provocation or suppression, to assist in the diagnosis of the various disorders

Describes proper sample collection and relevant interpretations of laboratory tests

Contains essential molecular biology and incorporates it with the clinical information

Includes the discovery of new diagnostic and treatment methods

Readership

Clinical chemists, chemical pathologists, endocrinologists, and senior medical technologists to aid them in the investigation of endocrine and metabolic disorders

Table of Contents

Maximizing the value of laboratory tests
Raffick A.R. Bowen, Roger L. Bertholf and Brett Holmquist
2. Laboratory investigation of disorders of the pituitary gland
Verena Gounden, Charlotte C. Ellberg and Ishwarlal Jialal
3. Thyroid disease and laboratory assessment
Sridevi Devaraj and Emily Garnett
4. Disorders of the adrenal gland
Roger L. Bertholf
5. Endocrine disorders of the reproductive system
Angela M. Ferguson and Mark A. Cervinski
6. Gastroenteropancreatic tumors
Neeraj Ramarishnan, Seong Hyun Ahn and Ishwarlal Jialal
7. Evaluation of hypoglycemia
William E. Winter and Neil S. Harris
8. Evaluation of hyperglycemia
William E. Winter, David L. Pittman, Sridevi Devaraj, Danni Li and Neil S. Harris
9. Lipoproteins
Anna Wolska and Alan T. Remaley
10. Disorders of calcium metabolism
William E. Winter and Neil S. Harris
11. Laboratory evaluation of endocrine hypertension
William E. Winter and Neil S. Harris
12. Malignancy-associated endocrine disorders
Lori J. Sokoll and Daniel W. Chan
13. Laboratory assessment of acquired immunodeficiency syndrome endocrinopathies
Verena Gounden and Manisha Chandalia
14. Laboratory evaluation of short stature in children
William E. Winter
15. Pregnancy and the fetus
K. Aaron Geno, Mark A. Cervinski and Robert D. Nerenz
16. Disorders of sexual development
William E. Winter, Paul Hiers and Dina N. Greene
17. Transgender endocrinology
Dina N. Greene, Tamar Reisman and Zil Goldstein
18. The endocrinology of aging
Daniel T. Holmes and Gregory Kline

 

 Childhood obesity has reached epidemic proportions in the United States and continues to increase in prevalence in almost all countries in which it has been studied, including developed and developing countries around the globe. The causes of obesity are complex and multi-factorial. Childhood obesity becomes a life-long problem in most cases and is associated with long term chronic disease risk for a variety of diseases including type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease, as well as psychosocial as issues and obesity seems to affect almost every organ system in the body. 

In recent years there has been tremendous progress in the understanding of this problem and in strategies for prevention and treatment in the pediatric years. Childhood Obesity: Causes, Consequences, and Intervention Approaches presents current reviews on the complex problem of obesity from the multi-level causes throughout early life before adulthood and the implications for this for long-term disease risk. It reviews numerous types of strategies that have been used to address this issue from conventional clinical management to global policy strategies attempting to modify the global landscape of food, nutrition, and physical activity. Each chapter is written by a global authority in his or her respective field with a focus on reviewing the current status and recent developments.

The book features information on contributing factors to obesity, including developmental origins, social/family, birth cohort studies, influence of ethnicity, and global perspectives. It takes a life-course approach to the subject matter and includes exhaustive treatment of contributing factors to childhood obesity, such as assessment, environmental factors, nutrition and dietary factors, host factors, interventions and treatment, consequences, and further action for future prevention. This broad range of topics relevant to the rapidly changing field of childhood obesity is suitable for students, health care professionals, physicians, 

 At the dawn of precision medicine, there is a new opportunity for novel approaches to understand, diagnose and treat endometrial disorders that affect fertility, reproductive outcomes, and women’s health more broadly. Herein, the editors have assembled critically evaluated state-of-the-art chapters presenting basic and clinical knowledge about the human endometrium that impacts or will impact clinical practice. All clinicians and researchers in Reproductive Medicine will find this book useful as a reference and a valuable tool for continued advancement in the understanding and management of the "endometrial factor".

 The Third Edition of Medical Management of Thyroid Disease provides the most up-to-date practical guidance for the diagnosis and management of common and uncommon thyroid diseases. It reflects the advancement in guidelines and research for thyroid cancer, nodules and hypothyroidism; all presented in an accessible format with more illustrations and algorithms for management. The contributions of internationally renowned endocrinologists present the clinical aspects from the world’s perspective.

