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SLEEP MEDICINE DEPARTMENT
Disease Main Symptom Secondary Symptoms Frequency Cost (€) Symptom Name Examination Methods Treatment Method Main Symptom? Discomfort Level Patient Complains? Danger Level Mobility Shyness Level Possible Complications
Chronic Insomnia Difficulty falling asleep Fatigue, irritability, poor concentration, mood swings Common 800 Difficulty falling asleep Sleep diary (Doctor’s Office); Actigraphy (Sleep Lab) Cognitive behavioral therapy for insomnia (CBT-I) Yes Moderate Yes Low Normal Low Chronic insomnia; anxiety
Acute Insomnia Frequent nighttime awakenings Daytime sleepiness, anxiety, decreased performance Common 600 Frequent nighttime awakenings Polysomnography (Radiology); Sleep diary (Doctor’s Office) Sleep hygiene coaching Yes Moderate Yes Low Normal Low Daytime fatigue; concentration issues
Psychophysiological Insomnia Nonrestorative sleep Tension, hyperarousal, daytime fatigue Uncommon 900 Nonrestorative sleep Polysomnography (Radiology); Epworth Sleepiness Scale (Office) Relaxation therapy Yes Moderate Yes Low Normal Low Cognitive impairment; mood swings
Adjustment Insomnia Situational sleep disruption Irritability, trouble focusing, mild anxiety Common 700 Situational sleep disruption Sleep history (Doctor’s Office); Actigraphy (Sleep Lab) Short-term hypnotics Yes Mild Yes Low Normal Low Performance decline; anxiety
Paradoxical Insomnia Perceived lack of sleep Sleep misperception, fatigue, stress Rare 1200 Perceived lack of sleep Sleep questionnaires (Doctor’s Office); Sleep diary Reassurance & CBT Yes Low Yes Low Normal Low Stress exacerbation
Idiopathic Insomnia Persistent insomnia since childhood Chronic fatigue, cognitive impairment, mood disturbances Rare 1500 Persistent insomnia since childhood Detailed sleep history; Actigraphy Long-term CBT-I Yes High Yes Low Normal Low Depression; substance use
Obstructive Sleep Apnea Loud snoring Morning headache, daytime drowsiness, hypertension Common 2000 Loud snoring Home oximetry (Lab); Sleep partner report Continuous Positive Airway Pressure (CPAP) Yes Mild Yes Moderate Normal Low Cardiovascular strain; hypertension
Central Sleep Apnea Recurrent breathing pauses Poor sleep quality, fatigue, morning headaches Uncommon 2200 Recurrent breathing pauses Polysomnography (Radiology); Blood gas analysis Adaptive servo-ventilation Yes Moderate Yes High Normal Low Hypoxia; heart failure
Complex Sleep Apnea Combined obstructive and central apneas Severe daytime sleepiness, hypertension, cognitive decline Rare 3000 Combined obstructive and central apneas PSG with effort belts Combined PAP therapy Yes Moderate Yes High Normal Low Severe hypoxia; arrhythmias
Upper Airway Resistance Syndrome Increased respiratory effort Fragmented sleep, daytime tiredness, mood swings Uncommon 1800 Increased respiratory effort Respiratory effort monitoring (Sleep Lab) Oral appliance therapy Yes Mild Yes Moderate Normal Low Daytime somnolence
Sleep-Related Hypoventilation Syndrome Elevated CO₂ during sleep Morning headache, breathlessness, daytime somnolence Rare 2500 Elevated CO₂ during sleep Overnight capnography (Lab) Noninvasive ventilation Yes Moderate Yes High Normal Low Pulmonary hypertension
Sleep-Related Hypoxemia Oxygen desaturation Polycythemia, cognitive impairment, fatigue Uncommon 2300 Oxygen desaturation Pulse oximetry (Lab); Polysomnography Supplemental oxygen Yes Mild Sometimes Moderate Normal Low Polycythemia
