مراجعة اندوكرين دكتور اسامة ودكتور احمد موافي مش كاملة لسه

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:

: : :
:

endocrine

parathyroid hormone
... calcium Normal serum calcium 10.5-8.5
11-9
11-9 10.5-8.5
clinical pathology 10.5-8.5 11-9
serum calcium %50 ......... albumin
albumin ........ non ionized
%40 Ionized
... active
albumin free ...... free nephritic
syndrome liver cirrhosis hypocalcaemia
albumin
total calcium normal manifested
tetany

1

..............................................................
parathyroid hormone stimulated hypocalcaemia
parathyroid hormone re absorption
tubules excrete ... Phosphorus
parathyroid
osteoclast
D Intestine
Parathyroid tubules
vitamin D ... Intestine absorption of
calcium
and phosphorus
calcitonin Parathyroid hormone antagonized
calcitonin Inhibitory osteoclast
Inhibitory Osteoclast
calcitonin ........ bisphosphonates
Osteoporosis calcitonin bisphosphonates
alendronate
calcitonin Level of serum
calcium
.... level
serum calcium calcitonin
calcium Normal
calcitonin Para malignant
thyroid carcinoma medullary carcinoma
thyroid

.. thyroxin hormone bone turn

over hyper calcaemia
hyper calcaemia ...
thyrotoxicosis thyrotoxicosis
bone turn over serum calcium
2

..............................................................
... albumin 0.8
Liver cirrhosis serum albumin

...
2.5 4.5 albumin 2
0.8 total level
Ionized form normal
hyper phosphataemia
hyper phosphataemia renal failure
chronic acute
excess growth hormone hypo parathyroid
alkaline phosphatase
test ...
... ... anti
... vitamin D ..... antagonize vitamin D
..... test serum
calcium
... related vitamin D
malignancy hyper parathyroid
related D sarcoidosis
sarcoidosis tissue sarcoidosis patient
Macrophages .......... vitamin D cortisone
.... related vitamin D
... ....... ..
.... ..... D
parathyroid malignancy
Parathormone hormone
...
hyper parathyroid hypo parathyroid
Hyper parathyroid

hyper parathyroid primary secondary tertiary
3

..............................................................

releasing factor of parathyroid
hormone
releasing factor pituitary gland
Hypothalamus
hypo calcaemia triggering
primary hyper parathyroid Primary hyper

parathyroid serum calcium normal Para
thyroid hyper active
Parathyroid hyperplasia adenoma
MEN multiple endocrinal neoplasia
.... multiple endocrinal neoplasia
hyper function
MEN syndrome multiple endocrinal
neoplasia
MEN type 1 P ...pancreas ....parathyroid ....
pituitary
hyper function ........... pituitary hyper
function islets cells
......... hyper function Para thyroid
MEN type 1
MEN type 2 OMA
.....pheochromocytoma .....medullary thyroid carcinoma
Hyper parathyroid
MEN type 3 OMA .... marfanoid

multiple endocrinal neoplasia

hyper function
3p pituitary pancreas
Parathyroid
4

..............................................................
pheochromocytoma oma
parathyroid medullary thyroid carcinoma
marfanoid Oma

search for other hyper function
Other endocrinal glands hyper function
hyper ... Parathyroid
hyper parathyroid parathyroid
pheochromocytoma
islets cells
secondary hyper parathyroid
Hypocalcaemic secondary to hypocalcaemia
parathormone hormone

secondary normal
hyper parathyroid
hyper parathyroid .... calcium 6
secondary hyper ... 10 ..... secondary ....
parathyroid
secondary hyper thyroidism .....what
MCQ Low about serum calcium
.... hypocalcaemia
Hyper secondary hyper parathyroidism
parathyroid
secondary to hypocalcaemia
Hyper calcaemic normal calcium
chronic renal failure hypo calcaeima
mal absorption
chronic renal failure
tertiary hyper parathyroid
5

..............................................................
Primary secondary
primary normal parathyroid
... adenoma, carcinoma , hyperplasia
secondary to hypocalcaemia ............ uraemic
uraemic hypocalcaemia Hyper phosphataemia
tertiary tertiary
secondary tertiary

secondary hyper parathyroid chronic
renal failure
chronic renal failure 15 secondary hyper
...... parathyroid parathyroid gland tertiary
.... tertiary Parathyroid ...
autonomous..
tertiary
... secondary hyper parathyroid
feed back ... secondary hyper parathyroid
..... due to hypocalcaemia ... secondary hyper
parathyroid
tertiary ........... secondary hyper parathyroid
... hyper parathyroid
secondary .... ... tertiary parathyroid
... autonomous parathormone
serum calcium
calcium
...
adenoma Hyperplasia
autonomous
endocrine Oral ...
... branch branch
endocrine ...
6

..............................................................
Hyper parathyroid primary ,
secondary and tertiary
Primary calcium normal
Hyper function MEN Multiple endocrinal
neoplasia
secondary secondary.... to hypo

calcaemia
secondary tertiary
secondary tertiary tertiary
autonomous Parathormone feed
back Parathyroid
autonomous
clinical pictures
primary tertiary hyper parathyroid hyper
calcaemia
.... hyper calcaemia clinical
pictures
GIT : anorexia, peptic ulcer
release gastrin
CNS drowsiness depression
.... convulsion

... excited tetany
weakness hypotonia
Hypertension ...
... vasoconstriction Ca channel blocker anti
hypertensive
Renal .... diabetes serum calcium
tubular defect nephrogenic diabetes
insipidus nephro calcinosis
7

..............................................................
Investigations
alkaline phosphatase phosphorus serum calcium
serum Primary hyper parathyroid
... normal Primary calcium

Parathormone .. Phosphorus
Phosphorus excrete
... alkaline phosphatase
alkaline phosphatase hyper parathyroid
serum calcium secondary hyper parathyroid
low normal Low
secondary .... Phosphorus
phosphorus uraemic renal failure
hypophosphataemia
secondary tertiary

secondary hypocalcaemic uraemic
hyper parathyroid
chronic renal failure uraemic
acute
MCQ
tertiary High In chronic renal failure
hyper parathyroid
hypocalcaemia chronic renal failure
chronic renal failure hyper calcaemic
tertiary hyper parathyroid
tertiary secondary Parathyroid

8

..............................................................
X-ray
... skull ...
hyper parathyroid bone
defect salt and pepper appearance

bone defect
differential diagnosis of multiple bone defect
ground glass appearance bone

)
(
Cod fish vertebra inter vertebral
disk vertebra body
vertebrae ) ( .......... disk
vertebra curve ....... vertebra
curve
curve ....
vertebra .... ..... disk disk
Indentation Indentation
Cod fish spine
MCQ loss of lamina dura around teeth
lamina dura ... teeth socket
mandible ........ layer
mandible
X-ray
.... lamina dura
hyper parathyroid
post graduates multiple bone defect
in skull
differential multiple myeloma
hyper parathyroid
lamina dura
lamina dura lamina dura
9

..............................................................

protein electrophoresis multiple
myeloma
serum converting enzyme sarcoidosis
Hyper calcaemia

localization parathyroid tumor
CT MRI radio isotope scan

differential diagnosis of hyper calcaemia

written ...approach to a case of hyper
calcaemia
approach
vitamin D toxicity
excessive calcium intake
milk alkali syndrome peptic ulcer
... ...
Under treatment proton pump inhibitor
gastrin
rebound ....

primary and tertiary hyper parathyroid
Hyper calcaemia

Muliple myeloma

sarcoidosis
thiazides thiazides secretion of
calcium in urine
hyper thyroidism
10

