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Heart (BNP), Endothelium, GI, Kidneys, Liver, CNS, and suprarenal glands.
What kind of blood is used for the glucose test?
DM type 1 Etiology?
80% is autoimmune, others idiopathic.
Type 2 DM etiology?
Decrease in Beta cells, which leads to insulin resistance. Usually begins because of obesity (increased adipose downregulates insulin receptor synthesis)
Other causes of DM?
- Pancreatic disease (cystic fibrosis, chronic pancreatitis)
- Drugs (glucocorticoid use, thiazides, alfa-interferon)
- Endocrine disease- pheochromocytoma, glucagonoma, Cushing's syndrome
- Infections- mumps, CMV
What do you test to see the production levels of insulin?
- Peptide C
- Insulin gets 80% metabolized in the liver, but peptide C does not go through First pass metabolism.
To measure the amount of Growth hormone in the body what does one measure?
IGF-1 (since GH readily absorbed and usually is produced in peaks)
What is myxedema?
- Deposition of mucopolysaccharides in the dermis. This results in swelling of the affected area. One manifestation of myxoedema occurring in the lower limb is pretibial myxedema (seen in Graves)
- Orbital myxedema seen in hypothryoidism (Hashimotos)
Acanthosis nigracans suggests what?
Insulin resistance: DM2
Cushing's syndrome often presents with swollen torso and red striate, what's it called?
Si hay presencia de maculas hiperpigmentadas que dx sugiere?
Child with a large tongue suggests?
If a px has glossitis, one of the possible causes is?
Vitamin B deficiency
Hirsutism- Hair over belly button, on back, and under chin. Most commonly occurs in what pathology?
Polycystic ovaries syndrome
Edema biparpebral, se hace retractar los parpebrals.
Ask the patient to raise their arms and they turn blue
Signo de vecindad
large tumor over sella turcica (hemianopsia bitemporal)- ultimo signo que aparece
Thyroid hormones use what kind of receptors?
They use nuclear receptors.
- Small, only 3-5 AAs, easily giested in pill form.
- Ex. Thyroid hormones, dopamine, and cathecholamines.
- Large molecules. Consist of majority of hormones. When split they lose their function, hence can't be taken orally. Injected only.
- Ex. LH, FSH, GH, PTH, insulin, and glucagon
- Usually suprarenal, or sex hormones.
- Cross membranes freely- enter nuclear receptors (if thyroid) or cytosolic receptors (steroids)
Free molecules (hormones)
Peptide hormones, proteicas, y catecholamines circulate freely because they are hydrosoluble, or bound to albumin (transporters).
Trabaja en la distancia
Over neighboring cells that don't produce their own hormones. (sex hormones over ovaries)
- cuando una hormona actua en una celula yuxtapuesta
- endothelial cells and their action on cells below them. (nitrous oxide?)
act on receptors within same cell
Three types of hormonal receptors
Membranous, cytosolic, and nuclear receptors
Insulin uses what kind of receptors and goes into what kinds of tissues?
Uses membrane receptors, and enters adipose tissue, liver, and muscular tissue (?)
GLUT-4 does what?
Insulin dependent, transport glucose.
MAP kinase function?
Works at nuclear level, in charge of growth and reproduction of cell. GDB2 ?
What hormones do somatotrophs produce?
What hormones do corticotrophs produce?
ACTH (adrenocorticotrophic hormone)
Growth Hormone (GH) 50%
- Produced by stomatotroph cells, GHRH stimulates its synthesis, along with exercise, stress, sleep, and hypoglycemia.
- Decreased by hyperglycemia.
- Increases hepatic synthesis- sometomedin IGF-1
Empty sell turica syndrome
Area is filled with brain fluid
If men don't have prolactin then...
Have imbalance in testosterone levels.
- Stimulates cortisol production from suprarenal cortices.
How to dx Acromegaly?
If IGF-1 is increased, PRL increased, and TSH/T4 function is increased.
Px with crecimiento oseo acral excesivo, hyperhidrosis, voz profunda y cavernosa, piel gruesa, artropatia, y cifosis. Develop DM, HTN, and ischemic cardiopathies. Dx?
