Endocrinediseases

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Unformatted text preview: ENDOCRINE DISEASES BY CYNTHIA L. DIETRICH, D.O. November 23, 2004 DIABETES MELLITUS DIABETES MELLITUS Problem in glucose metabolism, accompanied by predictable long­term vascular and neurologic complications Chronic disease Significant morbidity and mortality COMPLICATIONS COMPLICATIONS Hyperglycemia +/­ ketoacidosis Hypoglycemia: activation of the sympathetic nervous system (diaphoresis, tremulousness and tachycardia) and insufficient delivery of oxygen to the brain (confusion, seizures and unconsciousness Retinopathy­ microaneurysms cluster at macula­ >terminal vessels obstructed­>ischemia­>new vessel proliferation Nephropathy­leads to hypertension. Assoc with the highest mortality. Cardiovascular disease­ “silent ischemia” Peripheral neuropathy­ numbness and tingling progressing to total insensitivity Stiff joint syndrome­ “prayer sign” and atlanto­ occipital joint involvement Autonomic nervous system dysfunction ­orthostatic hypotension, resting tachycardia, absent beat­to­beat variation ­hypogylcemic unawareness ­gastroparesis occurs in 20­30% IDDM IDDM Prevalence 0.4% Onset most often prior to age 20 Environmental influences are superimposed on a genetic component located on chromosome 6 Absolute insulin deficiency Pancreatic beta islet cells are destroyed and anti­islet cell antibodies appear Clinical symptoms when 90% of the beta cells destroyed Associated with other autoimmune diseases: rhuematoid arthritis and thyroid disease Clinical presentation is unmistakable: hypergylcemia, polyuria, polydipsia, weight loss, blurred vision and ketoacidosis Long term management requires exogenous insulin, self monitoring, lifestyle adaptations including diet and exercise Insulin formulations rapid (regular), intermediate (Lente, NPH) or long­acting (Ultralente) Goal­ HbA1c less than 7.5% DKA DKA Insulin transfers glucose and amino acids into the cells. Hyperglycemia­>osmotic diuresis­>dehydration­ >acidosis. Also, a build up of amino acids in the blood­>lipolysis­>free fatty acids­>converted to ketone bodies in the liver Results in a intravascular fluid volume deficit of 5­8 liters, potassium...
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