Narcolepsy Type 1 Cataplexy episodes Excessive daytime sleepiness, sleep attacks, hallucinations Rare 3000 Cataplexy episodes Clinical observation (Doctor’s Office); EMG (Lab) Sodium oxybate Yes Severe Yes Moderate Normal Low Falls; injury
Narcolepsy Type 2 Excessive daytime sleepiness Microsleeps, memory problems, mood swings Rare 2800 Excessive daytime sleepiness MSLT (Lab); Epworth Sleepiness Scale Modafinil Yes Moderate Yes Moderate Normal Low Occupational accidents
Idiopathic Hypersomnia Prolonged sleep duration Sleep inertia, cognitive dysfunction, depression Rare 2600 Prolonged sleep duration Sleep diary (Doctor’s Office); Actigraphy Stimulant therapy Yes Low Yes Low Normal Low Social impairment
Kleine-Levin Syndrome Periodic hypersomnia episodes Hyperphagia, mood changes, derealization Rare 3800 Periodic hypersomnia episodes Sleep logs; Polysomnography Lithium or stimulant therapy Yes Moderate Yes Moderate Normal Low Hyperphagia; mood swings
Shift Work Sleep Disorder Impaired sleep on shift schedule Cognitive deficits, mood disturbances, gastrointestinal issues Common 1200 Impaired sleep on shift schedule Sleep diary (Doctor’s Office); Actigraphy Strategic napping & light therapy Yes Moderate Yes Low Normal Low Gastrointestinal disturbances
Delayed Sleep Phase Syndrome Delayed sleep onset Daytime fatigue, social conflict, concentration issues Uncommon 1000 Delayed sleep onset Dim-light melatonin onset test (Lab); Sleep diary Chronotherapy Yes Moderate Yes Low Normal Low Social conflict
Advanced Sleep Phase Syndrome Early evening sleepiness Early awakening, alertness fluctuations, irritability Uncommon 1000 Early evening sleepiness Sleep diary (Doctor’s Office); Actigraphy Evening bright-light avoidance Yes Mild Sometimes Low Normal Low Decreased evening function
Non-24-Hour Sleep-Wake Disorder Non-24-hour circadian rhythm Insomnia episodes, daytime sleepiness, mood swings Rare 2000 Non-24-hour circadian rhythm Core body temperature monitoring; Actigraphy Tasimelteon Yes Moderate Yes Low Normal Low Social isolation
Irregular Sleep-Wake Rhythm Disorder Fragmented sleep pattern Daytime sleepiness, memory problems, depression Rare 1900 Fragmented sleep pattern 24-h actigraphy Structured napping schedule Yes Moderate Yes Low Normal Low Memory lapses
Restless Legs Syndrome Unpleasant leg sensations Sleep disruption, fatigue, irritability Common 1400 Unpleasant leg sensations Clinical interview; PLM index via PSG Dopaminergic agents Yes High Yes Low Normal Low Iron deficiency; RLS exacerbation
Periodic Limb Movement Disorder Repetitive limb jerks Nonrestorative sleep, daytime tiredness, cognitive decline Uncommon 1600 Repetitive limb jerks Polysomnography; EMG Clonazepam Yes Moderate Yes Low Normal Low Sleep fragmentation
REM Sleep Behavior Disorder Violent movements during REM Sleep fragmentation, injuries, daytime fatigue Uncommon 2100 Violent REM movements Video-PSG Clonazepam or melatonin Yes High Yes Moderate Normal Moderate Injury to self/partner
Sleepwalking (Somnambulism) Sleepwalking events Injuries, confusion, daytime drowsiness Uncommon 1300 Sleepwalking events Video-PSG; clinical observation Safety measures & low-dose clonazepam Yes Moderate Sometimes Moderate Unsafe Low Injuries; daytime confusion
Sleep Terrors (Night Terrors) Screaming arousals Sweating, tachycardia, daytime anxiety Uncommon 1500 Screaming arousals Video-PSG; sleep history Low-dose benzodiazepines Yes High Yes Moderate Unsafe Low Daytime anxiety