- Complication of Colon polyps, colon cancer, or CV (mortal)
Prolactinoma has proliferation of what kind of cells?
Hypopituitarism due to post-partum ischemia of the pituitary (watershed area). Lactotrophic cells hypertrophy during pregnancy needing more irrigation. If there's hemorrhage postpartum-> severe hypotension-> hypoxia-> ischemia
Agalactia, amenorrea post-partum (no FSH or LH), bello se cae del pubis y axilar. Great weakness, arterial hypotension, weight loss (from lack of hormones), symptoms of hypothyroidism.
Tx for Sheehan's?
Levotiroxina (oral), analogo de GH (IV), FSH y LH (steroids oral okay), prenidsona y methlprenidsolona (smaller dosis so lasts longer effects), no need to give PRL (since will increase since there will be lack of feedback to control it)
If prev. px with Sheehan's wishes to get pregnant again, tx?
Cabergolina (dopamine agonist to suppress PRL production)
2 Hr glucose over what level is diagnostic of diabetes?
over 200 mg/dl
DM1 autoimmune can be diagnosed with which antibodies?
- Anti-GAD >20%
- Antibody antiglot ICA (30-90%)
- IAA 40-70%
Px with polyuria, polyphagia, polydypsia, weight loss and is at risk for ketoacidosis, has what?
Diabetes mellitus type 1
DM1 associated diseases?
Celiac disease, Addison's, Graves, Vitiligo, hipothyroidism, and pernicious anemia.
Chronic hyperglycemia, con alteracion de los hidratos de carbon, lipidos, y proteinas, debido a un defecit en insulina o un defecto en su accion. Syndrome de condicion de vida.
Syndrome endocrino metabolico de etiologia multifactorial
Insulin sensibilizadores- two groups
Biguanides (metformin) and Tiazolidinediones (pioglitazone)
- Increases insulin sensitivity
- 1st line tx along with diet change.
- Dose 500mg to 2.5 g
- Side effects: GI disturbance, interferes with B12 absorption so take with Ca2.
- Can decrease px weight, also has anti-coagulant and anti-inflammatory effects.
Tiazolidinediones: 2 types
Pioglitazone and rosiglitazon
- Binds to PPAR gamma nuclear transcription regulator: increases insulin sensitivity in peripheral tissue.
- side effects: osteoporosis, osteopenia, weight gain, edema, heart failure
- 15-30mg per day
- used if too much resistance to isulin and
- metformin isnt’ doing the job
- Can cause lower extremity edema, and CHF
- Helps lipid profile, and peroxisome nucleus receptor in tissues-> increase insulin sensitivity.
Sulfonylureas for tx DM do what?
Generally stays in blood 24-48hrs. Closes K+ channel in Beta-cell membrane, so cell depolarizes->triggering release of insulin through increase of Ca influx.
Tolbutamide is what kind of pharm?
It is a first generation sulfonylurea to help in tx of DM type 2. Helps release of endogenous insulin.
Glibenclamida- small doses one to 2 per day. What type of pharm and tx what?
Second generation sulfonylurea, can lead to hypoglycemia if not careful. Aumenta riesgo de muerte subita. Debe ser combinada con insulino-desensibiladores
Alpha-glucosidase inhibitors delay sugar hydrolysis and glucose asorption which leads to decrease in postprandial hyperglycemia. Types?
- Acarbose and Miglitol
- used with px that eat too much, but leads to a lot of flatulence and diarrhea depending on how much the person eats.
GLP-1 analogs: Exenatide
- Increases insulin and decreases glucagon release.
- Helps px feel fuller, is cardioprotective, decreases apoptosis of Beta cells, helps with weight loss, and decreases apetite.
- Injected only.
Inhibidores de transportador GCT2 like Invokana do what?
- Inhibit glucose reabsorption in the proximal tubule of kidneys.
- Can cause UTIs
When a px first finds out they are diabetic they go through these steps:
Niega (deny), rebeldia (rebel/reject), negociacion (negotiate), y acceptan