Key Features

• Completely revised and updated

• Reorganized with more algorithms for quick reference and enhanced usability

• Edited by internationally renowned physicians in the field

• Authoritative, comprehensive and yet easily digestible

The acclaimed clinical guide to managing both pediatric endocrine disorders and inborn errors of metabolism

No other text so skillfully blends the disciplines of endocrinology and inborn metabolic disorders into one clinically focused, highly visual resource as Pediatric Endocrinology and Inborn Errors of Metabolism.

In this practical, user-friendly tutorial, a team of international contributors delivers the latest information and clinical insights clinicians need to confidently diagnose and manage pediatric patients. This full-color resource guides readers through the etiology, pathophysiology, presenting signs and symptoms, diagnostic laboratory examinations, and treatments regimens of each disorder. Pediatric Endocrinology and Inborn Errors of Metabolism successfully balances authority and comprehensiveness with a strong clinical, practical approach that delivers an unmatched integrated discussion of the fields.

• Full-color presentation with numerous photos, illustrations, diagnostic algorithms, tables, and text boxes that summarize key concepts and assist in the decision-making process

• At-a-Glance feature beginning each disease-based chapter summarizes all the clinical information you need to differentiate between disorder sub-types in one easy-to-find place 

• Complete and detailed information on all laboratory and radiographic testing used to diagnose disorders in both disciplines

Features:
• Provides a cutting-edge, problem-orientated approach to the management of clinical problems in endocrinology
• Presents complete updates of existing chapters and new research data, diagnostic techniques, treatment options, and safety concerns
• Discusses neuroendocrine disease and examines strides made by the identification of aryl hydrocarbon receptor–interacting protein mutations
• Reviews changes in diagnostic imaging
• Explores the rapidly increasing incidence of neuroendocrine tumors and their management
• Reviews the endocrinology of aging
• Includes protocols for pituitary function testing

Summary:
Endocrinology is a complex specialty that spans a wide range of diseases, disorders, and conditions. The field is now moving toward an increasingly personalized approach to patient management, with a greater focus on mechanisms of disease and biomarkers. Written by internationally renowned specialists, the second edition of Endocrinology in Clinical Practice provides a cutting-edge, problem-orientated approach to the management of clinical problems in endocrinology.
Highlights of the new edition include:
• An overview of neuroendocrine disease
• Strides made by the identification of aryl hydrocarbon receptor–interacting protein mutations in patients with familial isolated pituitary adenomas
• The diverse roles of IGF-I
• Changes in diagnostic imaging and the increasing use of positron emission tomography
• The rapidly increasing incidence of neuroendocrine tumors and their management
• Hereditary primary hyperparathyroidism and multiple endocrine neoplasia
• Mechanistic and genomic advances related to disorders of calcium regulation and infertility
• The endocrinology of aging
• Protocols for pituitary function testing With complete updates to existing chapters, the second edition also presents new research data, diagnostic techniques, treatment options, and safety concerns related to existing therapies. This edition offers current guidance and scientifically focused information relevant to a range of clinical problems, making it an essential reference for practicing endocrinologists and specialist clinicians.

 The Essential Guide to Recognizing and Treating Acute Endocrine and Metabolic Illness

Endocrinology covers some of the most common conditions and serious public health challenges facing medicine today, and endocrine and metabolic emergencies constitute a large proportion of the clinical workload. Endocrine and Metabolic Medical Emergencies: A Clinician’s Guide provides a singular reference to help endocrinologists, acute and general medicine clinicians, hospitalists and critical care physicians, and general practitioners recognize the symptoms of endocrine emergencies and provide the highest standards of care. Already the definitive and most comprehensive guide to endocrine emergency care, this new second edition: provides acute care guidance for a range of both common and unusual endocrine emergencies; details the effects of acute medical and critical illness on metabolic and endocrine systems, and their impacts on endocrine investigations; discusses special patient populations, including the impacts of aging, pregnancy, transplantation, late-effects, perioperative, inherited metabolic disorders and HIV/AIDS on presentation and management; and features detailed coverage of disorders by system, as well as, metabolic bone diseases, neuroendocrine tumors, and more.

Packed with case studies, images, and chapters written by distinguished authors, this guide is designed for both quick reference and study. Coverage includes the presentation, diagnosis, management, and treatment of endocrine and metabolic disorders in an acute care setting, as well as the most up-to-date guidance on issues including clinical lipidology, glucose, sodium, calcium and phosphate, and more.