..............................................................
immobilization bone
resorption osteoclast ....

lymphoma
hyper calcaemia

malignancy Hyper calcaemia
hyper calcaemia
multiple myeloma lymphoma Para malignant
secretion of PTH paramalignant
......... Hyper plasia

parathyroid
adenoma
hyperplasia

forearm

) (

)

(
.... parathyroid .... hyperplasia

...... blood supply
Parathyroid blood
supply
.... .
forearm subcutaneous blood
supply

11

..............................................................
adenoma
adenoma
... .. .......
medical treatment of hypercalcaemia
plenty fluids saline lasix

plenty fluids lasix haemodialysis
calcitonin Bisphosphonates
....
saline diuretic saline and diuretic
calcitonine bisphosphonates
hypo parathyroidism
hyper parathyroid written hypo parathyroid
Problem problem tetany....... tetany

tetany
Hypo parathyroid Idiopathic surgical removal
-congenital DiGeorge syndrome
congenital tetany absent thymus gland

irradiation
Phosphorus
primary hyper parathyroid
phosphorus
Hypo parathyroid hypo
calcaemic phosphorus hyperphosphataemia
renal failure
hypo parathyroidism diagnosed triad
Low phosphorus high renal failure
serum Normal hypo parathyroid
12

..............................................................

low calcium hyper phosphorus
renal
Normal Hypo parathyroid
..... tetany

pseudo hypo parathyroid
parathormone hormone tissue resistance

... pseudo hypo parathyroid
manifested tetany
true hypo parathyroid hypo
parathyroid Hypo parathyroid true
true
Pseudo ...... pseudo parathormone
normal tissue
Parathormone ..... tissue
resistance
....
Big skull short stature ....
metacarpal Metatarsal 4th and
5th

X-ray Hand

tetany frank
pseudo pseudo pseudo pseudo
pseudo pseudo

13

..............................................................
Pseudo hypo parathyroid pseudo hypo
parathryoidism Pseudo pseudo
...
... ... phosphorus

pseudo hypo parathyroid tetany
hypocalcaemia
pseudo pseudo pseudo normal
phosphorus
pseudo pseudo Pseudo pseudo pseudo

Hypo parathyroid Hyper
parathyroid
items 6
definitely excellent
Primary hyper parathyroid serum calcium
normal parathyroid
adenoma , carcinoma, hyperplasia multiple endocrinal
neoplasia MEN
serum calcium parathormone hormone
.... suppression calcium

normal
secondary hypo calcaemia
Primary
Hypocalcaemia
Hypocalcaemia chronic persistent
hypoclacaemic chronic renal failure
Parathormone hormone ......
14

..............................................................
Parathormone hormone serum calcium
medication Normal
parathormone
secondary to hypo calcaemia feed back
..... Hyper plasia
tertiary secondary tertiary
autonomous hyper plasia autonomous adenoma
parathromone hormone regardless
parathormone
... ....
suppression parathormone hormone
autonomous tertiary
chronic renal failure hypo calcaemia
chronic renal failure .... tertiary hyper
parathyroid
Hypo parathyroidism
hypo parathyroid hypo parathyroid

enzymatic defect Irradiation

tetany
pseudo hypo parathyroid deficiency
para thyroid responding

metacarpal bone

tissue responding to parathormone
hormone hypocalcaemic tetany hypo
parathyroid
pseudo pseudo
normal calcium , normal phosphorus
15

..............................................................
Pseudo pseudo hypo parathyroid
serum calcium normal pseudo pseudo
pseudo

tetany
causes of tetany
Alkalosis
alkalosis HCL
Nasogastric suction tube
HCL
Alkali intake
Iatrogenic
Pyloric obstruction
tetany with normal
serum calcium
Alkalosis
alkalosis Ionized calcium total
..... tetany carpal

spasm tetany normal alkalosis
alkalosis respiratory
alkalosis HCL metabolic
alkalosis
alkali metabolic alkalosis
respiratory alkalosis Hyper ventilation syndrome

......
hyper ventilation syndrome anxiety
commonest cause normal

showers of pulmonary emboli anxiety
anxiety

16

..............................................................

......

react
..........
...

Hyper ventilation
convulsion ........ Investigations

quantitive

hypo parathyroid hypo parathyroid
Pseudo
vitamin D deficiency Mal absorption
hypo calcaemia without tetany

chronic renal failure chronic renal failure
Hypocalcaemia hypocalcaemia
tetany acidosis Ionized form
active form
Oral tetany ........... hypocalcaemia
normal calcium tetany alkalosis
Hypo calcaemic tetany renal
failure
Hypo albuminaemia nephrotic
syndrome Liver cirrhosis
nephrotic syndrome hypoalbuminaemia
albumin ........ Hypocalcaemia
...... tetany
hypo albuminaemia non ionized calcium
bound form albumin active free
17

..............................................................
.... albumin albumin ... ionized form
..... tetany
clinical pictures
latent manifestations
provocative test
tests
tragus ...

... trousseau's sign
tetany ... cuff
pressure above systolic carpal spasm
carpal spasm flexion wrist
metacarpophalngeal
wrist flexed Metacarpophalangeal flexed
Interphalngeal
joint extended
early sign
circum oral paratheasia ...

tingling , numbness muscle twitches
carpal spasm Pedal spam Planter
flexion inversion
pharyngeal muscle spasm
laryngisumus stridulus
Risus sardonicus contraction
opsitonous trunk arched
iron
Punctate
holes
18

..............................................................
Investigations
Phosphorus kidney function
Parathormone hormone vitamin D
emergency............Ca gluconate intravenous very

slowly
very slowly 10
standard %10

saline
by infusion

dose 10 very slowly
first aid

...
saline
emergency
Maintenance treatment
calcium carbonate
alpha calcidol active vitamin D analogue
One alpha
response
cause

K7 endocrinology

diabetes insipidus
problem solving
... Hypothalamic pituitary diabetes insipidus
19

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Head injury tumors
granuloma sarcoidosis histocytosis X
T.B
chest troubles diabetes
insipidus differential
chest

chest diseases may lead to diabetes insipidus
problem
sarcoidosis sarcoidosis
.T.B histocytosis X
histocytosis X
nephrogenic
nephrogenic tubules ADH
acquired kidney tubules

hyper calcaemia hypo kalaemia
hyper calcaemia hypo kalaemia
lithium .......amyloidosis kidney Kidney
tubules
nephrogenic diabetes insipidus

... Pituitary Hypothalamic
Anti diuretic hormone
nephrogenic anti diuretic hormone
............ kidney tubules
clinical pictures
poly urea poly depsia
poly urea , poly depsia coma
,
blood sugar normal
Poly urea poly depsia
.... diabetes insipidus
20

..............................................................
diabetes mellitus blood sugar
compulsive water intake

irritable

urine poly urea
specific gravity 1010 1010

........
Urine concentrated
urine diluted
diabetes insipidus


diabetes insipidus

History ....

water deprivation test
...... ....... specific gravity

specific gravity 1010 hours 8
water deprivation
urine osmolality 300 Unit
21

..............................................................
Osmolality
accurate osmolality urine
osmolality around 300 300

Osmolality
specific gravity 1003 1030
water deprivation
Osmolality urine 300 water
deprivation 800

CT scan
Pituitary gland
desmopressin test
Poly urea specific gravity ...
diabetes insipidus compulsive
water deprivation
compulsive
diabetes insipidus
........... desmopressin pituitary type
..... Nephrogenic type
plasma osmlality
diabetes insipidus
.... ... diluted hyper
nateraemia Plasma osmolality High
serum sodium elevated
nicotin test hypertonic sodium chloride test
diabetes insipidus

