Capillary leak syndrome differential diagnosis: Difference between revisions

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{{CMG}}; '''Associate Editor(s)-In-Chief:''' [https://www.wikidoc.org/index.php/User:Hassan_M M. Hassan, M.B.B.S]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [https://www.wikidoc.org/index.php/User:Hassan_M M. Hassan, M.B.B.S]
==Overview==
As capillary leak syndrome has overlapping clinical and laboratory findings with various other conditions, it should be considered as the diagnosis of exclusion. Some common ones include [[Adrenal insufficiency]], [[Anaphylaxis]], [[Carcinoid syndrome|Carcinoid Syndrome]], [[Chronic heart failure|Chronic Heart Failure]], [[Enteropathy]], [[Gleich syndrome]], [[Hereditary angioedema]], [[Inferior vena cava syndrome]], [[Mastocytosis]], [[Nephrotic syndrome]], [[Ovarian hyperstimulation syndrome]], [[Pancreatitis]], [[Pheochromocytoma]], [[Primary amyloidosis]], [[Sepsis]] and [[Toxic shock syndrome]]. Some other conditions that should be considered as a differential diagnosis include [[Differentiation syndrome]], [[Engraftment syndrome]], [[Hemophagocytic lymphohistiocytosis]], [[Viral hemorrhagic fevers]], [[Snakebites|Snakebite]] envenomation, [[Ricin]] poisoning, as well as multiple [[autoimmune conditions]].


