HYPERCHOLESTEROLEMIA

HYPERCHOLESTEROLEMIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. What is the serum albumin? A decreased serum albumin associated with an increased cholesterol strongly suggests the nephrotic syndrome or liver disease. These two conditions may be further differentiated by the finding of proteinuria in the nephrotic syndrome.
2. What is the free T ₄ ? Hypercholesterolemia associated with a low T ₄ suggests myxedema.
3. What is the triglyceride level? An elevated cholesterol coupled with a marked increase in the triglyceride is typical of type I and type II lipoproteinemia. Type IIB, type III, and type IV lipoproteinemias are associated with a high cholesterol but only mild increase of triglyceride. Oral contraceptive use, atherosclerosis, and xanthomatosis may present the same picture. These may be further differentiated by lipoprotein electrophoresis.

DIAGNOSTIC WORKUP

A workup of hypercholesterolemia should include a CBC, urinalysis, chemistry panel, overnight refrigeration of plasma, free T ₄ , TSH, and lipoprotein electrophoresis. If these tests suggest liver disease, liver function tests and liver biopsy may be indicated. If these tests suggest kidney disease, a nephrologist should be consulted for consideration of renal function tests or renal biopsy. A metabolic disease specialist or an endocrinologist may need to be consulted for further diagnostic evaluation and management.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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