Clinical Approach to Endocrine & Metabolic Diseases (2nd Edition)


The broad popular success of the first volume of A Clinical Approach to Endocrine & Metabolic Diseases in 2010 has now prompted the publication of the current collection of these up-to-date review articles that address everyday issues facing the clinical endocrinologist. As before, the chapters have been culled from the pages of the Endocrine Society's foremost clinical journal, The Journal of Clinical Endocrinology & Metabolism (JCEM) and are as timely today as when originally published. The authors of each chapter are acknowledged experts in their respective areas of endocrinology and were specifically nominated and selected by the Editors of the JCEM for their recognized clinical skills. Thus, the topics covered are those that are faced daily in the clinician's office, and this book provides a highly practical and useful reference compendium of the experts' personal ‘Approaches’ to each problem from the point of view of both diagnosis and management. In contrast to the original articles, these updated versions are all together in a handy one volume format that now can be readily accessed from your office bookshelf as needed.

Target Audience

This continuing medical education activity should be of substantial interest to practicing endocrinologists and trainees.

Learning Objectives

Upon completion of this educational activity, learners will be able to:

  • Diagnose a range of endocrine and metabolic disorders based on clinical manifestations
  • Select among current options for management and therapy of endocrine and metabolic disorders and co-morbid conditions


Chapter-specific Learning Objectives

After reading these chapters and completing the post test, learners will be able to do the following:

Chapter 1. Approach to the Thyroid Cancer Patient with Extracervical Metastases

  • Monitor patients with extracervical metastatic thyroid cancer for evidence of progression or symptomatic disease
  • Consider advantages and disadvantages of treatments available for extracervical metastatic thyroid cancer
  • Select treatments that will improve survival and decrease morbidity associated with disease progression

Chapter 2. Approach to the Patient with Amiodarone‐Induced Thyrotoxicosis and Refractory Arrhythmias

  • Differentiate the two main forms of AIT
  • Choose the more appropriate therapy for either form of AIT
  • Predict the response to glucocorticoids in patients with type 2 AIT
  • Select patients who might take advantage from thyroidectomy

Chapter 3. Approach to the patient with Resistance to Thyroid Hormone and Pregnancy

  • Recognize the importance of prenatal diagnosis of RTH by amniocentesis
  • Identify the symptoms and signs that warrant therapy in a gravida with RTH
  • Understand that RTH mothers harboring an unaffected fetus should be given propylthiouracil to maintain a serum free T4 not higher than 20% above the upper limit of normal

Chapter 4. Approach to the Patient with Incidental Papillary Microcarcinoma

  • Determine the appropriate extent of surgery based on various clinical parameters found in cases of thyroid microcarcinoma
  • Decide when radioactive iodine ablation is appropriate for patients with incidental microcarcinoma
  • Review risk-adjusted TSH suppression goals for thyroid microcarcinoma patients
  • Provide recommended follow-up management of patients with incidental microcarcinoma

Chapter 5. Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter

  • Describe the clinical picture and typical symptoms of intrathoracic goiter, including the possible risk of thyroid malignancy and the impact on the respiration
  • Establish a relevant diagnostic set-up for the patient with intrathoracic goiter
  • Select among therapeutic options for intrathoracic goiter, considering limitations and risks of the various treatments

Chapter 6. Approach to the Patient with Non-Toxic Multinodular Goiter

  • Recognize ultrasound features of benign and malignant thyroid nodules to assist in the selection of nodules that require FNA biopsy
  • Establish a diagnostic work up for patients with non toxic multinodular goiter
  • Select among different therapeutic modalities for the treatment of patients with non toxic multinodular goiter based on clinical symptoms and physical findings

Chapter 7. Approach to the Thyroid Cancer Patient with Bone Metastases

  • Recognize the limitations of the various radiological and radionuclide studies used to detect bone metastases from thyroid cancer
  • Discuss the efficacy and limitations of radioiodine in the treatment of patients with skeletal metastases from thyroid cancer
  • Incorporate intravenous bisphosphonates and subcutaneous monoclonal antibodies to RANKL in the management of patients with bone metastases from thyroid cancer
  • Evaluate novel modalities, such as radiofrequency ablation and cryotherapy, in the management of patients with bone metastases from thyroid cancer