22

..............................................................
low specific gravity.........
.... ... 12
... ....... urine
) ( Morning sample
specific gravity ..... compulsive

specific gravity .... Low
..... diabetes insipidus Proceed
diabetes insipidus
.... desmopressin test ..... ADH
CT, MRI sarcoidosis .T.B
Histocytosis X irradiation

desmopressin .......

diabetes insipidus
Desmopressin
desmopressin
vasopressin analogue
) (
Thiazides
Mechanism

Poly urea diuretic
Thiazides sensitivity of the kidney tubules
anti diuretic hormone

carbamazepine carbamazepine anti
23

..............................................................
epileptic
oral ... desmopressin
dose desmopressin
........... nasal spray 20ug /day

differential diagnosis of poly urea
major poly ureic syndrome
... .... poly urea
diuretic
diabetes mellitus

renal .....chronic interstitial nephritis
tubular kidney Unable to concentrate urine
diuretic phase of acute tubular necrosis

diabetes insipidus nephrogenic
diuretic therapy
endocrine diabetes cushing
functional
psychogenic poly depsia compulsive water
intake
anti cholinergic drugs
parkinsonism
anti cholinergic urine

.........

..... ....
.....
anxious and alert

24

..............................................................
DIDMOD syndrome

diabetes mellitus diabetes insipidus

diabetes
...
optic atrophy deafness
DIDMOD
DI diabetes insipidus
DM diabetes mellitus
O Optic atrophy
D deafness
DIDMOD syndrome

.... specific gravity ...
... diabetes mellitus
.... compulsive water intake
diabetes insipidus
.... water deprivation compulsive
water intake
diabetes insipidus
desmopressin
..... diabetes insipidus pituitary
......... nephrogenic
syndrome of inappropriate Anti diuretic hormone
MCQ oral
ADH High bronchogenic
carcinoma
Pneumonia
... legionella
ADH Anti diuretic
........ .... dilution hypo
25

..............................................................
nateraemia )(
anti diuretic
hormone
kidney tubules ........... lithium
lithium nephro toxic
tetra cylcine MCQ
... kidney tubules
anti diuretic hormone ....
nephro genic diabetes insipidus
Na low
chest case Hypo nateraemia
bronchogenic carcinoma
legionella legionella
pneumonia

Primary hyperaldosteronism
Conn's syndrome
Conn's
Conn's ............
......... aldosterone high Na
retention and K excretion
Hyper tension + hypo kalaemia

differential diagnosis of hypo kalaemic hyper
tension
Hypo kalaemic hyper tension
hypo kalaemic hypertension
Conn's syndrome
... Cushing's syndrome
aldosterone
Na retention K excretion
hypokalaemic and hypertension
26

..............................................................
renal artery stenosis renal ischaemia
renal ischaemia secondary
hyperaldosteronism
.......... renal ischaemia .....renin angiotensin
secondary hyper aldosteronism

hypo kalaemia alkalosis.....
Metabolic alkalosis ..... tetany
during of blood pressure carpal
spasm
Trousseau's sign
....
.... ...... carpal spasm
Hyper tension carpal spasm
Conn's
Hypo kalaemia
Problem
Conn's

etiology
Hyperplasia adenoma add
manifestations of hyper nateraemia
manifestations due to increase sodium
hyper tension Conn's Mild
edema .....Na retention
.... edema poly urea
poly urea Hypo kalaemia
Hypo kalaemia Hypo kalaemic
nepheropathy diabetes insipidus
chronic hypo kalaemia
Conn's hyper aldosteronism
Na retention edema
27

..............................................................
poly urea hypo kalaemic nephropathy
aldosterone escape
) aldosterone escape
( phenomenon aldosterone
retention level
kidney tubules not responding to aldosterone

aldosterone Na retention , Na
retention , Na retention aldosterone

kidney tubules aldosterone
Conn's Conn's
Poly urea aldosterone
escape
aldosterone retention,
retention , retention
Level
Investigations
CT
renin
aldosterone .... renin .... .... aldosterone
aldosterone
suppression Renin
renin suppressed

) cardiology
(
..... spironolactone anti hyper tensive

aldosterone antagonist full dose 400-200

28

..............................................................
Conn's ......primary hyper aldosteronism
secondary hyper aldostronism
renal artery stenosis secondary hyper aldosteronism
nephrotic syndrome -hepatic nephrotic syndrome Interstitial tissue edema
intra vascular
liver cirrhosis nephritic
edema extra vascular Intra vascular
intra vascular volume
renin ......... Hypo voluemic
secondary hyper aldosteronsim renal ischaemia
Mild primary hyper aldosteronism
hypertension
liver nephrotic Hyper tension secondary
renal artery stenosis cirrhosis
edema primary
edema nephrotic Hepatic secondary
aldosterone escape edema primary

renin
renal secondary ... secondary
ischaemia
Hyper aldosteronism Hyper reninism
primary
aldosterone adrenal primary
renin suppression excessive aldosterone
Problem
Pheochromocytoma
adrenal medulla the commonest tumor
adrenal medulla
.. adrenaline
29

..............................................................

,
. , ....... ....
, . .... . , , . , . , ; , .

Pheochromocytoma
common tumor adrenal medulla

it arise from chromaffin cells
adrenal gland
pheochromocytoma extra
adrenal sympathetic chain
adrenal gland
pheochromocytoma
MEN ( multiple endocrinal neoplasia (syndromes

clinical pictures
Bouts of catecholamine secretion hyper
tension Headache blurring of vision anxiety
tremors
differential diagnosis
anxiety panic acute
Hypo glycaemia
diencephalic epilepsy autonomic epilepsy
attacks Of catecholamine excess

thyrotoxicosis .. bouts
panic autonomic epilepsy
30

..............................................................
recurrent hypoglycaemia recurrent
thyrotoxicosis
thyrotoxicosis ...
recurrent ..
tremors

investigations
............... catecholamine level in plasma
catecholamine investigations
bouts of hyper tension ... .....
pheochromocytoma
.... catecholamine
metabolized
Vanyl mandylic acid
Vanylmandylic acid 24
catecholamine 24
) conclusive (
24 attack normal
... 3
Normal pheochromocytoma

catecholamine level blood reliable
.... vanyl mandlic acid in urine VMA metabolite
catecholamine
Localization tumor CT MRI
sympathetic ganglia adrenal
adrenal Uptake
pheochromocytoma written cardiology
..... curable hyper tension curable hyper tension
renal artery stenosis
Hypertension co arctation cardiology
written cardiology
31

..............................................................
very important
Pheochromocytoma

Hypertension

Hypertension

.....
pheochromocytoma ) (
pheochromocytoma very rare disease
) (

) (
...
Pre hypertensive stage

Pre hypertensive stage
presented bouts of hypertension
DNA ......
Iatrogenic
catecholamine ....
adrenaline and nor adrenaline
adrenaline tachycardia
adrenaline vasoconstriction vasodilation
vasoconstriction nor adrenaline
Main action of adrenaline ... Heart
cardic output
Nor adrenaline vasoconstriction
32

..............................................................
........ B-blocker B- blocker
.... B-blocker
B-blocker alpha receptor Beta receptor
Alpha vasoconstriction Beta vasodilatation
B-blocker alpha receptor dominant
B-blocker Block of beta receptors

......... alpha alpha
... Beta blocker
stroke
... Beta blocker
.... pheochromocytoma very rare

alpha blocker Beta blocker
Beta blocker
Beta blocker
pheochromocytoma

Beta blocker Harmful Pheochromocytoma
alone
alpha blocker )alpha
( and Beta
ACE inhibitor bilateral renal artery
stenosis precipitate precipitate acute
renal failure

enumration
hyper prolactinaemia
chronic illness liver cirrhosis
33

..............................................................
neurological and vascular

gynecomastia
gynecomastia
gynecomastia .....Enlargement of male breast
female Male

idiopathic physiological estrogen producing....
tumors

Chornic liver disease
drugs anti hypertensive
digitalis GIT ...metaclopramide
diuretic spironolactone
Hirsutism
written enumerate causes of hirsutism
enumerate causes of gynecomastia
endocrine

Ovarian tumors
poly cystic ovary
adrenal congenital adrenal hyper
plasia
medications
A,B,C and D

....