Nightmares Disorder Recurrent distressing dreams Insomnia, daytime anxiety, mood swings Uncommon 1200 Recurrent distressing dreams Sleep diary; dream logs Imagery rehearsal therapy Yes Moderate Yes Low Normal Low Insomnia; anxiety
Sleep-Related Eating Disorder Nocturnal eating Weight gain, daytime fatigue, mood disturbances Rare 1700 Nocturnal eating Sleep diary; partner report Cognitive therapy & dietary management Yes Moderate Sometimes Moderate Normal Moderate Weight gain; metabolic issues
Sleep Talking (Somniloquy) Vocalizations during sleep Partner disturbance, mild daytime fatigue, embarrassment Uncommon 800 Vocalizations during sleep Audio-PSG; partner report Vocal hygiene & reassurance Yes Mild Sometimes Low Normal Moderate Partner sleep disturbance
Sleep Bruxism Teeth grinding at night Jaw pain, headaches, tooth damage Common 900 Teeth grinding at night Bite strip; dental exam Night guard Yes Moderate No Low Normal Moderate Tooth damage; headaches
Exploding Head Syndrome Perceived loud noise at sleep onset Fear, insomnia, headaches Rare 1800 Perceived loud noise at sleep onset Patient interview; sleep diary Reassurance & sleep hygiene Yes Moderate Yes Low Normal Low Insomnia; anxiety
Sleep Paralysis Inability to move on awakening Anxiety, hallucinations, sleep avoidance Uncommon 1500 Inability to move on awakening Patient history; clinical interview Reassurance & sleep posture training Yes High Yes Low Normal High Sleep avoidance
Cataplexy Sudden muscle weakness Falls, anxiety, sleep attacks Rare 2600 Sudden muscle weakness Clinical observation; EMG Sodium oxybate Yes Severe Yes Moderate Normal Low Falls; fractures
Jet Lag Disorder Circadian misalignment after travel Insomnia, daytime sleepiness, digestive issues Common 800 Circadian misalignment after travel Sleep diary; Actigraphy Bright-light therapy & melatonin Yes Moderate Yes Low Normal Low Jet lag; performance issues
Fatal Familial Insomnia Progressive insomnia Weight loss, hallucinations, autonomic dysfunction Rare 4000 Progressive insomnia Detailed family history; Polysomnography Supportive care & hospitalization Yes Severe Yes High Normal Low Autonomic dysfunction; mortality
Sleep-Onset Association Disorder Inability to fall asleep without cues Bedtime anxiety, fragmented sleep, daytime drowsiness Uncommon 1100 Inability to fall asleep without cues Sleep diary; stimulus assessment Stimulus control therapy Yes Moderate Yes Low Normal Low Chronic insomnia
Inadequate Sleep Hygiene Disorder Poor sleep habits Insomnia, daytime fatigue, mood disturbances Common 700 Poor sleep habits Sleep hygiene assessment; questionnaire Sleep hygiene education Yes Low Yes Low Normal Low Insomnia; daytime fatigue
Primary Snoring Soft airway vibrations Mild daytime sleepiness, partner disturbance, fatigue Common 600 Soft airway vibrations Home oximetry; partner report Mandibular advancement device Yes Mild Sometimes Low Normal Low Progression to OSA
Rhythmic Movement Disorder Head banging motions Sleep disruption, headaches, daytime fatigue Rare 1600 Head banging motions Video-PSG; clinical observation Reassurance & protective padding Yes Moderate Sometimes Moderate Unsafe Low Injuries; disrupted sleep
Nocturnal Enuresis Bedwetting Embarrassment, sleep interruptions, daytime stress Uncommon 1200 Bedwetting Bladder diary; urodynamic testing Nocturnal alarm therapy Yes High Yes Low Normal High Skin irritation; embarrassment