Chapter 8. Approach to the Patient with Possible Cushing’s Syndrome


Chapter 9. Approach to the Patient with an Adrenal Incidentaloma

  • Assess the probability of malignancy based on radiographic features
  • Obtain pre-operative testing before resection of an incidentaloma
  • Predict improvements in patients with subclinical Cushing’s syndrome after resection of an adenoma

Chapter 10. Approach to the Patient with Adrenocortical Carcinoma

  • Review the approaches to investigate and treat patients with an adrenal mass that is considered at high risk of being an adrenal carcinoma
  • Implement anti-neoplastic therapy as appropriate based on knowledge of treatment indications, mode of administration, side effects, and requirements for monitoring and hormone replacement
  • Provide appropriate follow-up of patients after the surgical resection of adrenal carcinoma and choice of further therapies if relapse occurs

Chapter 11. Approach to the Patient with Diabetes and Progressive Kidney Disease

  • Identify how to alter the management of glycemic control and blood pressure in the setting of progressive renal disease
  • Recognize when a patient with type 2 diabetes and renal disease should be referred to a nephrologist for management of impending renal failure

Chapter 12. Approach to the Patient with Diabetes during Pregnancy

  • Recognize the dangers of undiagnosed diabetes during pregnancy
  • Facilitate achievement and maintenance of normoglycemia in all pregnant women
  • Explain the rationale for carbohydrate restriction in women with diabetes during pregnancy

Chapter 13. Approach to the Management of the Patient with Neuropathic Pain

  • Perform differential diagnosis of painful diabetic neuropathy
  • Make informed decisions based on the numbers needed to treat vs. the numbers needed to harm as well as the likelihood of success or failure of treatment
  • Understand pathogenesis-based management

Chapter 14. Approach to the Hospitalized Patient with Severe Insulin Resistance

  • Know current guidelines for glucose target values in the hospitalized patient
  • Evaluate potential causes of significant insulin resistance that can impair the ability to achieve those glucose target values
  • Understand potential strategies for addressing insulin resistance in the hospital as well as convert from intravenous to subcutaneous insulin injections in the hospitalized patient

Chapter 15. Approach to the Patient with New-Onset Diabetes after Transplant

  • Identify risk factors for the development of diabetes after solid organ transplantation
  • Discuss the most recent concepts and recommendations regarding the pathophysiology, diagnosis and management of new-onset diabetes after transplant

Chapter 16. Approach to the Patient with Gestational Diabetes after Delivery

  • Recognize the risk of diabetes after gestational diabetes and the spectrum of causes of beta cell dysfunction that underlie that risk
  • Select clinical approaches to reducing diabetes risk and assess success of those approaches

Chapter 17 Approach to the Patient with Turner Syndrome

  • Address cardiac, growth, gonadal and developmental abnormalities in patients with Turner syndrome
  • Implement recommended health care screening tests for patients with Turner Syndrome

Chapter 18. Approach to the Obese Adolescent with New-Onset Diabetes

  • Formulate an approach to the determination of diabetes type in the obese adolescent with new-onset diabetes
  • Design an initial treatment strategy for the obese adolescent with new onset diabetes and modify this strategy based on clinical course
  • Incorporate an understanding of autoimmunity and insulin resistance related disorders in the approach to treatment of the obese adolescent with new-onset diabetes

Chapter 19. Approach to the Pediatric Patient with Graves’ Disease: When is Definitive Therapy Warranted?