==Differential diagnosis==
==Differential diagnosis==
Due to overlapping clinical and laboratory findings of capillary leak syndrome with other conditions, it is considered as the diagnosis of exclusion. SCLS should be differentiated from many possible differential diagnoses many of which may have overlapping symptoms such as [[hypotension]], [[flushing]] and [[hypoalbuminemia]] with resultant [[edema]]. Such conditions include [[Adrenal insufficiency]], [[Anaphylaxis]], [[Carcinoid syndrome|Carcinoid Syndrome]], [[Chronic heart failure|Chronic Heart Failure]], [[Enteropathy]], [[Gleich syndrome]], [[Hereditary angioedema]], [[Inferior vena cava syndrome]], [[Mastocytosis]], [[Nephrotic syndrome]], [[Ovarian hyperstimulation syndrome]], [[Pancreatitis]], [[Pheochromocytoma]], [[Primary amyloidosis]], [[Sepsis]] and [[Toxic shock syndrome]].<ref name="pmid20634497">{{cite journal| author=Kapoor P, Greipp PT, Schaefer EW, Mandrekar SJ, Kamal AH, Gonzalez-Paz NC | display-authors=etal| title=Idiopathic systemic capillary leak syndrome (Clarkson's disease): the Mayo clinic experience. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 10 | pages= 905-12 | pmid=20634497 | doi=10.4065/mcp.2010.0159 | pmc=2947962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20634497  }} </ref><ref name="pmid25738482">{{cite journal| author=Zancanaro A, Serafini F, Fantin G, Murer B, Cicardi M, Bonanni L | display-authors=etal| title=Clinical and pathological findings of a fatal systemic capillary leak syndrome (Clarkson disease): a case report. | journal=Medicine (Baltimore) | year= 2015 | volume= 94 | issue= 9 | pages= e591 | pmid=25738482 | doi=10.1097/MD.0000000000000591 | pmc=4553957 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25738482  }} </ref>
{| class="wikitable"
|+Differential diagnosis<ref name="pmid206439902">{{cite journal| author=Druey KM, Greipp PR| title=Narrative review: the systemic capillary leak syndrome. | journal=Ann Intern Med | year= 2010 | volume= 153 | issue= 2 | pages= 90-8 | pmid=20643990 | doi=10.7326/0003-4819-153-2-201007200-00005 | pmc=3017349 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20643990  }}</ref>
!Disorder
!Similarities to Systemic capillary leak syndrome
!Distinguishing features
!Investigations to confirm Differential Diagnosis
|-
|[[Adrenal insufficiency]]
|
* [[Hypotension]]
|
* [[Fatigue]]
* [[Anorexia]]
* [[Weight loss]]
* [[Abdominal pain]]
* [[Nausea]]
* [[Vomiting]]
* [[Lethargy]]
|
* [[Hyponatremia]]<ref name="ChansonGuignat2017">{{cite journal|last1=Chanson|first1=Philippe|last2=Guignat|first2=Laurence|last3=Goichot|first3=Bernard|last4=Chabre|first4=Olivier|last5=Boustani|first5=Dinane Samara|last6=Reynaud|first6=Rachel|last7=Simon|first7=Dominique|last8=Tabarin|first8=Antoine|last9=Gruson|first9=Damien|last10=Reznik|first10=Yves|last11=Raffin Sanson|first11=Marie-Laure|title=Group 2: Adrenal insufficiency: screening methods and confirmation of diagnosis|journal=Annales d'Endocrinologie|volume=78|issue=6|year=2017|pages=495–511|issn=00034266|doi=10.1016/j.ando.2017.10.005}}</ref>
* [[Hyperkalemia]]
* [[Eosinophilia]]
* Episodic [[hypoglycemia]]
* Mild metabolic acidosis
|-
|[[Anaphylaxis]] (Idiopathic)
|
* [[Hypotension]]
* [[Flushing]]
|
* Normal [[albumin]]
* [[Hives]]
* [[Laryngeal edema]]
* Elevated serum [[tryptase]]
|
* Primarily based on clinical diagnosis<ref name="pmidDOI:https://doi.org/10.1016/j.jaci.2009.12.981">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=DOI:https://doi.org/10.1016/j.jaci.2009.12.981 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
* Elevated levels of [[tryptase]] and [[histamine]]
|-
|[[Carcinoid syndrome|Carcinoid Syndrome]]
|
* [[Hypotension]]
* [[Flushing]]
|
* Absence of [[edema]]
* Elevated [[serotonin]] metabolites
|
*Elevated [[Urinary]] [[5-hydroxyindoleacetic acid]] 
*Elevated [[Plasma (blood)|plasma]] levels of [[Chromogranin A]] (CgA)<ref name="diagnostics">Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref>