Confusional Arousals Mental confusion on awakening Disorientation, daytime anxiety, memory lapses Uncommon 1300 Mental confusion on awakening Clinical interview; EEG Reassurance & safety measures Yes Moderate Yes Moderate Impaired Low Falls; anxiety
Hypersomnolence Due to Medical Condition Daytime sleepiness from illness Fatigue, cognitive impairment, mood swings Uncommon 2000 Daytime sleepiness from illness Sleep diary; medical evaluation Treat underlying condition Yes Moderate Yes Moderate Normal Low Prolonged recovery
Hypersomnolence Due to Mental Disorder Sleepiness from psychiatric cause Low motivation, concentration issues, mood disturbances Uncommon 2100 Sleepiness from psychiatric cause Psychiatric evaluation; sleep diary Treat mental disorder & sleep therapy Yes Moderate Yes Moderate Normal Low Medication side effects
Shift Lag Syndrome Difficulty adapting to rotating shifts Insomnia, fatigue, mood swings Common 1000 Difficulty adapting to rotating shifts Sleep diary; Actigraphy Melatonin & light scheduling Yes Moderate Yes Low Normal Low Chronic fatigue
Cheyne-Stokes Breathing Crescendo-decrescendo respiration Insomnia, daytime breathlessness, fatigue Rare 2300 Crescendo-decrescendo respiration Polysomnography; capnography Optimize heart failure management Yes Moderate Yes High Normal Low Cardiac decompensation
Post-Traumatic Sleep Disorder Trauma-related nightmares Insomnia, anxiety, hypervigilance Uncommon 1800 Trauma-related nightmares Sleep diary; clinical interview Trauma-focused CBT Yes High Yes Low Normal Low PTSD; insomnia
Medication-Induced Sleep Disorder Drug-related insomnia Daytime fatigue, mood changes, dependency Uncommon 1400 Drug-related insomnia Medication review; sleep diary Adjust medication regimen Yes Moderate Yes Low Normal Low Dependence; rebound insomnia
Hypnagogic Hallucinations Vivid hallucinations at sleep onset Fear, sleep avoidance, insomnia Rare 1600 Vivid hallucinations at sleep onset Clinical interview; sleep diary Reassurance & sleep hygiene Yes Moderate Yes Low Normal Low Fear; sleep avoidance
REM Sleep Without Atonia Muscle tone during REM Sleep fragmentation, injuries, daytime fatigue Rare 2200 Muscle tone during REM Video-PSG; EMG Clonazepam Yes Moderate Yes Moderate Normal Low Injuries; parasomnia
Periodic Sleep Reversal Disorder Reversed sleep-wake cycle Insomnia, daytime drowsiness, social isolation Rare 2000 Reversed sleep-wake cycle Actigraphy; sleep diary Light therapy & sleep scheduling Yes Moderate Yes Low Normal Low Social isolation

ENDOCRINOLOGY DEPARTMENT

Disease Main Symptom Secondary Symptoms Frequency Cost (€) Symptom Name Examination Name Treatment Method Main Symptom? Discomfort Level Patient Complains? Danger Level Mobility Shyness Level Possible Complications Examination Name Required Room Duration Discomfort Level Symptom Name Treatment Name Treatment Type Hospitalization Required Discomfort Level
Type 1 Diabetes Mellitus Polyuria Polydipsia, polyphagia, weight loss, fatigue Uncommon 1500 Polyuria 24-hour urine volume measurement Insulin replacement therapy Yes Moderate Yes Moderate Normal Low Dehydration; electrolyte imbalance 24-hour urine volume measurement Lab 24 h Low Polyuria Insulin replacement therapy Non-surgical No Moderate
Type 2 Diabetes Mellitus Acanthosis nigricans Polyuria, polydipsia, obesity, peripheral neuropathy Common 1200 Acanthosis nigricans Skin examination Metformin therapy Yes Low Sometimes Low Normal Moderate Progression to type 2 diabetes mellitus Skin examination Doctor’s Office 10 min Low Acanthosis nigricans Metformin therapy Non-surgical No Low