Hair eye brow eye lashes
34

..............................................................
Hair depend on adrenal low pubic axillary hair
adrenal
by inspection pubic hair axillary hair
adrenal gland
adrenal gland
by inspection
....... axilla axilla axilla
.....

hair depend on testicular androgens
...............

K10 revision
parathyroid
)
(
normal level 10.5-8.5
50% serum calcium albumin ionized
calcium active
hypoalbuminaemia hypocalcaemia
tetany .... Ionized form free

.... bone osteoclast bone resorption
Intestine absorption ........ kidney
35

..............................................................
calcium reabsorption , phosphorus tubules
excretion
main action ....intestine .....absorption of vitamin D
Calcium and absorption of phosphorus
D absorbed
serum calcium calcitonin
anti parathromone hormone

tumor marker calcitonin ...
thyroid gland medullary carcinoma

serum calcium thyroxin
bone turn over
MCQ
... hyper thyroidism hypercalcaemia
mild hyper calcaemia
Parathyroid function
serum calcium
0.8 albumin

hypo albuminaemia Liver cirrhosis
hypo albuminaemia nephrotic syndrome
albumin Hypocalcaemia
tetany
alkaline phophatase
Hyper Phosphorus
phosphataemia
Hypo parathyroidism
36

..............................................................
acromeglay ......growth hormone excess
renal failure
renal failure
renal failure hyper phosphataemia
hypocalcaemic
steroid test test
antagonize vitamin D
Hyper calcaemia
calcium
D

Hyper vitaminosis D
vitamin D .... sarcoidosis macrophages
active vitamin D like D
steroid suppress Hyper calcaemia
sarcoidosis
cortisone
para thyroid hormone relative

nephrogenous cyclic AMP
parathormone hormone Kidney
tubules reabsorb excrete Phosphorus
......... nephrogenous cyclic AMP
kidney tubules respond parathormone
hormone
... parathormone hormone tubules
......... nephrogenous cyclic AMP
nephrogenous cyclic AMP urine kidney
tubules respond parathromone hormone
37

..............................................................
resistance tissue Parathormone hormone
Pseudo hypo parathyroidism
nephrogenous cyclic parathormone hormone
urine AMP
Urnie ...in response nephrogenous cylic AMP
to action of parathormone hormone
tissue resistance pseudo hypo parathyroidism

Hyper parathyroidism
tertiary secondary primary
... hypo calcaemia Primary
hypo calcaemia Hyper parathyroidism

Hyper plasia -adenoma
hyper activity gland ...
search for other glands
MEN part Hyper parathyroid
Multiple endocrinal neoplasia MEN
Hyper function P MEN 1
p
parathyroid pancreas Pituitary
pheochromocytoma OMA MEN 2
parathyroid medullary carcinoma
marfanoid MEN 2 MEN type3
features
secondary hyper parathyroidism
secondary to Hyper parathyroid
hypo calcaemia
38

..............................................................
chronic renal hypo calcaemia
hypo calcaemia failure
secondary hyper ........ Normal serum calcium
parathyroidism
secondary hyperparathyroidism
hypocalcaemia
secondary hyper Hypo calacemia
parathyroidism
Hypocalcaemia secondary hyperparathyroidism
driving hypocalcaemia hypocalcaemia
hyper parathyroid stimuls
secondary hyper parathyroidism maximum
calcium low normal
low normal maximun
... feed back secondary hyper parathyroidism
suppress calcium supplement
Long standing secondary

.. chronic renal failure
feed autonomous
Para adenoma autonomous
chronic renal failure
tertiary
autonomous
hyper parathyroidism
Para thyroid hormone
back
....hyper plasia
thyroid
MCQ
serum calcium 14
tertiary hyper parathyroidism
tertiary hyper parathyroidism
serum calcium
clinical pictures
tertiary Primary
39

..............................................................
Primary tertiary hyper
calcaemia
clinical pictures of hyper calcaemia
hyper calcaemia essay
Hyper calcaemia
Hyper parathyroid
hyper calcaemia
GIT ...nasuea vomiting anorexia
calacium stimulate gastrin
..... CNS drowsiness
neuromuscular junction tetany
excited

Heart ...hyper tension vasoconstriction
Ca channel ....vaso dilator
nephrocalcinosis.. . renal stones
Investigations
primary hyper parathyroidism normal
Phosphorus
secondary low Low normal
tertiary hyper parathyroidism No way
very high
X-ray skull

motling bone defect
hyper parathyroidism loss of lamina dura
lamina dura Socket
lamina dura

cortisone suppression para thyroid
assessment
40

..............................................................

casuses of hyper calcaemia

Hyper calcaemia hyper
vitaminosis D excessive calcaium intake tertiary
hyper parathyroid Primary secondary hyper
prarthyroid
thiazide diuretic thiazide excretion of
calcium in urine
lyphoma multiple myeloma
haematological malignancy hyper calcaemia
Interlukin stimulate osteoclast
sarcoidosis
osteolytic metastasis cancer breast
hyper thyroidism
hyper calcaemia
Malignant hyper calcaemia Hyper
calcaemia malignancy multiple
myeloma Lyphoma osteolytic
metastasis

..... adenoma Hyper plasia Para thyroid
gland
forearm
adenoma

saline and lasix
serum calcium ...
Haemodylasis
antagonize Parathormone hormone
calcitonin

saline lasix first aid

41

..............................................................
bisphosphonates osteoclast inhibitor
dylasis

malignancy ... Hyper
calcaemia ...sarcoidosis respond...
Malignancy bisphosphonates
osteoclast inhibitor
Hypo parathyroidism
Hypo parathyroid idiopathic surgery
irridation syndrome Di George syndrome
absence in thymus para thyroid gland
clinical pictures
tetany
triad
Hypo paratriad ...Hypo calcaemia -Hypo
phosphateamia ureamic
Normal serum creatinine hypo
parathyroid
Hypo parathyroid
.... true hypo parathyroid hypo parathyroid
Pseudo hypoparathyroid
tissue resistance Parathromone hormone normal
tissue
tetany

4th and 5th metacarpal bones in x-ray
) (
urine nephrogenous cyclic
AMP tissue resistance
pseudo pseudo hypo parathyroid Pseudo
normal
calcium , normal phosphorus
Pseudo Pseudo Pseudo pseudo
42

..............................................................
tetany

tetany
tetany
alkalosis alkalosis Metabolic alkalosis
repeated vomiting
respiratory alkalosis hyper ventilation
alkalosis tetany Normal
serum calcium
alkalosis ionized form
quantitive hypo parathyroidism
vitamin D deficiency mal absorption tetany
Mg related
normal calcium tetany
alkalosis
hypocalcaemic tetany
uraemic uraemic ionized calcium
clinical pictures
latent Chvostek sign tapping tragus
contraction
Trousseau's Pressure systolic
diastolic blood flow
already
blood flow flexion
in wrist flexion in metacarpophalangeal extension in
inter phalngeal joint carpal spasm
manifest
Irritable restlessness symptom
circum oral numbness