*Other biochemical markersinclude:<ref name="diagnostics2">Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref>
*[[Substance P]], [[Neurotensin]], [[Bradykinin]], [[Human chorionic gonadotropin|hCG]] , [[Neuropeptide]] L, [[Pancreatic polypeptide]]
|-
|[[Chronic heart failure|Chronic Heart Failure]]
|
* [[Edema]] (of the ankles)
|
* [[Breathlessness]]
* [[Orthopnoea]]
* [[Paroxysmal nocturnal dyspnoea]]
* [[Fatigue]]
* Reduced exercise tolerance and Increased recovery time
|
* Elevated Natriuretic Peptides ([[BNP]] or [[NT-proBNP|NT-proBNP)]]<ref name="pmid22541282">{{cite journal |vauthors=Verdú JM, Comín-Colet J, Domingo M, Lupón J, Gómez M, Molina L, Casacuberta JM, Muñoz MA, Mena A, Bruguera-Cortada J |title=Rapid point-of-care NT-proBNP optimal cut-off point for heart failure diagnosis in primary care |journal=Rev Esp Cardiol (Engl Ed) |volume=65 |issue=7 |pages=613–9 |date=July 2012 |pmid=22541282 |doi=10.1016/j.recesp.2012.01.019 |url=}}</ref>
|-
|[[Enteropathy]] with protein loss
|<br />
* [[Edema]]
* [[Hypoalbuminemia]]
|
* [[Diarrhea]]
|
* Differs according to underlying subtype of [[enteropathy]]
|-
|[[Gleich syndrome]]
|
* Cyclical [[edema]]
|
* [[Urticaria]]
* [[Eosinophilia]]
* Elevated [[IgM]]
* Normal [[albumin]]
|
* [[Hypereosinophilic syndrome|Hypereosinophilic]]<ref name="pmid32557651">{{cite journal| author=Haber R, Chebl JA, El Gemayel M, Salloum A| title=Gleich syndrome: a systematic review. | journal=Int J Dermatol | year= 2020 | volume= 59 | issue= 12 | pages= 1458-1465 | pmid=32557651 | doi=10.1111/ijd.14963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32557651  }}</ref>
|-
|[[Hereditary angioedema]]
|
* [[Edema]]
|
* [[Normotension]]
* [[Visceral effusions]]
|
* Decreased levels of [[C1 esterase inhibitor]]
|-
|[[Inferior vena cava syndrome]]
|
* Lower extremity [[edema]]
* [[Hypotension]]
|
* Irreversible [[hypotension]]
* Normal [[albumin]]
|
* Diagnosed using imaging modalities such as [[Duplex Ultrasound]] or [[CT]] abdomen and pelvis<ref name="pmid328097202">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=32809720 | doi= | pmc= | url= }}</ref>
|-
|[[Mastocytosis]] (Mast cell disease)
|
* [[Hypotension]]
* [[Flushing]]
|
* [[Urticaria pigmentosa]]
* Elevated serum [[tryptase]]
|
* Elevated serum [[tryptase]]<ref name="OzdemirDagdelen2010">{{cite journal|last1=Ozdemir|first1=Didem|last2=Dagdelen|first2=Selcuk|last3=Erbas|first3=Tomris|last4=Agbaht|first4=Kemal|last5=Serefhanoglu|first5=Songul|last6=Aksu|first6=Salih|last7=Ersoy-Evans|first7=Sibel|title=Hypotension, Syncope, and Fever in Systemic Mastocytosis without Skin Infiltration and Rapid Response to Corticosteroid and Cyclosporin: A Case Report|journal=Case Reports in Medicine|volume=2010|year=2010|pages=1–4|issn=1687-9627|doi=10.1155/2010/782595}}</ref>
|-
|[[Nephrotic syndrome]]
|
* [[Edema]]
* [[Hypoalbuminemia]]
|
* [[Proteinuria]]
|
* 24-hour urine collection shows [[proteinuria]] > 3.5g/24 hrs<ref name="pmid199048972">{{cite journal| author=Kodner C| title=Nephrotic syndrome in adults: diagnosis and management. | journal=Am Fam Physician | year= 2009 | volume= 80 | issue= 10 | pages= 1129-34 | pmid=19904897 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19904897 }}</ref>
|-
|[[Ovarian hyperstimulation syndrome]]
|
* [[Hypotension]]
* [[Hypovolemia]]
* [[Edema]]
|
* [[Visceral effusions]]
|
* Diagnosed with imaging modalities
|-
|[[Pancreatitis]]
|
* [[Hypotension]]
* [[Hypoalbuminemia]]
|
* Severe [[abdominal pain]]
* [[Nausea]]
* [[Vomiting]]
* Elevated [[amylase]]
|
* Elevated [[amylase]] and [[lipase]]
* [[CT scan]] findings
|-
|[[Pheochromocytoma]]
|
* [[Hypotension]]
* [[Flushing]]
|
* [[Hypertension]]
* [[Palpitations]]
* [[Anxiety]]
* [[Sweating]]
* [[Headaches]]
* Elevated [[norepinephrine]] and [[epinephrine]] metabolites
|
