Endocrinology

Metabolic action of Insulin

Causes of thyrotoxicosis

Sings and symptoms of hyperthyroidism

Hyperthyroidism investigation

Thyrotoxicosis Tx

Toxic adenoma

Subclinical thyrotoxicosis

Clinical features of thyroid storm (thyrotoxic crisis)

Cause of thyroid storm

Deferential diagnosis of thyroid storm

Septic shock

Upper GI bleeding

Sympathomimetic toxin ingestion

Ischemic liver disease

Pheochromocytoma

Thyroid storm treatment

Deferences between type 1,2 DM

What is the immune antigen for DM1

HLA-DR3 and HLA-DR4

Associated autoimmune with DM1

Primary adrenal insufficiency

Hashimoto thyroiditis

Vitiligo

Celiac disease

Pernicious anemia

Associated conditions with DM2

HTN

Dyslipidemia

Fatty liver

PCOS

DM should be suspended in patients with

Recurrent cellulitis

Candidiasis

Gangrene

Pneumonia

UTI

DM investigation

Microalbuminuria or proteinuria, in the absence of UTI , is an Important indicator of

diabetic nephropathy

(MODY) Maturity onset diabetes in the young

Metformin

When to stop metformin

SGL2I

GLP-1

Sulfonylureas

indications for insulin therapy in DM2

Antidiabetic treatment failed

Contraindications for Antidiabetic like end stage renal failure

Pregestational and gestational DM

Hyperglycaemic crisis

DKA characteristics

Hyperketonaemia (> 3)

Ketonuria (+2)

Hyperglycaemic (>200mg/dl)

Metabolic acidosis (HCl3<15) (ph <7.3) (H+ > 50 )

Sever DKA

DKA

Hyperglycaemic Hyperosmolar state HHS

Medical emergency in older DM2

Hypovolemia

Severe Hyperglycaemia > 600mg/dl

Hyperosolality > 320

Without ketonaemia or acidosis

Common precipitating factors for HHS

Infections

MI

Cerebrovascular events

Drugs ( glucocorticoids)

In management of HHS

Rapid shifts in osmolality avoided

Normal valve of osmolality is 280-296 DLOC if >340

IV fluid 0.9% NS 1 litre over 1 hour

( mortality are higher than DKA )

Common symptoms of hypoglycaemia

Sweating

Hunger

Anxiety

Palpitations

Tremor

Delirium

Drowsiness

Headache

Nausea

Severe hypoglycaemia management

If patient unconscious ( IV 200ml 10% dextrose over 15 minutes ) or ( IM glucagon 1mg)

Causes of Adrenal insufficiency

Adrenal insufficiency C.F and comparison

C.F of Adrenal insufficiency

Investigation Of adrenal insufficiency

Tx of primary and secondary adrenal insufficiency

glucocorticoids oral

Mineralocorticoids

DHEAS (50mg/day) given for some women with low libdo

Dose of corticosteroids must be increased in stress conditions to avoid adrenal crisis

Adrenal crisis signs and symptoms (Addisonian crisis)

Hypotension, shock

DLOC

Vomiting, Diarrhea

Severe abdominal pain

Adrenal crisis (Addisonian crisis)

Causes of hypothyroidism

Hashimoto thyroiditis

Most common cause of acquired hypothyroidism , most prevalent in women 30-50years , thyroid is firm not tender diffuse goiter

Always look for autoimmune conditions

Clinical features:

In early stage is asymptomatic then hyperthyroidism (irritable, heat , diarrhoea)

In late stage thyroid normal size or small fibrosis then hypothyroidism (cold, fatigue, constipation)

Why you need T3,T4 in follow up

Because TSH take several weeks to catch up

Confirming Hashimoto thyroiditis by

Serum antithyroid peroxidase and antithyroglobulin antibody

ECG findings in hypothyroidism

Sinus bradycardia with low voltage complexes

ST-segment and T-Wave abnormalities

Hypothyroidism Tx

Start dose of levothyroxine 50ug/day for 3 weeks

Then 100ug/day for 3 weeks

Maintenance dose 100-150ug/day

In patients with Hx of ischemic heart disease start low and go slow

dose adjustment in levothyroxine

Symptoms of hypothyroidism

Subclinical hypothyroidism

Myxedema coma clinic features

DLOC

Hypothermia

Myxedema

Hypoventilation ( hypercapnnia and hypoxia)

Hypotension ( possibly shock)

Bradycardia

Myxedema coma Causes

Myxedema coma Tx