Gestational Diabetes Mellitus Polyhydramnios Macrosomia, maternal hypertension, hyperglycemia Common 1000 Polyhydramnios Obstetric ultrasound Amnioreduction Yes High Yes Moderate Normal Low Preterm labor; cord prolapse Obstetric ultrasound Radiology 30 min Low Polyhydramnios Amnioreduction Surgical Yes High
Diabetic Ketoacidosis Ketonuria Abdominal pain, Kussmaul respirations, vomiting, dehydration Uncommon 1800 Ketonuria Urinalysis IV insulin infusion Yes Moderate Sometimes High Normal Low Diabetic ketoacidosis; metabolic acidosis Urinalysis Lab 10 min Low Ketonuria IV insulin infusion Non-surgical Yes Moderate
Hyperosmolar Hyperglycemic State Severe dehydration Polyuria, altered mental status, extreme hyperglycemia Rare 2000 Severe dehydration Clinical examination IV fluid resuscitation Yes Moderate Yes High Impaired Low Hypovolemic shock; renal failure Clinical examination Doctor’s Office 20 min Low Severe dehydration IV fluid resuscitation Non-surgical Yes Moderate
Hypoglycemia Sweating Tachycardia, tremor, hunger, confusion Common 900 Sweating Blood glucose measurement Oral glucose administration Yes Moderate Yes Moderate Normal Low Seizures; loss of consciousness Blood glucose measurement Lab 5 min Low Sweating Oral glucose administration Non-surgical No Low
Addison’s Disease Hyperpigmentation Hypotension, fatigue, weight loss, hyperkalemia Rare 2200 Hyperpigmentation Serum cortisol assay Glucocorticoid replacement Yes Low Sometimes Moderate Normal Low Adrenal crisis; hyperkalemia Serum cortisol assay Lab 15 min Low Hyperpigmentation Glucocorticoid replacement Non-surgical No Low
Secondary Adrenal Insufficiency Hypotension Fatigue, nausea, hyponatremia, weight loss Rare 2000 Hypotension Blood pressure measurement Tapered steroid withdrawal Yes Low Yes Moderate Normal Low Syncope; adrenal crisis Blood pressure measurement Doctor’s Office 5 min Low Hypotension Tapered steroid withdrawal Non-surgical No Low
Cushing’s Syndrome Central obesity Moon facies, hypertension, osteoporosis, glucose intolerance Uncommon 2300 Central obesity DEXA scan Ketoconazole therapy Yes Moderate Yes Moderate Normal Low Hypertension; diabetes DEXA scan Radiology 15 min Low Central obesity Ketoconazole therapy Non-surgical No Moderate
Conn’s Syndrome (Primary Hyperaldosteronism) Hypokalemia Hypertension, muscle weakness, polyuria Rare 2100 Hypokalemia Serum potassium assay Spironolactone therapy Yes Low Sometimes High Normal Low Arrhythmias; muscle weakness Serum potassium assay Lab 10 min Low Hypokalemia Oral potassium supplementation Non-surgical No Low
Pheochromocytoma Episodic hypertension Headache, sweating, palpitations, pallor Rare 2500 Episodic hypertension Ambulatory blood pressure monitoring Adrenalectomy Yes High Yes High Normal Low Hypertensive crisis; stroke Ambulatory blood pressure monitoring Lab 24 h Moderate Episodic hypertension Adrenalectomy Surgical Yes High
Congenital Adrenal Hyperplasia Ambiguous genitalia Salt wasting, hypotension, adrenal crisis Rare 2400 Ambiguous genitalia Karyotype Genital reconstructive surgery Yes High Sometimes Moderate Normal Moderate Psychosocial distress; fertility issues Karyotype Lab 3 days Low Ambiguous genitalia Genital reconstructive surgery Surgical Yes High