Blending the latest science with clinical and practical advice, this invaluable resource helps clinicians stay up to date with the field’s relevant body of knowledge while providing the practical, clinical insight they need in order to provide their patients with the utmost level of care.

 

Presents comprehensive coverage of the many microvascular complications of diabetes

Diabetes remains one of the main causes, in the western world, of legal blindness, end stage renal disease, and amputation, despite the implementation of tight glycemic control and the great progress in the management and care of our patients. This book provides a useful and handy tool to professionals and students in the field of diabetes and its microvascular complications by integrating information from clinical settings as well as from the frontlines of diabetic research. It provides readers with up-to-date diagnostic criteria, classifications, and therapeutic approaches. and recent discoveries on mechanisms of disease, experimental therapeutic agents, and biomarkers of disease. 

Written by top experts in the field, Microvascular Disease in Diabetes offers in-depth chapters covering pathophysiology; the genetics of diabetic microvascular disease; and the epigenetics of diabetic microvascular disease. It then provides sections featuring both clinical and research information on diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, and diabetic foot. It also looks at coronary microvascular dysfunction and cerebral microvascular disease.

·         Integrates new and accessible material on diabetic microvascular comorbidities

·         Covers all relevant microvascular systems

·         Provides a much-needed resource synthesizing research and clinical applications to treating microvascular complications of diabetes

·         Presents current diagnostic criteria, classifications, and therapeutic approaches, as well as recent discoveries on the mechanisms of disease, experimental therapeutic agents, and biomarkers of disease

Assembled in an easily consultable manner, Microvascular Disease in Diabetes is an excellent text for investigators, clinicians, and students looking to improve their understanding of diabetic complications.

ABOUT THE AUTHOR

FRANCESCO TECILAZICH, MD, PhD, is a physician and scientist in the Endocrinology and Metabolic Diseases department of the Ospedale San Raffaele—Vita Salute San Raffaele University in Milan, Italy.

TABLE OF CONTENTS

Foreword to: Microvascular Disease in Diabetes xv

Editor Biography xvii

List of Contributors xix

1 Introduction 1
Andrea Giustina and Stefano Frara

References 3

2 Pathophysiology 5
Francesco Tecilazich

Introduction 5

Anatomo-Physiology of Microvessels 5

Regulation of Microvascular Tone 6

Endothelial-Dependent Vasodilation 6

Endothelial-Independent Vasodilation 6

Nerve Axon Reflex (NARV) 7

Myogenic Response 7

Functional Hyperemia 7

Venoarteriolar Response (VAR) 8

Structural Changes in the Microcirculation 8

Functional Changes in the Microcirculation 8

Endothelial Dysfunction 8

VSMC Dysfunction 9

NARV Impairment 9

Defective Myogenic Response 10

Reduced Functional Hyperemia 10

Endothelial Dysfunction 11

Role of the Immune System and Leukostasis 11

Role of Hyperglycemia 12

AGEs 12

Polyol Pathway 12

Oxidative Stress 13

PKC 13

Transforming Growth Factor (TGF)-β 14

Hexosamine Pathway 14

PARP 14

ET-1 14

Vasoconstrictor Prostanoid Synthesis 15

Role of Insulin Resistance 15

Role of Inflammation 15

References 16

3 Genetics of Diabetic Microvascular Disease 23
Niina Sandholm and Carol Forsblom

Introduction 23

Genetics of DKD 23

Heritability of DKD 23

Candidate Genes for DKD 24

Linkage Studies for DKD 25

Genome-Wide Association Studies on DKD 25

Sequencing Efforts for DKD 29

Genetics of Diabetic Retinopathy 30

Heritability of Diabetic Retinopathy 30

Candidate Genes for Diabetic Retinopathy 30

Linkage Studies for Diabetic Retinopathy 31

GWAS on Diabetic Retinopathy 31

Sequencing Efforts for Diabetic Retinopathy 33

Genetics of Diabetic Neuropathy 33

Heritability of Diabetic Neuropathy 33

Candidate Genes for Diabetic Neuropathy 33

GWASs on Diabetic Neuropathy 34

Future Directions 34

Larger Studies are Needed 34

How to Define the Phenotype? 35

Variability in the Phenotypic Definitions 35

Criteria for Controls 36

Do Genetics of Microvascular Complications in T1D and T2D Differ? 36

Low-Frequency and Rare Variants May Affect Diabetic Complications 36

Sequencing of Rare and Low-Frequency Variants 36

Linkage Analysis with GWAS Data 37

Genetics May Reveal Biology and Infer Causality 37

Conclusions 37

References 37

4 Epigenetics of Diabetic Microvascular Disease 45
Luciano Pirola

Diabetic Complications Include Microvascular and Macrovascular Injury 45

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study in Type 1 Diabetic Patients, and the UKPDS Study in Type 2 Diabetic Patients, Support the Existence of the Hyperglycemic Memory Phenomenon 46