Risus sardonicus hicupp .....contraction
43

..............................................................
diaphragm opsitonus ...contraction back muscle
High arched trunk
Hypo calcaemia
roughness punctuate holes

brittle
Investigations
Ca , Ph , parathoromone hormone
tetany
during attack dose
10 10 Intravenous very slowly
mins 10
to be followed 40
saline
dose
recurrence
calcium carbonate
active vitamin D One alpha
causes of hypo pituitarism

Neoplasm Inflammatory
Neoplasm Inflammatory sarcoidosis
for example .T.B
Infiltration haemochromatosis
irridiation surgery
empty sella syndrome
sella turcica
Pituitary gland

diaphragma sellae
defect in diaphragma sellae
arachonid Herniation sella
44

..............................................................

diaphragma sellae sella turcica
defect in diaphragma sellae
arachonoid CSF sella
Pituitary gland compressed
empty sella syndrome
it may be normal variant empty sella syndrome
Normal
defect diaphragma sellae
arachonoid Pituitary gland Pituitary
gland Normal function
CT brain MRI brain
empty Sella serum prolactine
Hyper prolactinaemia

hypo pituitarism childhood

pituitary dwarfism

growth hormone deficiency

growth hormone releasing factor
pituitary dwarfism normal mentality
Normal
growth hormone ......... fasting
hypo glycaemia
....... Hypo gonadism pituitary infantilism
pituitary dwarfism growth
hormone
hyop gonadism pituitary infantilism
low level of growth hormone
growth hormone growth hormone
supplement
Frohlich's syndrome
45

..............................................................
stunted growth
Frohlich's syndrome Hypo pituitarism
obesity ...dwarfism obesity hypo
gonadism
hypo thalamic dysfunction

Laurance-Moon-Biedle syndrome
retinitis pigmentosa

fundus examination
fundus examination
diabetes
fundus examination
retinitis pigmentosa Laurance-Moon-Biedle
syndrome hypo pituitarism stunted
growth retinitis pigmentosa

growth
stunted growth chapter
stunted growth familial
endocrinal
endocrine diabetes type 1
Hypo thyroidism
... Pseudo hypo
parathyroid precusious puberity
androgens early closure of epiphysis
chromosomal
chronic diseases congenital cyanotic heart
congential kidney disease Liver disease
choronic chest disease

emotional stress

very common
Malnutrition emotional deprivation

46

..............................................................

systemic disease malnutrition thyroxin
... thyroxin growth hormone

stunted growth
written endocrine

cardiology
congenital pulmonary
stenosis murmur
cardiology
cardiology
endocrine cardiology
stunted growth differential diagnosis of stunted
growth
constitutional
malnutrition emotional deprivation
chronic disease
cardic disease
endocrinal disease critinism
hypo pituitarism
diabetes type 1
stunted growth ...
Heart

stunted growth
systemic disease constitutional endocrinal
diseases emotional deprivation
47

..............................................................
) stunted
(growth
Hypo pituitarism adult
Simmond's disease
adult Hypo pituitarism
irradiation tumors
hypophysecotmy
Sheehan syndrome
Sheehan syndrome Problem solving
case

Sheehan syndrome ... size of
pituitary gland
size of pituitary gland blood
supply
Pituitary gland blood supply
circle of wilis end arteries
Pituitary gland double size
blood supply Post partum
haemorrhage Necrosis Pituitary gland
Post partum
hypo pituitarism
growth hormone deficiency adult
fatigue
... growth hormone
adult fatigue
pre mature senile depression
vital
Hypo pituitarism adult target
gland
hypo thyroidism hypo function adrenal
48

..............................................................
hypo gonadism
Pan hypo pituitarism
gonads
adults pan hypo pituitarism hypo
gonadism

Pituitary apoplexy tumor
pituitary gland hemorrhage
Infraction some times
acute hypo pituitarism
pituitary apoplexy

clinically
fatigue

Hypo thyroidism
.... adrenal gland
..... gonads Pan hypo
pituitarism
differential diagnosis ... auto immune
anti bodies gonads thyroid adrenal

ACTH
TSH
Gonadotorphin gonads
pituitary
TSH
ACTH
primary
Level growth hormone
growth hormone level Low

49

..............................................................
low normal
... ... stimulation test
stimulation test ... hypo glycaemia
Hypo glycaemia growth
hormone

growth hormone low
hypo glycaemia low
Low abnormal
Insulin test
dangerous dangerous pan hypo
pituitarism hypo glycaemia

growth hormone releasing factor
amino acid release growth hormone
arginine

thyroxin Permissive effect on growth hormone
permissive
..permission effecto on growth hormone..
growth hormone growth
thyroxine
Hypo thyroidism
insulin deficiency type 1 diabetes
stunted linear growth
growth hormone
growth hormone

thyroxine otherwise
50

..............................................................
anorexia nervosa
Pallor Long standing pna hypo
pituitarism skin
skin
deficiency of ACTH
Pigmentation ACTH
replacement

thyroxine gonads
thyroxine
. thyroxine
thyroxine

thyroxine thyroxine
stimulate metabolic activaties
consumption
.... .... thyroxine
consumption

thyroxine
thyroxine

posterior pituitary gland
diabetes insipidus
diabetes insipidus poly urea , poly dpesia...
... GFR
glomerulo filtration rate
GFR already ....
Poly urea diabetes insipidus
51

..............................................................
steroid replacement
GFR
diabetes insipidus
steroid therapy poly urea
coexistence diabetes insipidus

dose
... steroid replacement
therapy
predinosolone
Predinosolone replacement 7.5
one dose

eqivalent dose Hydrocortisone
hydrocortisone
predinosolone
) IQ
(

adrenal gland

Addison adrenal gland ....
replacement
dose
dose Natural
7.5 7.5 prednisolone
prednisolone Hydrocortisone
hydrocortisone 30-20
adrenal gland 30 Hydrocortisone

growth hormone
thyroxine replacement therapy aroung
52

..............................................................
100
150-100


anterior pituitary gland hyper function
Pituitary tumors
tumors pituitary gland Increase tension
neuro
headache , vomiting
chismal lesion bitemporal hemianopia
endocrinal
acromeglay cushing hyper
prolactinaemia
amenorrhea glactorrhea syndrome

Prolactin

prolactin prolactin releasing factor

prolactin inhibiting factor dopamine
dopamine Prolactin inhibiting factor

male and female
male prolactin ..

male ....impotance
Male
lacatation
females tonic inhibition prolactin dopamine
Pregnancy lactation ....
prolactin
53

..............................................................

causes
lactation , pregnancy late pregnancy
stress
stress
adrenaline

growth hormone
prolactin

pituitary gland
Pituitary gland tumors
prolactinoma ...prolactin secreting pituitary
gland
Pituitary gland
prolactin
release
... dopamine Prolactin
inhibiting factor
dopamine Hypo thalamus
pituitary gland prolactin
pituitary gland Hypo
thalamus dopamine Hypo thalamus
Pituitary gland dopamine Inhibitory
substance prolactin ...
prolactin
adenoma Pituitary gland prolactin

release prolactin
tumor effect inhibitory dopamine
Hypo thalamus
metabolic
... renal failure renal failure
renal failure .....decrease clearance
54

..............................................................
of prolactin
prolactin excreted Urine
hypo thyroidism
hypo thyroid TSH TSH
TRH TSH releasing factor
TSH releasing factor
prolactin Hyper prolactinaemia
.... primary hypo thyrodism excess TRH
release prolactin
prolactin releasing factor ......pathological
excess TSH releasing factor TRH
dopamine prolactin
anti dopaminergic Hyperprolactinaemia