* Elevated 24-hour urine fractionated metanephrines and catecholamines<ref name="pmid12574179">{{cite journal| author=Sawka AM, Jaeschke R, Singh RJ, Young WF| title=A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. | journal=J Clin Endocrinol Metab | year= 2003 | volume= 88 | issue= 2 | pages= 553-8 | pmid=12574179 | doi=10.1210/jc.2002-021251 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12574179  }}</ref>
* Elevated urinary [[vanillyl mandelic acid]]<ref name="pmid11903030">{{cite journal| author=Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P et al.| title=Biochemical diagnosis of pheochromocytoma: which test is best? | journal=JAMA | year= 2002 | volume= 287 | issue= 11 | pages= 1427-34 | pmid=11903030 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11903030  }}</ref>
|-
|[[Polycythemia vera]]
|
* Severe [[leukocytosis]]
* [[Erythrocytosis]]
* [[Thrombocytosis]]
|
* [[Normotension]]
* Normal [[albumin]]
* Absence of [[edema]]
|
* Abnormal [[CBC]] values:<ref name="pmid17178662">{{cite journal| author=Mazzotta S, Guerranti R, Gozzetti A, Bucalossi A, Bocchia M, Sammassimo S et al.| title=Increased serum lactate dehydrogenase isoenzymes in Ph-negative chronic myeloproliferative diseases: a metabolic adaptation? | journal=Hematology | year= 2006 | volume= 11 | issue= 4 | pages= 239-44 | pmid=17178662 | doi=10.1080/10245330600774835 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17178662  }}</ref><ref name="pmid5947579">{{cite journal| author=Denman M, Szur L, Ansell BM| title=Hyperuricaemia in polycythaemia vera. | journal=Ann Rheum Dis | year= 1966 | volume= 25 | issue= 4 | pages= 340-4 | pmid=5947579 | doi= | pmc=PMC2453349 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5947579  }}</ref><ref name="pmid23606974">{{cite journal| author=Murakami J, Shimizu Y| title=Hepatic manifestations in hematological disorders. | journal=Int J Hepatol | year= 2013 | volume= 2013 | issue=  | pages= 484903 | pmid=23606974 | doi=10.1155/2013/484903 | pmc=PMC3626309 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23606974  }}</ref>
* [[Erythrocytosis]], Increased [[hemoglobin]], [[Thrombocytosis]], [[Leukocytosis]], Increased [[basophil]]s and [[eosinophils]]
|-
|[[Primary amyloidosis]]
|
* Generalized [[edema]] ([[Anasarca]])
|
* [[Bleeding]] tendency
* Frothy [[urine]]
* [[Chest pain]]
* [[Numbness]] or [[tingling]]
* [[Early satiety]]
* [[Joint pains]]
|
*[[Beta-2 microglobulin|Beta-2-microglobulin]]<ref name="pmid24145344">{{cite journal| author=Kourelis TV, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR et al.| title=Coexistent multiple myeloma or increased bone marrow plasma cells define equally high-risk populations in patients with immunoglobulin light chain amyloidosis. | journal=J Clin Oncol | year= 2013 | volume= 31 | issue= 34 | pages= 4319-24 | pmid=24145344 | doi=10.1200/JCO.2013.50.8499 | pmc=4881366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24145344  }}</ref>
*[[Serum protein electrophoresis]]
*[[Immunoglobulin]] levels
:
|-
|[[Sepsis]]
|
* [[Hypotension]]
* [[Edema]]
|
* Normal [[albumin]]
* [[Acute respiratory distress syndrome]]
|
* Elevated [[WBC]]
* [[Fever]]
* May be accompanied by [[DIC]] with raised [[PT]], [[aPTT]], and [[D-dimer]]<ref name="pmid27387712">{{cite journal| author=Fan SL, Miller NS, Lee J, Remick DG| title=Diagnosing sepsis - The role of laboratory medicine. | journal=Clin Chim Acta | year= 2016 | volume= 460 | issue=  | pages= 203-10 | pmid=27387712 | doi=10.1016/j.cca.2016.07.002 | pmc=4980259 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27387712  }}</ref>
|-
|[[Toxic shock syndrome]]
|
* [[Hypotension]]
|
* Normal [[albumin]]
* Desquamating [[rash]]
* [[Nausea]]
* [[Vomiting]]
* [[Renal failure]]
* [[Mucosal hyperemia]]
* [[Delirium]]
|
* Elevated [[WBC]]
* [[Fever]]
* [[Metabolic acidosis]]<ref name="pmid6692240">{{cite journal| author=Chow AW, Wong CK, MacFarlane AM, Bartlett KH| title=Toxic shock syndrome: clinical and laboratory findings in 30 patients. | journal=Can Med Assoc J | year= 1984 | volume= 130 | issue= 4 | pages= 425-30 | pmid=6692240 | doi= | pmc=1876096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6692240  }}</ref>
|}


