Differentials
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Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2010Cardiovasculaire risicobepaling in de eerste lijnPublished by: Domus MedicaLast published: 2020Obstructive liver disease
SIGNS / SYMPTOMS
Stigmata of liver disease, such as jaundice and abdominal tenderness, may be present.
With significant elevations of bilirubin the patient may also complain of pruritus.
INVESTIGATIONS
Elevated alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, and bilirubin.
Imaging studies such as abdominal ultrasound or computed tomography scan and magnetic resonance imaging may show dilated biliary ducts and possible cause for obstruction.
Nephrotic syndrome
SIGNS / SYMPTOMS
The hyperlipidaemic response is triggered at least in part by the reduction in plasma oncotic pressure, and the severity of the hyperlipidaemia is inversely and closely related to the fall in oncotic pressure.
Spontaneous or drug-induced resolution of nephrotic syndrome reverses hyperlipidaemia.
INVESTIGATIONS
Marked elevations in plasma levels of cholesterol and, less predictably, triglycerides and lipoprotein(a).
HDL-cholesterol is usually normal or reduced.
Abnormal serum creatinine, urea, and serum albumin.
Elevated 24-hour urinary protein.
Chronic renal insufficiency
SIGNS / SYMPTOMS
Dyslipidaemia normally presents as hypertriglyceridaemia (due to diminished clearance). Low HDL-cholesterol levels are also seen in many patients.
Patients undergoing peritoneal dialysis are more likely to have an atherogenic lipid profile than those undergoing haemodialysis.
INVESTIGATIONS
About half of patients have triglyceride levels >2.7 mmol/L (>200 mg/dL), about one third have total cholesterol levels >6.2 mmol/L (>240 mg/dL), and 10% to 45% have low-density lipoprotein cholesterol levels >3.4 mmol/L (>130 mg/dL).
Total cholesterol concentration is sometimes normal or low, which may be in part due to malnutrition in this subset of patients.
Abnormal serum creatinine, urea, and serum albumin.
Elevated 24-hour urinary protein.
Estimated glomerular filtration rate should be calculated.
Hypothyroidism
SIGNS / SYMPTOMS
There may be lethargy, cold intolerance, constipation, dry hair or skin, goitre, or delayed return of deep tendon reflexes.
In a study investigating people referred for the evaluation of hyperlipidaemia, hypothyroidism was found to be present in 4.2% of patients.
A significant reduction in the serum cholesterol concentration during thyroid hormone replacement was only seen in those patients with a serum thyroid-stimulating hormone (TSH) concentration >10 milliunits/L.[49]
INVESTIGATIONS
Serum TSH is high and serum free thyroxine may be low.
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