The following medical news items are relevant to diagnosis and misdiagnosis issues for Kleptomania:
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Routine laboratory tests include a CBC, urinalysis, chemistry panel, 2-hr postprandial blood sugar, and thyroid profile. If an insulinoma is strongly suspected, a 24- to 36-hr fast, a 5-hr glucose tolerance test, and tolbutamide tolerance test may be done. If Cushing's syndrome is suspected, a serum cortisol and cortisol suppression test should be done. Pelvic ultrasound will help diagnose polycystic ovaries. Chromosomal analysis will help diagnose Klinefelter's syndrome. Perhaps a psychiatrist should be consulted.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Routine studies include a CBC, sedimentation rate, urinalysis, chemistry panel, ANA assay, serum B 12 and folic acid, VDRL test, chest x-ray, and EKG. If there are cranial nerve signs, a CT scan or MRI of the brain will usually be necessary. However, it is wise to get a neurology consultation before undertaking these expensive tests. A spinal tap may be done if the imaging study is negative.
If vascular disease is suspected, carotid scans to rule out carotid stenosis or plaque and a search for an embolic source using echocardiography and blood culture should be done. A cardiologist can assist in this search. Four-vessel cerebral angiography may be necessary. In fact, if a cerebral hemorrhage has been ruled out and there is no significant hypertension, a four-vessel cerebral angiographic study should probably be done. Evoked potential studies and HIV antibody titers should also be done. If there are no cranial nerve signs, MRI of the cervical spine or thoracic spine should be done, depending on the level of the lesion. Myelography may also be helpful. Serum protein electrophoresis and immunoelectrophoresis all may be necessary in the workup.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
A neurologist should be consulted at the outset. The neurologist will be able to determine whether a CT scan or magnetic MRI should be ordered and whether it should be of the brain, brainstem, or spinal cord. If there are obvious cranial nerve signs, the imaging study will include the brain and brainstem. Spinal cord lesions usually require x-ray of the spine and possibly myelography and spinal fluid analysis. In suspected intracranial pathology, a spinal tap should not be done until a CT scan or MRI has ruled out a space-occupying lesion.
Source: Differential Diagnosis in Primary Care, 2007
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