Acromegaly Enlarged hands and feet Coarse facial features, insulin resistance, joint pain Rare 2600 Enlarged hands and feet Pituitary MRI Transsphenoidal pituitary surgery Yes High Yes High Normal Low Cardiomyopathy; insulin resistance Pituitary MRI Radiology 45 min Moderate Enlarged hands and feet Transsphenoidal pituitary surgery Surgical Yes High
Gigantism Increased height Delayed puberty, pituitary enlargement, headaches Rare 2700 Increased height GH level assay Somatostatin analog injection Yes Moderate Sometimes Moderate Normal Low Arthropathy; visceromegaly GH level assay Lab 15 min Low Increased height Octreotide injection Non-surgical No Moderate
Growth Hormone Deficiency (child) Short stature Increased adiposity, delayed bone age, hypoglycemia Uncommon 2000 Short stature Bone age X-ray Recombinant GH therapy Yes Moderate Sometimes Low Normal Low Low bone density; delayed puberty Bone age X-ray Radiology 10 min Low Short stature Recombinant growth hormone therapy Non-surgical No Moderate
Non-functioning Pituitary Adenoma Visual field defect Headache, hypopituitarism, fatigue Uncommon 2100 Visual field defect Humphrey visual field test Transsphenoidal adenoma resection Yes Moderate Yes High Normal Low Permanent vision loss Humphrey visual field test Lab 30 min Low Visual field defect Transsphenoidal adenoma resection Surgical Yes High
Prolactinoma Galactorrhea Amenorrhea, infertility, decreased libido, headache Uncommon 2000 Galactorrhea Prolactin level assay Dopamine agonist (cabergoline) Yes Low Yes Low Normal Low Infertility; osteoporosis Prolactin level assay Lab 15 min Low Galactorrhea Cabergoline Non-surgical No Low
Hypopituitarism Fatigue Hypotension, cold intolerance, weight loss Rare 2200 Fatigue TSH/FT₄ panel Hormone replacement therapy Yes Moderate Yes Moderate Normal Low Adrenal insufficiency; cardiac complications TSH/FT₄ panel Lab 15 min Low Fatigue Hormone replacement therapy Non-surgical No Low
Central Diabetes Insipidus Polydipsia Polyuria, nocturia, hypernatremia Rare 1800 Polydipsia Water deprivation test Desmopressin nasal spray Yes Low Yes Moderate Normal Low Hyponatremia; seizures Water deprivation test Lab 8 h High Polydipsia Desmopressin nasal spray Non-surgical No Low
SIADH Hyponatremia Nausea, confusion, seizures, low urine output Uncommon 1600 Hyponatremia Serum sodium assay Fluid restriction & demeclocycline Yes Low Sometimes Moderate Normal Low Cerebral edema; seizures Serum sodium assay Lab 10 min Low Hyponatremia Fluid restriction & demeclocycline Non-surgical No Low
Hypothyroidism Weight gain Cold intolerance, constipation, bradycardia Common 1000 Weight gain Anthropometry (BMI & waist circumference) Levothyroxine replacement Yes Low Yes Low Low Low Myxedema coma; hyperlipidemia Anthropometry (BMI & waist circumference) Doctor’s Office 15 min Low Weight gain Levothyroxine replacement Non-surgical No Low
Hyperthyroidism Palpitations Weight loss, heat intolerance, tremor Common 1200 Palpitations Holter monitoring Methimazole therapy Yes Moderate Yes Moderate Normal Low Agranulocytosis; arrhythmias Holter monitoring Lab 24 h Moderate Palpitations Methimazole therapy Non-surgical No Moderate
Graves’ Disease Exophthalmos Pretibial myxedema, heat intolerance, palpitations Uncommon 1500 Exophthalmos Orbital CT Orbital decompression surgery Yes High Yes Moderate Normal Moderate Corneal ulceration; optic neuropathy Orbital CT Radiology 30 min Low Exophthalmos Orbital decompression surgery Surgical Yes High
