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Flowers, K. C., et al. (2024). "Investigative algorithms for disorders causing hypercalcaemia and hypocalcaemia: a narrative review." Journal of Laboratory and Precision Medicine 9:
Background and Objective: The following article is part of a special series to aid the reader in diagnosing the cause of various electrolyte imbalances. By the end of the article, the reader should be able to order and interpret appropriate laboratory investigations when faced with a patient with hypercalcaemia or hypocalcaemia. Methods: A narrative, focused literature review was performed using Medline, PubMed, Google Scholar and OMIM during August 2023 to November 2023 to identify references published from database inception. Reference lists from these articles, as well as expert opinion from the authors, were also used. Language was restricted to English. Key Content and Findings: Calcium is an essential electrolyte and its blood concentration is tightly controlled by multiple homeostatic hormones, including parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D. However, calcium imbalance can occur in many disease states and can lead to significant morbidity and mortality. PTH analysis is of primary importance in identifying the cause of a calcium disturbance. It should be noted that calcium results are particularly susceptible to being falsely low or high depending on whether ionised or total calcium is analysed, therefore the validity of calcium results should always be questioned if the results are not consistent with the clinical presentation. Hypercalcaemia is most commonly associated with primary hyperparathyroidism (PHPT) or malignancy. Hypocalcaemia is much rarer than hypercalcaemia, and if no obvious cause is found—e.g., post total thyroidectomy—consider hypomagnesaemia. Conclusions: Diagnostic flow charts are presented, and the limitations of the laboratory tests discussed. These algorithms, by focusing on the approach to the investigation of hypercalcaemia and hypocalcaemia, should support healthcare professionals to efficiently and rapidly diagnose the majority of causes of abnormal calcium states.
Hilker, C., et al. (2023). "“The chameleon among diseases” - an explorative view of sarcoidosis and identification of the consequences for affected patients and relatives using qualitative interviews." Orphanet Journal of Rare Diseases 18(1): 276 https://doi.org/10.1186/s13023-023-02866-4 PDF @ LINK
Sarcoidosis is a multisystemic disease, with the lungs being the main site of manifestation. Although the exact etiology remains unclear, both genetic and environmental factors are being discussed. Diagnostic evaluation is challenging, and the management of chronic patients and assessment of their needs proves difficult, especially in the absence of targeted therapy. Studies on sarcoidosis patients have shown that quality of life is limited even after clinically measurable parameters have resolved. The question remains how patients and their relatives perceive medical care and the diagnostic process and how these affect their well-being.
Jeny, F., et al. (2020). "Diagnosis issues in sarcoidosis." Respiratory Medicine and Research 77: 37-45 https://www.sciencedirect.com/science/article/pii/S2590041219300261 REQUEST ARTICLE
Multiple problems may be encountered during the diagnosis of sarcoidosis: at first diagnose sarcoidosis in an appropriate clinical setting, secondly, identify any manifestation to be linked to sarcoidosis at diagnosis work-up and during evolution; thirdly, recognize “danger” in sarcoidosis and parasarcoidosis syndromes, and finally, diagnose sarcoidosis recovery. Diagnosis is often delayed as presentation may be diverse, non-specific, or atypical. Diagnosis of sarcoidosis is based on three criteria: a compatible presentation; evidence of non-caseating granulomas and exclusion of any alternative diagnosis. However, even when all criteria are fulfilled, the probability of sarcoidosis diagnosis varies from definite to only possible depending upon the presence of more or less characteristic radio-clinical and histopathological findings and on the epidemiological context. Bilateral hilar lymphadenopathy and/or diffuse lung micronodules mainly along lymphatics are the most frequent highly suggestive findings. Evidence of granulomas relies on superficial biopsies of clinically suspected lesion when present or most often by bronchial endoscopy. The diagnosis of sarcoidosis may be difficult in absence of thoracic or skin manifestations and may require the benefit of hindsight before being definitive. Differential diagnoses, mainly tuberculosis, must be considered. The diagnosis of events during evolution relies on serial clinical, pulmonary function, radiographic evaluation and on extrapulmonary manifestations work-up, including electrocardiogram and blood biology. Affected organs need to be related to sarcoidosis using an appropriate diagnostic assessment instrument. To declare the recovery of sarcoidosis, all manifestations must have disappeared spontaneously or after 3–5 years post-treatment without relapse.