DCCT/EDIC Study 46

The UKPDS Study 46

Models of Hyperglycemic Memory 47

Animal Models 47

Cell Culture Models 48

The “Epigenetic Code” 48

DNA Methylation 49

Histone Methylation in Models of Hyperglycemic Variability 49

Epigenetic Changes in Microvascular Models of Glycemic Memory 50

MiRNAs Contribute to the Control of Glucose Homeostasis and are Dysregulated in Diabetes 52

Future Prospects 52

References 54

5 Diabetic Retinopathy – Clinical 59
Francesco Bandello, Rosangela Lattanzio, Alessandro Marchese, and Emanuela Aragona

Introduction 59

Epidemiology 60

Screening 60

Risk Factors 61

Clinical Patterns 61

Non-Proliferative Diabetic Retinopathy (NPDR) 61

Clinical Findings 62

Diagnostic Tools 64

Treatment Strategies 65

Proliferative Diabetic Retinopathy (PDR) 65

Clinical Findings 65

Diagnostic Tools 67

Treatment Strategies 67

Diabetic Macular Edema (DME) 69

Classification 70

Clinical Findings 71

Diagnostic Tools 71

Treatment Strategies 71

Conclusions 73

References 74

6 Diabetic Retinopathy – Research 79
Gopalan Gnanaguru

Retina and Induction of Hyperglycemia 79

Hyperglycemia and Retinal Microvasculature 80

Hyperglycemia and Reactive Gliosis 80

Hyperglycemia and Neurodegeneration 81

Hyperglycemia and Inflammation 81

References 82

7 Diabetic Nephropathy – Clinical 85
Gianpaolo Zerbini

Epidemiology 85

Natural History 86

Stages of DN 86

Morphologic Changes 87

Pathophysiology 88

Clinical Course 89

Treatment 90

Primary Prevention 90

Secondary Prevention 91

Tertiary Prevention 91

Perspectives 91

References 92

8 Diabetic Nephropathy – Research 97
Silvia Maestroni and Gianpaolo Zerbini

Essential Hypertension and DN 97

Role of Genetics in the Pathogenesis of DN 99

Polyol Pathway and Non-Enzymatic Glycation 100

Environment 100

Perspectives 101

Sodium–Glucose Cotransporter-2 (SGLT2) and DN 101

B7-1 and DN 101

Animal Models 102

DN in Induced Model of Type 1 Diabetes Mellitus (T1DM) 102

DN in Spontaneous Model of T1DM 103

Ins2^Akita Mice 103

Non-Obese Diabetic (NOD) Mice 104

OVE26 Friend leukemia virus B (FVB) Mice 104

DN in Spontaneous Models of T2DM 105

db/db Mice 105

References 105

9 Diabetic Neuropathy – Clinical 111
Christopher H. Gibbons

Introduction 111

Classification of Diabetic Neuropathies 111

Distal Symmetric Polyneuropathy (DSPN) 112

Diagnosis 113

Management 113

Small Fiber Neuropathy 114

Diagnosis 115

Management 115

Autonomic Neuropathy 116

Diagnosis 117

Management 117

Treatment-Induced Neuropathy of Diabetes (TIND) 119

Diagnosis 119

Management 120

Diabetic Radiculoplexopathy 120

Diagnosis 120

Management 121

Mononeuropathies 121

Diagnosis 121

Management 121

Cranial Neuropathies 121

Diagnosis 121

Management 122

Screening for Neuropathy 122

Summary of Management of Diabetic Neuropathy 122

References 123

10 Diabetic Neuropathy – Research 129
Krish Chandrasekaran, Lindsay A. Zilliox, and James W. Russell

Basic and Translational Research in Diabetic Neuropathy 129

Animal Models of Diabetic Neuropathy 129

Basic Pathophysiology of Diabetic Neuropathy 131

Changes in Redox Potential 131

Role of Mitochondrial Dysfunction in Diabetic Neuropathy 133

Protein Kinase C (PKC) and Neuropathy 137

Advanced Glycation End Products 137

Modifying Molecular Chaperones 138

Inflammation and Neuropathy 138

TGF-β and Neuropathy 138

Metabotropic Glutamate Receptors (mGluRs) and Oxidative Injury 139

Growth Factors and Diabetes 139

Clinical Research in Diabetic Neuropathy 140

Treatment of Hypertension 141

Improved Glycemic Control 141