Toxic Multinodular Goiter Goiter Hyperthyroid signs, dysphagia, neck discomfort Uncommon 1600 Goiter Thyroid ultrasound Hemithyroidectomy Yes Moderate Yes Moderate Normal Low RLN injury; dysphagia Thyroid ultrasound Radiology 30 min Low Goiter Thyroid lobectomy Surgical Yes Moderate
Subacute (De Quervain’s) Thyroiditis Painful thyroid Fever, malaise, transient hyperthyroidism Uncommon 1400 Painful thyroid ESR/CRP assay NSAIDs & beta-blocker Yes High Yes Low Normal Low Transient hypothyroidism ESR/CRP assay Lab 10 min Low Painful thyroid NSAIDs & beta-blocker Non-surgical No Moderate
Papillary Thyroid Carcinoma Thyroid nodule Cervical lymphadenopathy, hoarseness Uncommon 3000 Thyroid nodule Fine-needle aspiration biopsy Total thyroidectomy Yes High Yes Moderate Normal Low Hypocalcemia; vocal cord paralysis Fine-needle aspiration biopsy Lab 15 min Moderate Thyroid nodule Total thyroidectomy Surgical Yes High
Primary Hyperparathyroidism Hypercalcemia Kidney stones, osteoporosis, polyuria Uncommon 2000 Hypercalcemia Serum calcium/PTH assay Parathyroidectomy Yes Moderate Yes High Normal Low Kidney stones; hungry bone syndrome Serum calcium/PTH assay Lab 15 min Low Hypercalcemia Parathyroidectomy Surgical Yes Moderate
Hypoparathyroidism Tetany Paresthesias, seizures, positive Chvostek sign Rare 2200 Tetany Chvostek’s/Trousseau’s signs IV calcium gluconate Yes Severe Yes High Impaired Low Laryngospasm; arrhythmias Chvostek’s/Trousseau’s signs Doctor’s Office 5 min Low Tetany IV calcium gluconate Non-surgical No High
Pseudohypoparathyroidism Brachydactyly Hypocalcemia, elevated PTH, short fourth metacarpals Rare 2300 Brachydactyly Hand X-ray Calcium & vitamin D supplements Yes Low No Low Normal Low Growth retardation; seizures Hand X-ray Radiology 10 min Low Brachydactyly Calcium & vitamin D supplementation Non-surgical No Low
Osteoporosis Fragility fracture Kyphosis, low bone density, back pain Common 1200 Fragility fracture DEXA scan IV bisphosphonate infusion Yes Moderate Yes Moderate Impaired Low Atypical fracture; osteonecrosis DEXA scan Radiology 15 min Low Fragility fracture IV bisphosphonate infusion Non-surgical No Moderate
Osteomalacia Bone pain Muscle weakness, fractures, hypocalcemia Uncommon 1500 Bone pain X-ray Vitamin D & calcium supplements Yes Moderate Yes Low Impaired Low Fractures; muscle weakness X-ray Radiology 10 min Low Bone pain Vitamin D & calcium supplements Non-surgical No Moderate
Rickets Bowed legs Costochondral beading, dental defects Rare 1600 Bowed legs X-ray High-dose vitamin D therapy Yes Moderate Yes Low Impaired Low Dental defects; growth delay X-ray Radiology 10 min Low Bowed legs High-dose vitamin D therapy Non-surgical No Moderate
Polycystic Ovary Syndrome Hirsutism Oligomenorrhea, obesity, insulin resistance Common 1500 Hirsutism Ferriman-Gallwey score Spironolactone & OCPs Yes Moderate Yes Low Normal High Acne; menstrual irregularities Ferriman-Gallwey score Doctor’s Office 15 min Low Hirsutism Spironolactone Non-surgical No Moderate
Premature Ovarian Failure Amenorrhea Hot flashes, infertility, osteoporosis Uncommon 1800 Amenorrhea FSH/LH/estradiol panel Estrogen-progestin replacement Yes Low Yes Low Normal Low Osteoporosis; infertility FSH/LH/estradiol panel Lab 15 min Low Amenorrhea Estrogen-progestin replacement Non-surgical No Low
Klinefelter Syndrome Gynecomastia Small testes, infertility, tall stature Uncommon 2000 Gynecomastia Breast examination Testosterone replacement Yes Moderate Yes Low Normal High Infertility; mood changes Breast examination Doctor’s Office 10 min Low Gynecomastia Breast reduction surgery Surgical Yes High