==References==
==References==
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Latest revision as of 15:26, 18 August 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S

Overview

As capillary leak syndrome has overlapping clinical and laboratory findings with various other conditions, it should be considered as the diagnosis of exclusion. Some common ones include Adrenal insufficiency, Anaphylaxis, Carcinoid Syndrome, Chronic Heart Failure, Enteropathy, Gleich syndrome, Hereditary angioedema, Inferior vena cava syndrome, Mastocytosis, Nephrotic syndrome, Ovarian hyperstimulation syndrome, Pancreatitis, Pheochromocytoma, Primary amyloidosis, Sepsis and Toxic shock syndrome. Some other conditions that should be considered as a differential diagnosis include Differentiation syndrome, Engraftment syndrome, Hemophagocytic lymphohistiocytosis, Viral hemorrhagic fevers, Snakebite envenomation, Ricin poisoning, as well as multiple autoimmune conditions.

Differential diagnosis

Due to overlapping clinical and laboratory findings of capillary leak syndrome with other conditions, it is considered as the diagnosis of exclusion. SCLS should be differentiated from many possible differential diagnoses many of which may have overlapping symptoms such as hypotension, flushing and hypoalbuminemia with resultant edema. Such conditions include Adrenal insufficiency, Anaphylaxis, Carcinoid Syndrome, Chronic Heart Failure, Enteropathy, Gleich syndrome, Hereditary angioedema, Inferior vena cava syndrome, Mastocytosis, Nephrotic syndrome, Ovarian hyperstimulation syndrome, Pancreatitis, Pheochromocytoma, Primary amyloidosis, Sepsis and Toxic shock syndrome.[1][2]

Differential diagnosis[3]
Disorder Similarities to Systemic capillary leak syndrome Distinguishing features Investigations to confirm Differential Diagnosis
Adrenal insufficiency
Anaphylaxis (Idiopathic)
Carcinoid Syndrome
Chronic Heart Failure
Enteropathy with protein loss
Gleich syndrome
Hereditary angioedema
Inferior vena cava syndrome
Mastocytosis (Mast cell disease)
Nephrotic syndrome
Ovarian hyperstimulation syndrome
  • Diagnosed with imaging modalities
Pancreatitis
Pheochromocytoma
Polycythemia vera
Primary amyloidosis
Sepsis
Toxic shock syndrome

