Download e-book for iPad: Endocrinology by M Gurnell; John D Firth; Royal College of Physicians of

By M Gurnell; John D Firth; Royal College of Physicians of London. Education Department

ISBN-10: 1860162606

ISBN-13: 9781860162602

ISBN-10: 1860162738

ISBN-13: 9781860162732

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This will clearly involve brought to our surgery by her daughters who are concerned about her mental state: they Management fear she is depressed. Her past The general principles governing management of the hypogonadal medical history is unremarkable, Station 2: History Taking 21 END_C01 12/15/10 8:39 Page 22 ENDOCRINOLOGY: PACES STATIONS AND ACUTE SCENARIOS TABLE 9 PHYSICAL ILLNESSES WITH DEPRESSION AS A COMMON PRESENTING FEATURE Type of problem Example ‘Obvious’ Any condition causing severe physical debility Any condition causing chronic pain ‘More subtle’ Endocrine Neurological Malignancy ‘Systemic illness’, eg advanced cardiac/ respiratory failure or chronic renal failure (dialysis) Parkinson’s disease ‘Arthritis/rheumatism’ Refractory headache Postherpetic neuralgia Hypothyroidism Hyperparathyroidism Cushing’s syndrome Pseudo-Cushing’s syndrome • Liver chemistry and calcium (hypercalcaemia, metastases).

We would both be grateful for your advice on his further investigation and management. Yours sincerely, Introduction Although it is important to bear in mind the possibility that the symptoms of flushing and diarrhoea are unrelated, taken together they suggest a number of specific diagnoses (Table 14). Also check for other systemic symptoms, eg weight loss, malaise. Other relevant history Bearing in mind the possible diagnoses in Table 14, ask about the following if the information is not forthcoming spontaneously.

It may be that he is simply trying to work too hard, but I would be grateful for your opinion as to whether there could be a medical explanation for his symptoms. Yours sincerely, Introduction Tiredness and lethargy are nonspecific symptoms, which most of us Station 2: History Taking 29 END_C01 12/15/10 8:39 Page 30 ENDOCRINOLOGY: PACES STATIONS AND ACUTE SCENARIOS TABLE 13 DISORDERS PRESENTING WITH TIREDNESS AND LETHARGY Type of condition Common or important example ‘Normal variant’ Hard work Childcare Psychological/psychiatric disorder Anxiety Depression Alcohol dependence Chronic fatigue syndrome Chronic/systemic illness, usually obvious in this context Malignancy Heart failure Respiratory failure Systemic illness, not always obvious Anaemia Thyroid deficiency (or occasionally excess) Diabetes mellitus Primary hyperparathyroidism Addison’s disease Hypopituitarism experience from time to time – just think of the average junior doctor!

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Endocrinology by M Gurnell; John D Firth; Royal College of Physicians of London. Education Department


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