Diet and Lifestyle Interventions 142

Alpha-Lipoic Acid 144

Benfotiamine and Neuropathy 145

Treatment of Neuropathic Pain 145

Acknowledgments 146

References 147

11 Diabetic Foot – Clinical 157
Cristian Nicoletti

Introduction and Size of the Problem 157

Pathogenesis of Diabetic Foot Complications 158

Neuropathy 158

Peripheral Vascular Disease 158

Other Risk Factors 159

Prevention 159

Treatment 160

Treatment of Neuropathic Diabetic Foot Ulcers: Offloading 160

Treatment of PAD: Revascularization 161

Diabetic Foot Infections (DFIs) 163

Introduction 163

Diagnosis 163

Treatment 164

Wound Healing 166

Debridement 166

Dressings 167

Topical Negative Pressure Wound Therapy (NPWT) 167

Other Topical Treatments 167

References 167

12 Diabetic Foot – Research 173
Georgios Theocharidis and Aristidis Veves

Introduction 173

Anatomy of the Skin and Microcirculation 174

Structural Changes in the Microcirculation 174

Functional Changes in the Microcirculation 175

Functional Changes in the Diabetic Foot 176

Vasodilation 176

Endothelium-Dependent Vasodilation 177

Endothelium-Independent Vasodilation 178

Nerve Axon Reflex 179

Mechanisms of Endothelial Dysfunction 180

Endothelial Dysfunction and Hyperglycemia 180

Endothelial Dysfunction and Insulin Resistance 182

Endothelial Dysfunction and Inflammation 183

Pathophysiology of Diabetic Wound Healing 184

Hyperglycemia 184

Chronic Inflammation 184

Impaired Angiogenesis and Vasculogenesis 186

Hypoxia 186

Impaired Neuropeptide Signaling 186

Adjunctive Treatment Options 186

Bioengineered Skin Substitutes 187

Growth Factors 187

Hyperbaric Oxygen Therapy 188

Negative Pressure Wound Therapy 188

Electrical Stimulation and Shockwave Therapy 189

Future Therapeutic Perspectives 189

Gene Therapies 189

Stem Cell Therapies 189

Norleu3-Angiotensin-(1–7) 190

Neuropeptides 190

Cytokine Inhibition 190

Conclusion 191

References 191

13 Coronary Microvascular Dysfunction in Diabetes – Clinical and Research 201
Guglielmo Gallone, Francesco Moroni, and Marco Magnoni

Introduction 201

Clinical Classification and Mechanisms of CMD 202

CMD in Diabetic Patients 203

Clinical Assessment of CMD 205

Non-Invasive Imaging Technique for the Assessment of CMD 205

Transthoracic Doppler Evaluation 205

Contrast Echocardiography 206

Cardiovascular Magnetic Resonance (CMR) Imaging 206

Positron Emission Tomography (PET) 207

Invasive Techniques for the Evaluation of CBF 207

Indicator Dilution-Based Methods 207

Thermodilution 208

Gas Wash Out Method 208

Intracoronary Doppler Flow Wire 208

Treatment for CMD 210

The Effects of Glucose-Lowering Drugs on CMD 211

Future Perspectives for the Treatment of CMD in Diabetes 211

References 212

14 Cerebral Microvascular Disease in Diabetes – Clinical and Research 221
Eelco van Duinkerken and Richard G. IJzerman

Introduction 221

Postmortem Studies of the Brain in Diabetes 222

Cerebral Small Vessel Disease on MRI 223

MRI-Measured Cerebral Small Vessel Disease in Type 1 Diabetic Patients 224

White Matter Hyperintensities 224

Cerebral Microbleeds 226

Summary 226

Type 2 Diabetes and Cerebral Small Vessel Disease 227

Lacunar Infarcts 227

White Matter Hyperintensities 228

Cerebral Microbleeds 230

Synthesis 230

Clinical Impact of Cerebral Small Vessel Disease in Diabetes 231

Cognitive Functioning 231

Stroke 233

Dementia 234

The Influence of Microvascular Disease on the Structure and Functioning of the Diabetic Brain 235

Type 1 Diabetes 236

Type 2 Diabetes 237

Conclusions and Future Directions 239

References 240

Index 247