.... Metaclobramide Metaclobramide
females very sensitive .....
disturbances Motilium
metaclobramide anti dopaminergic
... extrapyramidal side effect

metaclobramide extrapyramidal
clinical pictures
glactorrhea , amenorrhea
glactorrhea Milk production
breast Post partum
Milk !!!!
glactorrhea
glactorrhea significant
amenorrhea
glactorrhea amenorrhea
sub fertility
55

..............................................................
Male imptance
Investigations
prolactin
Prolactin

amenorrhea
... subfertility
Prolactin
prolactin
... MRI sella turcica

tumor

tumor Medical
treatment
small tumor
dopamine agonist
dopamine agonist ... dopamine
dopamine inhibitory bromocryptine
resistance surgery
hypophysectomy urgent
pergolide prolactin lactation
vomiting naseuea
very effective minimal
side effects expensive bromocryptine
pituitary gigantism
56

..............................................................
gigantism giant 190
190
giant minimum 190

190

190 Never
gigantism
causes

Pituitary gigantism
hypo gonadism familial racial marfan

........

pituitary gigantism
hyperplasia
Hyper plasia
Hyper plasia ...

violent ...
...
11

behaviour
57

..............................................................

..........
... ...
....

... ...

tall stature - too strong - intelligent

precocious puberty
11 adult suddenly

...
) (.............
clininal
Sheehan acromegaly

Pituitary gigantism Hyper plasia
adult
acromegaly adenoma adult

tissues

faces skull Nose supra
orbital ridges Prominent mandibule Protruded
( (prganthism
acromeglay

...
hand spade like
hand foot
58

..............................................................
viscera
liver spleen
organ Heart
....cardiomyopathy

... acromegaly prolactin
prolactin Inhibitory
gonadotrophin prolactin ... Impotance
Prolactin female infertility Male

thyroid ... viscera tissue
hyper thyroidism
neuro carpel tunnel syndrome
diabetic diabetic neuropathy

deep voice
vocal cord
larynx
hyper tension
Hyper tension hyper insulinism
diabetic

insulin resistance insulin
resistance
hypertension salt and water
retention triggering sympathetic
salt and water retention edema
...
X-ray skull sella turcica X-ray
... terminal phalanx ..
59

..............................................................
...... appearance
MRI
micro adenoma micro adenoma

micro adenoma CT
MRI
... .... active
active active
activity hormone
growth hormone
somatomedines Mediator ... insulin
growth factor 1
.......... phosphorus vitamin D
intestine absorption

Phophorus kidney tubules phosphorus

active serum phosphorus High

gorwth hormone growth hormone
Pathological not responding
suppression glucous infusion
growth hormone ... suppression
complications
growth hormone excess
tumor polyps malignancy
cardiac complications Hyper tensive
diabetic cardio vascular complications
trans sphenoidal hypophysectomy

somatostatin analougue
60

..............................................................
somatostatin analogue octereotide
release growth hormone

Prognosis prognosis
musculoskeletal manifestations curse features

diabetes exhausted

diabetes insipidus problem

acromegaly clinical diabetes insipidus
problem
diabetes insipidus
pituitary hypo thalamic kidney
pituitary gland .... Pituitary
gland tumor... .... tumor
removal , irradiation
infiltration
sarcoidosis
... granuloma .T.B Histocytosis X

granulomas pituitary gland
Nephrogenic diabetes insipidus
.... X-linked recessive
acquired
Kidney tubules sensitive anti diuretic
hormone
hypo kalaemic nephropathy ...
chronic hypokalaemia disturbances
kidney tubules

61

..............................................................

sickle cell nephropathy
... sickle cell
in sickle cell anaemia sickling may occur
sickling medulla kidney
medulla relatively hypoxic ............ hyper tonic
Medulla cortex Hyper
tonic
sickling ... Medulla Medulla
blood vessel Medulla
vasa recta
blood supply tubules medulla
tubules ischaemia medulla
kidney tubules not sensitive anti diuretic hormone
sickling Medulla
ischaemic Hyper tonic
sickling blood vessel
medulla
tubules Medulla Ischaemic
not sensitive anti diuretic hormone
Nephrogenic diabetes insipidus
sickle cell anaemia poly urea
poly depsia
clinical pictures
Poly urea poly depsia
specific gravity
Investigation
urine analysis water deprivation
12 9
Morning sample specific gravity .....still low
urine osmolality
specific gravity 030-1003
62

..............................................................
water deprivation specific gravity 1030-1025
low
deprivation specific gravity
... compulsive water intake
specific gravity osmolality
osmolality urine 300 300
water deprivation 800
water deprivation specific gravity low
water deprivation Osmolality low
diabetes insipidus
shift desmopressin
desmopressin .... anti diuretic hormone
diabetes insipidus Hypo
thalamus Pituitary
... nephrogenic
urine CT desmopressin
plasma osmolality
diabetes insipidus

concentrated Na Osmolality

DI serum Na
DI plasma osomlality High
.... concentrated
concentrated
concentrated Na osmolality

desmopressin
Injection nasal spray
nasal spray twice daily

63

..............................................................
thiazide desmopressin
kidney tubules thiazide ....
ADH sensitive
anti epileptic carbamazepine
causes of poly urea
..... chronic renal failure ...chronic diuretic phase
Diabetes Interstitial nephritis
excessive water intake diabetes insipidus mellitus
conn's cushing psychogenic poly depsia
psychogenic poly depsia
DIDMOD syndrome
diabetes insipidus DI
diabetes melliutes DM
Optic atrophy O
deafness D
Poly urea and poly depsia approach
specific gravity ...
diabetes.... high specific gravity
mellitus
diabetes insipidus low specific gravity
water deprivation test
compulsive water specific gravity urine
intake
diabetes insipidus
pituitary nephrogenic diabetes insipidus
desmopressin
pituitary desmopressin
Nephrogenic cause desmopressin
64

..............................................................
SIADH syndrome secretion
ADH
syndrome of In appropriate Anti diuretic hormone
ADH broncho genic
carcinoma pneumonia legionella
ADH C/P
water intoxication
ADH ... .... anti diuretic dieresis
urine Na dilution
hyponateraemia
hypo nateraemia
bronchogenic carcinoma
legionella
pneumonia Hypo nateraemia

legionella
pneumonia + hypo nateraemia
legionella
....

osmolality
Hypo osmolality

lasix
Kidney tubules Insensitive Anti
diuretic hormone
litheium
manic depression psychosis
Nephrotoxic
tetracylcine
65

..............................................................