  • Distinguish the differences in clinical presentation between pre- and post-pubertal children with Graves’ disease
  • Identify and discuss the available treatment options for Graves’ disease and convey the advantages and disadvantages for each therapeutic option
  • Define the predictors associated with a decreased likelihood of remission in the pediatric patient
  • Debate the benefits and limitations of prolonged use of antithyroid medications compared to definitive therapy

Chapter 20. Approach to the Girl with Early Onset Pubic Hair

  • Evaluate a young girl who presents with early onset of pubic hair
  • Manage the clinical care of a child with premature adrenarche
  • Describe the progression of metabolic abnormalities in some girls with premature adrenarche

Chapter 21. Approach to the Child with Fractures

  • Recognize the numerous primary and secondary causes of childhood osteoporosis
  • Perform a complete evaluation of a child with fractures, including the importance of a thorough history and physical exam
  • Consider confounding variables in the interpretation of DXA scans in pediatric patients, including body size, bone age and pubertal status
  • Select the most appropriate pharmacologic and non-pharmacologic therapies for the management of low bone density in children

Chapter 22. Approach to the Diagnosis and Treatment of Neonatal Hypothyroidism

  • Select an optimal starting dose of levothyroxine in infants with congenital hypothyroidism, tailoring the dose to the severity of hypothyroidism
  • Undertake tests to monitor thyroid hormone treatment at recommended intervals in the first three years of life in infants diagnosed with congenital hypothyroidism
  • “Problem-solve” reasons for serum free T4 and/or TSH levels outside the recommended target range (e.g, low levothyroxine dosing, problems with GI absorption, compliance issues) and fix the problem in infants diagnosed with congenital hypothyroidism

Chapter 23. Approach to the Patient who is Intolerant to Statin Therapy

  • Review the definition, frequency, pathopharmacology, and the diagnostic and therapeutic strategies of statin intolerance, specifically myopathy
  • Outline steps to be taken to assess patients with myalgias and/or CK elevations on statin therapy
  • Characterize therapeutic options for patients with statin-induced myopathy based on the presence or absence of symptoms and/or CK elevation, LDL and non-HDL cholesterol goals, statin pharmacokinetics, and published reports

Chapter 24. Approach to the Patient with Persistent Acromegaly after Pituitary Surgery

  • Identify the medical co-morbidities associated with acromegaly, and understand the appropriate tests to assess these co-morbidities
  • Assess individual patient profiles to determine the appropriate therapy for a postoperative patient with persistent and active acromegaly
  • Identify the medical therapy options for acromegaly, and determine the appropriate medical therapy for an individual patient

Chapter 25. Approach to Assigning Gender in 46,XX Congenital Adrenal Hyperplasia (CAH) with Male External Genitalia: Replacing Dogmatism with Pragmatism

  • Appreciate the historical clinical management of 46,XX infants born with congenital adrenal hyperplasia
  • Become familiar with the factors to be considered in the infant requiring gender assignment
  • Be acquainted with guidelines for the clinical approach to infants with DSD based on clinical findings

Chapter 26. Approach to the Patient with Gynecomastia

  • Discuss the hormonal pathogenesis of gynecomastia
  • Appropriately evaluate and recommend therapy for patients with gynecomastia

Chapter 27. Approach to the Patient with Hyperparathyroidism after Parathyroid Surgery

  • Manage a patient who undergoes surgery in the setting of primary hyperparathyroidism but fails to obtain a curative result
  • Undertake the appropriate imaging studies for such a patient
  • Describe the surgical adjuncts available to assist in the management of this patient both in and out of the operating room
  • Predict post-operative problems that should be anticipated in such a patient

Additional Information

Target Audience: 
Clinical researcher
Scientific researcher
Nurse/Nurse practitioner
Physician assistant
Allied health professional
Competency Area: 
Patient Care and Procedural Skills
Medical Knowledge
Topic Area: 
General Endocrinology
Pediatric Endocrinology
Level of Outcomes: 
Level 1 (Participation)
Level 2 (Satisfaction)
Level 3A (Learning: Declarative Knowledge (Knows))
Level 3B (Learning: Procedural Knowledge (Knows How))
Level 4 (Learning: Competence (Shows How))
Activity summary
Available credit: 
  • 27.00 AMA PRA Category 1 Credits
  • 27.00 CME Certificate of Participation
Course opens: 
Course expires: 

Statement of Independence

As a provider of continuing medical education (CME) accredited by the Accreditation Council for Continuing Medical Education, The Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous. The clinical content for this activity was developed by the authors with the oversight of JCEM’s Editor-in-Chief, Leonard Wartofsky, M.D.