References

  1. ↑ Kapoor P, Greipp PT, Schaefer EW, Mandrekar SJ, Kamal AH, Gonzalez-Paz NC; et al. (2010). "Idiopathic systemic capillary leak syndrome (Clarkson's disease): the Mayo clinic experience". Mayo Clin Proc. 85 (10): 905–12. doi:10.4065/mcp.2010.0159. PMC 2947962. PMID 20634497.
  2. ↑ Zancanaro A, Serafini F, Fantin G, Murer B, Cicardi M, Bonanni L; et al. (2015). "Clinical and pathological findings of a fatal systemic capillary leak syndrome (Clarkson disease): a case report". Medicine (Baltimore). 94 (9): e591. doi:10.1097/MD.0000000000000591. PMC 4553957. PMID 25738482.
  3. ↑ Druey KM, Greipp PR (2010). "Narrative review: the systemic capillary leak syndrome". Ann Intern Med. 153 (2): 90–8. doi:10.7326/0003-4819-153-2-201007200-00005. PMC 3017349. PMID 20643990.
  4. ↑ Chanson, Philippe; Guignat, Laurence; Goichot, Bernard; Chabre, Olivier; Boustani, Dinane Samara; Reynaud, Rachel; Simon, Dominique; Tabarin, Antoine; Gruson, Damien; Reznik, Yves; Raffin Sanson, Marie-Laure (2017). "Group 2: Adrenal insufficiency: screening methods and confirmation of diagnosis". Annales d'Endocrinologie. 78 (6): 495–511. doi:10.1016/j.ando.2017.10.005. ISSN 0003-4266.
  5. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID DOI:https://doi.org/10.1016/j.jaci.2009.12.981 Check |pmid= value (help).
  6. ↑ Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
  7. ↑ Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
  8. ↑ Verdú JM, Comín-Colet J, Domingo M, Lupón J, Gómez M, Molina L, Casacuberta JM, Muñoz MA, Mena A, Bruguera-Cortada J (July 2012). "Rapid point-of-care NT-proBNP optimal cut-off point for heart failure diagnosis in primary care". Rev Esp Cardiol (Engl Ed). 65 (7): 613–9. doi:10.1016/j.recesp.2012.01.019. PMID 22541282.
  9. ↑ Haber R, Chebl JA, El Gemayel M, Salloum A (2020). "Gleich syndrome: a systematic review". Int J Dermatol. 59 (12): 1458–1465. doi:10.1111/ijd.14963. PMID 32557651 Check |pmid= value (help).
  10. ↑ "StatPearls". 2022. PMID 32809720 Check |pmid= value (help).
  11. ↑ Ozdemir, Didem; Dagdelen, Selcuk; Erbas, Tomris; Agbaht, Kemal; Serefhanoglu, Songul; Aksu, Salih; Ersoy-Evans, Sibel (2010). "Hypotension, Syncope, and Fever in Systemic Mastocytosis without Skin Infiltration and Rapid Response to Corticosteroid and Cyclosporin: A Case Report". Case Reports in Medicine. 2010: 1–4. doi:10.1155/2010/782595. ISSN 1687-9627.
  12. ↑ Kodner C (2009). "Nephrotic syndrome in adults: diagnosis and management". Am Fam Physician. 80 (10): 1129–34. PMID 19904897.
  13. ↑ Sawka AM, Jaeschke R, Singh RJ, Young WF (2003). "A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines". J Clin Endocrinol Metab. 88 (2): 553–8. doi:10.1210/jc.2002-021251. PMID 12574179.
  14. ↑ Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P; et al. (2002). "Biochemical diagnosis of pheochromocytoma: which test is best?". JAMA. 287 (11): 1427–34. PMID 11903030.
  15. ↑ Mazzotta S, Guerranti R, Gozzetti A, Bucalossi A, Bocchia M, Sammassimo S; et al. (2006). "Increased serum lactate dehydrogenase isoenzymes in Ph-negative chronic myeloproliferative diseases: a metabolic adaptation?". Hematology. 11 (4): 239–44. doi:10.1080/10245330600774835. PMID 17178662.
  16. ↑ Denman M, Szur L, Ansell BM (1966). "Hyperuricaemia in polycythaemia vera". Ann Rheum Dis. 25 (4): 340–4. PMC 2453349. PMID 5947579.
  17. ↑ Murakami J, Shimizu Y (2013). "Hepatic manifestations in hematological disorders". Int J Hepatol. 2013: 484903. doi:10.1155/2013/484903. PMC 3626309. PMID 23606974.
  18. ↑ Kourelis TV, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR; et al. (2013). "Coexistent multiple myeloma or increased bone marrow plasma cells define equally high-risk populations in patients with immunoglobulin light chain amyloidosis". J Clin Oncol. 31 (34): 4319–24. doi:10.1200/JCO.2013.50.8499. PMC 4881366. PMID 24145344.
  19. ↑ Fan SL, Miller NS, Lee J, Remick DG (2016). "Diagnosing sepsis - The role of laboratory medicine". Clin Chim Acta. 460: 203–10. doi:10.1016/j.cca.2016.07.002. PMC 4980259. PMID 27387712.
  20. ↑ Chow AW, Wong CK, MacFarlane AM, Bartlett KH (1984). "Toxic shock syndrome: clinical and laboratory findings in 30 patients". Can Med Assoc J. 130 (4): 425–30. PMC 1876096. PMID 6692240.

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