Hypo thyroidism
Hypo thyroidism

auto immune
radio active iodine therapy
Irridiation
thyroidectomy .... rare
..... removal para thyroid
congenital hypo thyroidism

idiopathic
secondary hypothyroidism
hypothalamic hypo pituitarism
transient hypo thyroidism
transient hyper thyroidism
cretinism written stunted

growth
stunted growth cretinism
cretinism congenital absence of thyroid
congenital enzymatic defect
Pendred syndrome ... deafness
Hypo thyroidism
endemic goiter ....
cretinism 25
stunted
endemic goiter

66

..............................................................
general features
nose
lips thick
horseness cry
constipation
abdomen pot belly abdomen
tachycardia
Heart rate beat per min 140 Motions
defecation
brady cardia
constipation

defecation

Mental retardation
cretinism
nervous system Mentality
T3-T4
TSH very high
juvenile myxoedema
juvenile myxoedema juvenile myxoedema
4 14-10
adult .... Hypothyrodism
hypothyroidism cretinism
early childhood juvenile myxoedema
Normal person
adult myxoedema
thyroxine children
67

..............................................................
grave's disease thyrotoxicosis
.... tall stature
juvenile myxoedema Myxoedema
stunted growth
adult myxoedema

adult myxoedema
primary hypo thyroidism
Myxoedema neglected
features signs of myxoedema

primary
hypothyroidism clinically myxoedema
Myxoedema facies skin thick
deposit deposit Mucopoly
saccharide
Puffiness
face apathy face
causes myxoedema
irridiation thyroidectomy autoimmune
auto immune disease thyroid

pituitary myxoedema ....

pituitary myxoedema
myxoedema
Hypopituitarism
.............

myxoedema primary
68

..............................................................
pituitary gland
pituitary gland
pituitary hypo thyroidism thyroxine
gland function
features of hypo thyroidism
general features
bloated with puffy Mask face face
eyelids
puffiness differential diagnosis
problem solving puffiness
face Puffiness

nephrotic and nephritic
superior vena caval obstruction
... superior vena caval obstruction
... thrombosis, mediastinal syndrome
mediastinal syndrome
medistinal syndrome ... Lymphoma
constrictive constrictive pericarditis
superior vena fibrous tissue pericarditis
caval
congested Neck vein
superior vena cava non pulsating

neck vein congested neck vein
superior right atrium One line
problem vena cava
puffiness
constrictive pericarditis Problem
Puffy
puffiness constrictive puffiness
superior vena cava cardic

Hypo thyroidism face Puffiness
69

..............................................................

chronic cough
skin dry carotinaemia

provitamin A pro vitamin A
thyroxine ... vitamin A Hypo thyroidism
carotinaemia
skin dry sebacous
secretion deficient
sebacous gland Inactive thyroxine
cardiovascular bradycardic
Pericardial effusion
susceptible cornary
hyper lipidaemia thyroxine
metabolize
hyper hyper lipidaemia
TSH ....... TSH athrogenic
coronary heart disease TSH
athrogenic already Hyper cholestrolaemia

coronary
Beta blocker
thyroxine therapy ... thyroxine therapy
small dose gradual
dose full dose
... coronary
heart rate Beta blocker
neuro slow movement
tongue macroglossia slurred
speech hoarseness of voice
knee jerk reflex time
Prolonged reflex time
hand up reflex knee jerk
70

..............................................................

hand up
Long reflex time
hyper thyroidism hyper reflexia
psychosis
... stroke atherosclerosis
GIT
chronic constipation T3 and T4
TSH hypo thyroid
hypo thyroidism manifested constipation

sertonine reuptake inhibitor

T3 T4
....
T3 and T4
Hypothyroidism
hypo thyroidism Mood
thyroxine .....

myxoedema myxoedema

...
hypothyroid
investigation

71

..............................................................
genital menorrhagia amenorrhea
endometrium ... thyroxine
... endometrium thyroxine endometrium
iron deficiency anaemia

endocrinal pleural effusion
Pericardial effusion ascites
ascites
ascites hypo thyroidism
ascites Liver heart
Hypothyroid ascites

.... hypo thyroid

investigations
Investigations
Myxoedema coma
hypo thyroid coma
coma hypo thyroid
stress .... Infection...
sign
hypo thermia rectal
Hypo thermia 35 rectal
coma
coma

72

..............................................................
......... Metabolic
blood sugar , Na , K Liver function kidney function

T3 T4 TSH

Puffiness puffiness
myxoedema
... Hypo thermia

thyroxine IV ...
tube l troxine

Hypothyroid
myxoedema frank
frank

problem
female fatigue Pulse
60 60 Hypo
thyroidism
investigations
T3 and T4
TSH

haemoglobin
causes Hypo thermia
cold weather
hypo thyroidism
hypo glycaemia
73

..............................................................
addison's
pale
Pallor myxoedema itself
Pallor Mucopoly saccharide substance
subcutaneous pale Nephrotic
syndrome
nephrotic syndrome Pale edema
face edematous nephroitc mask color of
capillaries
Nephrotic syndrome anaemia
nephrotic anaemia
anaemia transferrin urine
degree of pallor degree of
anaemia .... markedly pale facial
edema
Pallor
Nephrotic edema renal failure
chronic

nephrotic
anaemia ... erythropoietin
erythropoietin chronic renal failure
chronic renal failure kidney
Nephrotic kidney
transferrin ... Iron deficiency
Neglected
pale 11
Pale
Pallor
menorrhagia ...iron deficiency
Hypo thyroid RBCs
macro cytic non megaloblastic
thyroid disease auto immune
74

..............................................................
megaloblastic Pernicious
bone marrow proliferation thyroxine
Normochromic normocytic Hypo thyroidism
anaemia of chronic disease
anaemia of chronic disease
rheumatoid chronic inflammatory condition
bronchiectasis .T.B chronic infection
malignancy disseminated
Hypo thyroidism
anaemia of normocytic normochromic
normo cytic normochromic chronic disease
TSH Prolactin
TRH
prolactin release TRH
complexes Low voltage ECG
limb leads
edema anaemia ... anaemia
false Pallor face
nephrotic syndrome
weight gain
depression

complications
heart
acromegaly Heart
susceptible to coronary heart disease
diabets
cretinism
L thyroxine per square surface area 100
75

..............................................................

adult L thyroxine 50 100
50 25 25
50 75 100
assessment TSH
TSH normal
Normal
300
100 150
50
L thyroxine 100
L thyroxine 150
One dose divided one dose

... heart

subclinical hypothyroidism
TSH T3 and T4 Low
normal

T3 and T4 normal range low normal
TSH vague ..... Hypo thyroidism
...

Hypo thyroidism Hyperthyroidism
subclinical

... ...
.... hypo thyroid hypo thyroid
Hypo thyroid

76

..............................................................
Normal
diabetes
diabetic
fundus examination retinal changes
diabetes diabetic

endocrine clinical
... Investigations

Addison clincial
pictures of Addison disease Investigations
.... normal clinically
Addison normal ..... Normal
.... stimulation test
normal
Normal
normal level

thyroxine
thyroxine normal level
Normal ...

thyroxine

Graves' disease
thyrotoxicosis
hypo thyroidism pregnancy

50
77

..............................................................
pregnancy
Hypo thyroidism
hypo thyroidism pregnant 50
pregnancy thyroxine level

thyroxine globulins

TSH TSH
ultra sensitive most sensitive
.... hypo thyroid TSH
... normal
TSH
TSH

thyrotoxicosis
thyroxine ..... thyroxine
tissue clinically thyrotoxic
thyrotoxicosis
thyroxine
...
thyrotoxicosis thyroxine
Hyper thyroidism thyroxine
excessive secretion thyroxine thyroid gland
excessive secretion ... active secretion
thyroiditis

thyroditis inflamed thyroid follicles
..... leakage thyroxine leakage
Passive
)
( thyroiditis
Leakage thyroxine 3
thyrotoxic hyper thyrodism
thyroid Passively

thyroxine
thyrotoxic
78

..............................................................
ovary
teratoma
Ovary thyroid tissue thyroxine
thyrotoxicosis
T3 and T4
thyroid scanning
.... thyroid scan recently technetium
uptake High
uptake ... hyper thyroidism
Itself

thyrotoxicosis .... with high radio active
iodine uptake
uptake
technetium
thyroid scan
.... thyroxine active secretion...
Graves' disease toxic
nodular goiter
Graves goiter
goiter nodular
nodules Nodular goiter
toxic thyroxine

low radio active iodine uptake
thyroxine uptake
thyroxine

thyroiditis
thyroiditis high ESR
5 ESR

79

..............................................................
basic
....

pathology Oral

post graduates

... 5
International

thyroiditis thyrotoxicosis
) (
... thyroid
Graves' disease
definition triad

...
.... !!!!!
.... ...