Disclosure Policy

The faculty, committee members, and staff involved in planning this CME activity are required to disclose to learners any relevant financial relationship(s) that have occurred within the last 12 months with any commercial interest(s) whose products or services are discussed in the CME content. Financial relationships are defined by remuneration in any amount from the commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (e.g., stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers’ bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent CME planners with relevant financial relationships from planning or delivery of content, but rather to provide learners with information that allows them to make their own judgments of whether these financial interest or relationships may have influenced the educational activity with regard to exposition or conclusion. The Endocrine society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.

The following authors reported relevant financial relationships: Samuel Refetoff, MD, is an Academic Associate for Quest Diagnostics; Laszlo Hegedüs, MD, has received honoraria from, serves on the advisory board of, and has provided expert witness for Genzyme; Jason A. Wexler, MD, is a member of the Speaker's Bureau for Novartis Pharmaceutical Corporation and Amgen, and has received research funding from Amgen, Pfizer Inc., and Exelixis; Aaron Vinik, MD, PhD, FCP, MACP, is a consultant for Ansar, AstraZeneca, Eli Lilly, KV Pharmaceuticals, Merck, Novartis Pharmaceuticals, R.W. Johnson Pharmaceutical Research Institute, Sanofi-Aventis, Takeda, and Tercica; and is on the speakers bureau for Abbott, Ansar, AstraZeneca, Bristol Meyer Squibb, Eli Lilly, GlaxoSmith Kline Beecham, Merck, Novartis Pharmaceuticals, Pfizer Inc., Sanofi-Aventis, and Takeda; Marsha A. Davenport, MD, is currently an investigator in a clinical study sponsored by Eli Lilly, postmarketing surveillance studies sponsored by Eli Lilly, Pfizer, and Genentech and is receiving grant support from Pfizer. She has previously received lecture fees from Pfizer (2009) and Genentech (2007-2008) and has consulted for Genentech (2007); Laurence Katznelson, MD, has served on advisory boards for Pfizer and Novartis Pharmaceuticals, receives research funds from Novartis Pharmaceuticals, and is on the speakers' board for Ipsen; Harold E. Carlson, MD, has previously consulted for Eli Lilly, Inc.

The following authors reported no relevant financial relationships: Bryan R. Haugen, MD; Madeleine A. Kane, MD; Fausto Bogazzi, MD; Luigi Bartalena, MD; Enio Martino, MD; Roy E. Weiss, MD; Alexandra Dumitrescu, MD; Victor Bernet, MD; Steen J. Bonnema, MD; Rebecca S. Bahn, MD; M. Regina Castro, MD; Marco Boscaro, MD; Giorgio Arnaldi, MD; Lynnette K. Nieman, MD; Andr é Lacroix, MD; Elizabeth R. Seaquist, MD; Hassan N. Ibrahim, MD; Lois Jovanovič, MD; Jennifer Larsen, MD; Whitney Goldner, MD; James T. Lane, MD; Samuel Dagogo-Jack, MD; Thomas A. Buchanan, MD; Kathleen A. Page, MD; Philip Zeitler, MD, PhD; Andrew J. Bauer, MD; Sharon E. Oberfield, MD; Aviva B. Sopher, MD; Adrienne T. Gerken, AB; Alison M. Boyce, MD; Rachel I. Gafni, MD; Stephen H. LaFranchi, MD; Robert H. Eckel, MD; Christopher P. Houk, MD; Reema L. Habiby, MD; Peter A. Lee, MD, PhD; Robert Udelsman, MD.

The Editor-in-Chief, Leonard Wartofksy, MD, has no relevant financial disclosures.

Endocrine Society staff and the medical writer associated with the development of content for this activity reported no relevant financial relationships.


The information presented in this activity represents the opinion of the faculty and is not necessarily the official position of The Endocrine Society.

Commercial Support
This activity is not supported by grants, other funds, or in-kind contributions from commercial grants.

Policy on Unlabeled/Off-Label Use

The Endocrine Society has determined that disclosure of unlabeled/off-label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation. Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration (FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.

Privacy and Confidentiality Statement

The Endocrine Society will record learner’s personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties.

Available Credit

  • 27.00 AMA PRA Category 1 Credits
  • 27.00 CME Certificate of Participation