Androgen Insensitivity Syndrome Female external genitalia Undescended testes, sparse pubic hair Rare 2500 Female external genitalia Physical examination Gonadectomy & hormone replacement Yes High Sometimes Moderate Normal High Gonadal tumors; psychological distress Physical examination Doctor’s Office 15 min Low Female external genitalia Gonadectomy & hormone replacement Surgical Yes High
Turner Syndrome Webbed neck Short stature, coarctation of aorta, ovarian dysgenesis Rare 2600 Webbed neck Cardiac echocardiogram Cervical skin excision surgery Yes Moderate Sometimes Moderate Normal Moderate Lymphedema; cardiac anomalies Cardiac echocardiogram Radiology 30 min Low Webbed neck Cervical skin excision surgery Surgical Yes Moderate
Male Hypogonadism Low libido Erectile dysfunction, decreased body hair, osteoporosis Uncommon 1200 Low libido Psychosexual evaluation Testosterone therapy Yes Low Yes Low Normal Low Depression; osteoporosis Psychosexual evaluation Doctor’s Office 45 min Moderate Low libido Testosterone therapy Non-surgical No Low
Female Hypogonadism Hot flashes Vaginal dryness, mood swings, osteoporosis Uncommon 1200 Hot flashes Clinical interview Low-dose estrogen therapy Yes Moderate Yes Low Normal Low Thromboembolism; endometrial cancer Clinical interview Doctor’s Office 30 min Low Hot flashes Low-dose estrogen therapy Non-surgical No Moderate
Metabolic Syndrome Dyslipidemia Hypertension, hyperglycemia, central obesity Common 1000 Dyslipidemia Lipid panel Statin therapy Yes Low No Moderate Normal Low Myopathy; hepatotoxicity Lipid panel Lab 15 min Low Dyslipidemia Statin therapy Non-surgical No Low
Endocrine-related Obesity Increased BMI Joint pain, sleep apnea, insulin resistance Common 1100 Increased BMI Anthropometry (BMI & waist ratio) Lifestyle modification & GLP-1 agonist Yes Moderate Yes Moderate Impaired Moderate Cardiometabolic disease; OA Anthropometry (BMI & waist ratio) Doctor’s Office 15 min Low Increased BMI Bariatric surgery Surgical Yes High
Insulinoma Hypoglycemic seizures Confusion, sweating, tremor Rare 2400 Hypoglycemic seizures Mixed-meal tolerance test Diazoxide therapy Yes High Yes High Impaired Low Neurologic damage; arrhythmias Mixed-meal tolerance test Lab 3 h Moderate Hypoglycemic seizures Diazoxide therapy Non-surgical No Moderate
Gastrinoma (Zollinger-Ellison) Refractory peptic ulcers Diarrhea, abdominal pain, weight loss Rare 2600 Refractory peptic ulcers Upper GI endoscopy Surgical resection of gastrinoma Yes High Yes Moderate Normal Low Metastases; recurrence Upper GI endoscopy Endoscopy 30 min Moderate Refractory peptic ulcers Antrectomy & vagotomy Surgical Yes High
VIPoma Secretory diarrhea Hypokalemia, dehydration, achlorhydria Rare 2800 Secretory diarrhea VIP level assay Somatostatin analog injection Yes Moderate Yes Moderate Normal Low Dehydration; hypokalemia VIP level assay Lab 30 min Low Secretory diarrhea Octreotide injection Non-surgical No Moderate
Glucagonoma Migratory necrolytic erythema Weight loss, anemia, new-onset diabetes Rare 3000 Migratory necrolytic erythema Skin biopsy Surgical resection of glucagonoma Yes High Yes Moderate Normal Low Necrolytic rash recurrence; diabetes Skin biopsy Pathology 15 min Moderate Migratory necrolytic erythema Surgical resection of glucagonoma Surgical Yes High

im working on an holistic department, i think could be fun to play

@Fedo_340, could you send me with Google Drive or other link?