HYPERCHOLESTEROLEMIA
HYPERCHOLESTEROLEMIA: Excerpt from Differential Diagnosis in Primary Care
Anatomy is the key to forming a list of possible causes of
hypercholesterolemia. If we consider the liver, it should prompt
recall of primary biliary cirrhosis, hepatoma, glycogen storage disease, and
obstructive jaundice. If we consider the kidney, it should facilitate recall
of uremia and the nephrotic syndrome. Considering the endocrine glands
should facilitate recall of diabetes mellitus, acromegaly, hypothyroidism,
Cushing disease, insulinoma, and isolated growth hormone deficiency. Two
other groups of conditions associated with hypercholesterolemia are drugs
and the primary hyperlipoproteinemias. Drugs that may cause an elevated
cholesterol level include exogenous estrogen and corticosteroids, thiazides,
and β -adrenergic blocking agents. The primary hyperlipoproteinemias include
types II-a, II-b, III, and V. These can be differentiated from the other
primary hyperlipoproteinemias by determining the presence of chylomicrons
and elevated triglycerides. Types II-a and II-b hyperlipoproteinemia are not
associated with elevated chylomicrons. Type II-b is associated with an
increased triglyceride, whereas type II-a is not. Type III
hyperlipoproteinemia is associated with both chylomicrons and an elevated
triglyceride level. Type I hyperlipoproteinemia is not associated with an
increased cholesterol, whereas type V is associated with chylomicrons and an
increase of both cholesterol and triglyceride levels.
Approach to the Diagnosis
One should look for a family history of lipoproteinemia as well as
determine what drugs the patient is taking. On examination, one should look
for tendon xanthomas. As mentioned above, lipoprotein electrophoresis should
be done as well as a lipid profile and overnight refrigeration of plasma to
look for lactescence (a sign of chylomicrons). An endocrinology consult will
be helpful.
Other Useful Tests
-
CBC
- Sedimentation rate
- Chemistry panel (liver disease, kidney disease)
- Urinalysis (nephrosis)
- Liver profile (biliary cirrhosis, obstructive jaundice)
- Thyroid profile (hypothyroidism)
- Antimitochondrial antibody titer (biliary cirrhosis)
- 24-hour urine protein level (nephrosis)
- Liver biopsy (cirrhosis)
- Renal biopsy (nephrosis)
- Consult with metabolic disease specialist
- CT scan of the abdomen (Cushing syndrome, renal disease, liver
disease)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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