VITILIGO-30% AQUIRED THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO

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VITILIGO-30% AQUIRED
THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO
AUTOIMMUNE DISEASE-DM PERNICIOUS ANEMIA
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VITILIGO VERSUS
HYPERPIGMENTATION
ADDISON DISEASE- HYPERPIGMENTATION
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DM-BP
BP-120/80
ACE
TARGET-CHF CRF
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Hypercalcemia+malignancy
80%-MTS-bone destruction
20%-PTH like substation
Most-ca of breast lung renal
MM-lytic mts-hypercalcemia
Most-paraneoplastyc syndrom
Secondary hyperparathyroidismhypocalcemia-hypephosphatemia-high pth
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No family history of graves or hashimoto for ca of
thyroid
Solid nodules more malignant than cystyc
Nodule hyperactive non malignant
70% pappilary cancer 15% follicular cancer 5%
anaplastic 5% lymphoma
Medullary carcinoma-0,5%
Men 2-medullary cancer+pheochromacytoma Men 1hyperparahyroidism+prolactinoma+glucagonoma
Calcitonin-marker of thyroid cancer threatment
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Dopamine lower prolactine level
28
Bromocriptin/dopamine agonist/ for
microadenoma threatment
Neuroleptics = high prolactine
Only high doses of estrogen=high prolactine
Microadenoma less 1 sm macroadenoma
more then 1 sm
Threatmentbromocriptine’surgery’radiotherapy’pergolide
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Hyperthyroidism
More female
Graves d.-most common 90% before40
Ophtalmopathy,pretibial mixedema after
therapy,vitiligo,gynecomasty,onycholysis
thyroid enlarged +bruits
Reversible cardiomyopathy
Toxic multinodular goiter-elderly,long standing
goiter,cardiovascular symptoms,weight
loss,constipation,
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HYPERTHYROIDISM
Single hot-toxic nodule •
T3 high t4 high,threatment elthroxin anr then •
surgery
Transient hyperthyroidism-subacute or •
-After viral infection esr high ,zahvat joda nizkij
Lymphatyc
Hashimoto-female middle age antiperoxidase ab
Subacute pospartum thyroidit –transient.mild,like
hashimoto
Subclinical hyperthyroidism-low tsh normal t4 t3
Hypethyroidism
Goiterogenic medications-jod
contrast,amiodaron,lithium
Diagnostic-thyroid scan
Lab-hypercalcemia,anemia,lymphocytosis,GOT GPT
high
Treatment-bb ,methimasol,ptu
Methimasol-agranulocitosis
Elderly-ablation with radioactive jod,young-surgery
Side effects-hypothyroidism,laryngeoparalysis
Treatment of oftalmopathy-high doses iv steroids
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hypothyroidism
Female,most hashimoto ,primary –thyroid
function secondary-hypophisis function
Severe-mixedema+cts+amenorrhea+hypotension
Hdl-decrease ldl-increase
Anemia normo-normo
B12 def anemia
Elthroxin-dexa
Cabg-chf-severe cihd-not replacement of
elthroxin
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Diabetes insipidus
Plasma osmolarity more 290—adh secretion—
sensitivity H2O --reabsorbtion of water rise
rise in distal canals
Water diuresis/di/ versus solution
diuresis/dm/
Water diuresis-low osmolarity of urine
Nephrogenic di-lithium or amphotericin
Di-high osmolarity of plasma
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Addison disease
Primary adrenocortical insufficiency
100%weakness,weight loss,hypotonia,
Na low k high bun high ca high acth high
Hyperpigmentation
Causes-tb cancer
Therapy if acute-iv hydrocortison
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Conn’s syndrom
Primary hyperaldosteronism
Mineralcorticoids excess
Weakness
Hypertension
Adenoma or hyperplasia
Na high k low renin low
High kalium in urine
Treatment-surgery ,spironolactone
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hypoglycemia
Whipple triade-glucose low 50 •
+neuroglycopenia/confusion,letargy,blurred
vision/ +adrenogenic stimulationanxiety,sweating,palpitation/+symptoms
dissapearance with glucose level
Normalization
Thrue reactive hypoglycemia-after gastric surgerynot demping syndrome
Non-isled cell tumors-hepatoma-insulin low cpeptide low
Insulinoma-insuline high c-peptide high
DM
DCCT-DIABETES CONTROL AND DIABETES COMPLICATION
STUDY-TYPE 1-GLUCOSE CONTROLE LOWER
MICROVASCULAR COMLICATIONS
UKPDS-UNATED KINGDOM PROSPECTIVE DIABETES STUDY
GLUCOSE CONTROLE LOWER NEPHROPATHY AND
RETINOPATHY
IGT -5% EVERY EAR-DM
DRUGS-THIAZIDES BB ZYPREXA
A-MIMETICS
FENITOIN
LADA-LATE AUTOIMUNE DIABETES OF ADULTS-AB TO
INSULIN
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Risk factors for dm
Недостаточность упражнений
Этнические –азиаты.эфиопы
Вес при рождении более 4 кг
Igt ifg
Pregnancy diabetes
Pco
Htn
Hdl<35 tg>250
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Metabolic syndrom
x-syndrom
Fg>110
Abdominal obesiry -102\88
Tg>150
hdl<40
htn >130\85
3 criterions
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ACCORD –Action of Control Cardiovascular
Risk in DM
No significant decrease in cardiovascular •
events with intensive glucose control
Trial ended after 3.5 years because of •
significant increase in death in intensive
glucose control group
ADVANCE –Action in Diabetes and vascular
disease
Published 12.06.08 NEJ of Medicine •
11 .400 patients with DM type 2 •
There was no evidence that intensive glucose •
control reduce new retinopathy
,nephropathy,polyneuropathy or risk of major
cardiovascular events
Reduce Hb A1C to 1%
Microvascular complication reduce to 37%
MI risk less 14%
All diabetes related complications 21%
Amputation 47%
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VADT INVESTIGATION- vascular
complications in Veteran with type 2 DM
Median Hb A1C in standard group 8.4% •
Median Hb A1C in intensive group 6.9% •
1791 military veterans •
Median follow up 5.6 years •
No significant difference in retinopathy, •
neuropathy, nephropathy and major
cardiovascular events
Сульфонуреа
Глибенкламид – Глюбен - 5 мг •
Глипизид - Глюко Райт – 5 мг •
Глимеперид – Амарил -1, 2. 3 мг •
Бигуанид
Глюкофаж, Мерформин,Глюфор 850мг •
Репаглинид
Новонорм 0.5, 1, 2 мг •
Инкретины
GLP 1- Glucagon Like Peptide выделяется •
В тонком кишечнике Л клетками и стимулирует
выброс инсулина на пищу
Подавляет секрецию глюкагона Замедляет опорожнение желудка Вызывает чувство сытости , меньше потребность в пище
-уменьшает апоптоз в бета клетках
Баета – эксенатид и Виктоза
-липаглутид
Иньекции баеты дважды в день •
Первый месяц 5 мг дважды в день
и далее по 10 мг
Перерыв между первым и вторым уколом не
менее 6 часов
- Виктоза 6 мг – раз в день
GPP4 – энзим ди пептидил пептидаза 4
разрушает GLP 1
GPP4 inhibitor – sitagliptin- Januvia •
Таблетки 25, 50, 100 мг
И 50 мг при почечной недостаточности 25
Metformin + Januvia = Januet Metformin500/50 , 850/50 , 1000/50
Розиглитазоны и пиоглитазоны
Авандия, Россини 4, 8 мг –розиглитазон •
Новопиоглитазон •
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