Sreeja, C., et al. (2022). "Sarcoidosis – A review article." Journal of Oral and Maxillofacial Pathology 26(2): 242-253 FULL TEXT @ LINK https://journals.lww.com/jpat/fulltext/2022/26020/sarcoidosis___a_review_article.18.aspx
Sarcoidosis is a granulomatous disorder of multiple organs, with lungs and lymphatic systems being the most frequently affected sites of the body. It was first reported in 1877 and has continued to engross both clinicians and scientists since that time. Because sarcoidosis being a diagnosis of exclusion, it demands the physician to rule out all the possible diagnosis. Most of the patients remain asymptomatic and this makes the disease remain unnoticed for a prolonged period. Later after years, the disease could be diagnosed after witnessing the patient being symptomatic or suffering from organ failures. It could affect middle aged people of any sexes, often its clinical features correlate with tuberculosis. On immunological and histopathological examination, it reveals noncaseating granuloma in simple terms. Glucocorticoids remain the standard drug now and then. Further research has to be done to know the exact pathogenesis, early detection and betterment in treatment plan of sarcoidosis. The current review article gives a brief knowledge about etiopathogenesis, Clinical features, upgraded diagnostic methods such as biomarkers detection and the organized treatment plan to treat sarcoidosis.
Tana, C., et al. (2022). "Clinical Features, Histopathology and Differential Diagnosis of Sarcoidosis." Cells 11(1): 59 https://www.mdpi.com/2073-4409/11/1/59 FULL TEXT @ LINK
Sarcoidosis is a chameleon disease of unknown etiology, characterized by the growth of non-
necrotizing and non-caseating granulomas and manifesting with clinical pictures that vary on the
basis of the organs that are mainly affected. Lungs and intrathoracic lymph nodes are the sites
that are most often involved, but virtually no organ is spared from this disease. Histopathology is
distinctive but not pathognomonic, since the findings can be found also in other granulomatous
disorders. The knowledge of these findings is important because it could be helpful to
differentiate sarcoidosis from the other granulomatous-related diseases. This review aims at
illustrating the main clinical and histopathological findings that could help clinicians in their
routine clinical practice.
Thillainadesan, S., et al. (2022). "Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care." Internal Medicine Journal 52(9): 1596-1601 REQUEST ARTICLE https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15402
Abstract Background Studies examining hypercalcaemia in inpatients were largely published over 20 years ago, and it is likely the epidemiology of hypercalcaemia has changed related to increased lifespan and changes in the prevalence of the underlying causes such as malignancy. Aim To explore the epidemiology of hypercalcaemia in a modern tertiary hospital setting in Australia and evaluate the risk of mortality associated with hypercalcaemia. Methods A retrospective study was performed in all inpatients with elevated blood calcium levels admitted from July 2013 to June 2018. ICD coding data identified primary diagnoses and mortality. Electronic medical records were reviewed in n = 292 patients admitted across 12 months from January to December 2017, to determine the causes of hypercalcaemia. Results Hypercalcaemia occurred in 1819 admissions (0.93% of all hospital admissions), during the 5-year period. The admission primary diagnoses were: malignancy (20% of cases), cardiovascular disease (17%) and gastrointestinal disease (11%). The top causes of hypercalcaemia among the 292 cases where electronic records were reviewed were malignancy (26%), primary hyperparathyroidism (25%) and hyperparathyroidism in the setting of chronic kidney disease (12%). Mortality occurred in 17% of these admissions. Non-survivors had significantly higher calcium levels, phosphate and white cell count, and had lower haemoglobin and albumin levels. Conclusion Hypercalcaemia occurred in ~1% of admissions with main causes being malignancy and primary hyperparathyroidism, similar to historical studies. Hypercalcaemia in hospitalised patients is associated with high mortality and higher levels may be a marker for more severe underlying disease.
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