HYPERGLYCEMIA

HYPERGLYCEMIA: Excerpt from Differential Diagnosis in Primary Care

To form a list of diagnostic possibilities in a case of hyperglycemia, one needs only to think of the endocrine glands. Considering the pancreas should prompt the recall of diabetes mellitus and glucagonomas. Considering the adrenal gland would prompt the recall of Cushing disease and pheochromocytoma. Visualizing the pituitary should help one to recall acromegaly and basophilic adenoma, whereas visualizing the thyroid should prompt the recall of hyperthyroidism. Other considerations in hyperglycemia are starvation and drug-induced hyperglycemia.

Approach to the Diagnosis

Obviously, the first thing to do is repeat the blood sugar test after fasting. If the result is borderline, a glucose tolerance test should be done. Clinical evaluation for a history of diabetes, hypertension (Cushing disease and pheochromocytoma), protruding jaw and increasing hat size (acromegaly), polyuria, polydipsia, and weight loss (diabetes mellitus and hyperthyroidism) is important. Further workup depends on which endocrine disorder is being considered.

Other Useful Tests

1. CBC (Cushing syndrome)
2. Sedimentation rate (pancreatitis)
3. Chemistry panel (diabetic acidosis)
4. Plasma insulin level (diabetes mellitus)
5. Urinalysis and urine culture (pyelonephritis)
6. Glycosylated hemoglobin (diabetes mellitus)
7. Growth hormone assay (acromegaly)
8. Plasma cortisol level (Cushing syndrome)
9. Dexamethasone suppression (Cushing syndrome)
10. 24-hour urine catecholamine level or vanillylmandelic acid (VMA) (pheochromocytoma)
11. Free T₄ and thyrotropin (hyperthyroidism)
12. CT scan of the abdomen (Cushing syndrome)
13. Endocrinology consult

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.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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