...

generally
generally

... curve
80

..............................................................
1/5 curve
years 10

)..
(

reliable

...

) (

97

81

..............................................................

relaxed
....
Male female
...

Graves' disease
triad
diffuse goiter nodular
ophthalmopthy dermopathy
aetiology
TSI ... auto immune auto immune
immune system TSI thyroid stimulating
immunoglobulins
< TSI ... TSH anti body
82

..............................................................
thyroid ... ... stimulation stimulatory antibody
TSH
thyrotoxicosis T3 and T4
thyroid scan
Uptake high hyperthyroidism
TSI serum positive 'Graves
disease
Graves' disease ophthalmopathy
dermopathy
clinical picture
general weight loss ploy phagia Intolerance to
hot
AF

AF
thyrotoxic
T3 and T4
700
.... T3 and T4
Plammer nail Loose skin
Peritibial myxoedema plaque skin
mucopoly saccharide
clubbing
endocrinal disease clubbing
... ... thyrotoxicosis Graves' disease

cardiovascular tachycardia systole
diastole
systole diastole systole
heart rate ... contractility cardic output
diastolic throxine . peripheral vaso
dilatation
83

..............................................................
heart ....hyper kinetic chest wall
scratch Pulmonary area scratch

smooth Nodular
Neuropsychatery nervousness fine tremors

.... myopathy endocrinal
myopathy Graves' disease
cushing
GIT ...diarrhea Hyper defecation
thyroxine stimulation gastro colic
reflex
gastro colic reflex

gastro colic reflex colon

gastro colic reflex 24

habbit gastro colic reflex
... ... ...
...
25
desire ....
peak gastro colic reflex
gastro colic reflex Peak
constipation

....

84

..............................................................

25
peak gastro
colic reflex

cycle
25
occular manifestations
non infiltrated spastic
lid retraction Dalrymple's sign
Lid lag Von Graefes' sign
Inferquent blinking Stellwag's sign
gentle closure eye lid twitches

lid retraction staring look
Dalrymple's sign
Lid lag eye globe upper eye lid
follow up
Von Graefes' sign
Stellwag's sign Infrequent blinking
gentle closure eye lid
Infiltrated
extra ocular muscles infiltrated tissues
lymphocytes exophthalmos
corneal ulcers
malignant exophthalmos
exophthalmos exaggerated after
85

..............................................................
thyroidectomy
exophthalmos producing factor
Lag of convergence external ocular muscles
Mobius sign medial recti
one Mono symptomatic
thyrotoxicosis symptom
thyrocardia atrial fibrillation
cardic thyrotoxic thyrocardia
manifestation
Investigations
suppressed TSH T3 and T4
thyrotoxicosis
thyroid scan technetium radio active iodine uptake
...high uptake
Graves' disease
hyper ... hyper dynamic mal absorption anxiety
arterio venous fistula ... dynamic
Hyper dynamic circulation
anxiety
differential thyrotoxic
diagnosis
other causes of hyper dynamic circulation
anxiety beri beri
medical
refuse ... ... first attack medical
- goiter contraindication
malignancy
beta blocker sedation
86

..............................................................
diazepam beta blocker
anti thyroid carbimazole
propylthiouracil
thyroxine
thyroxine

euthyroid ...normal thyroid function 6
diazepam
anti thyroid
diazepam beta blocker
euthyroid
... anti thyroid side effects
GIT upset bone marrow depression
radio active iodine uptake
radio active iodine therapy

medical treatment
refuse surgery surgery
fit surgery
contraindications
........ pregnancy goiter
radio active
goiter
contraindication 'Graves
disease medical
radio active
recurrent hyper thyroidism
goiter
contraindication exophthalmos

vocal cords
thyroid 7/8 residual

87

..............................................................
euthyroid
... euthyroid euthyroid
10 Lugol's iodine
vascularity thyroid gland
thyroid gland
release thyroxine
Lugol's iodine vascularity
release of thyroxin
ocular complications
Protection eye

............ exophthalmos ...
deroofing eye globe

eye orbit
pedicles

orbit
...
skin peritibial myxoedema
Inflammatory
thyrotoxic crisis

... euthyroid Lugol's iodine
stable

release thyroxin

thyrotoxic crisis
hyper thermia .......fever
disproportionate tachycardia .........tachy cardia

88

..............................................................
Hyper pyrexia
hypotension vaso dilatation fluids
....volume expansion
thyroxine catabolize
steroid infusion
uses of steroid in endocrinal disease
chapter cortisone
Pituitary gland ..hypo pituitarsim ... pan hypo
pituitarism
replacement
addison replacement
myxoedema coma
thyrotoixcrisis cortisone

Beta blocker

Beta blocker tachycardia
anti thyroid drugs Oral tube
hyper pyrexia hypotension
fluids steroid
addison's disease
Addison's disease
Problem solving
auto immune .T.B
HIV adrenal in sufficiency
ketoconazol anti fungal
clinical pictures
Hypo tension
hypo tension
89

..............................................................
addison's disease cortisone aldosterone
salt and water retention ... salt loser

sensitize blood vessel to catecholamines

hyper pigmentation
.... ATCH
amino acid tyrosine tyrosine
adrenal gland catecholamine
adrenal gland tyrosine
hyper pigmented pigmentation
palmer cresis nipple areola axilla
buccal mucosa
pigmentation abnormal buccal
mucosa
scars
scars pigmented
scars Pigmented
scar
scar scar ...

scar
scar fibrous tissue
pigmentation
scar hyper pigmented
asthenia hypo nateraemia hyper kalaemia
hypo tension hypo glycaemia
diarrhea poly urea
Poly urea
Investigations
ATCH
... Level

...
90

..............................................................
addison's disease
normal
stimulation test

eosinophilia blood pictures

dose
predinsolone 7.5 ml ...

H

..... adrenal insufficiency pituitary gland

hypo pituitarsim ... Hypo function
adrenal ... Addison Addison primary

Addison
.T.B auto immune
.T.B clinically fundus examination
tubercles in choroid

hypo renninaemic hypo aldosteronism ....
rennin aldosterone
renin aldosterone
hyper reninaemic hypo aldosteronism
aldosterone renin
Hypo reninaemic hypo aldostronism
defect release of rennin
91

..............................................................
renin ... kidney aldosterone
Hyper reninaemia hypo aldosteronism
defect adrenal aldosterone renin
release

cushing
adrenal cortical hyper function ............cushing
cushing baso philic adenoma
adenoma Micro adenoma
adenoma space occupying lesion
Micro adenoma
micro adenoma ACTH adrenal
gland bilateral adrenal hyper plasia
commonest cause

adrenal gland tumor steroid
ectopic ACTH bronchogenic
steroid
cushing disease cushing
syndrome

cushing disease
cushing disease pituitary gland
cushing syndrome adrenal

clinical pictures
Fat ...abnormal fat deposition
redistribution
trunk
trunkal obesity
... Obesity
Inter scapular area
92

..............................................................
supra claviclar fossa obliterated
buffalo-hump
buttocks hollow
abnormal distribution
carbohydrates steroid .............diabetes
protein catabolic .....rupture of collagen fibers
vascular tissue stria rubra
striae rubra Over lying skin very thin

skin very thin collagen fibers
underlying vascular tissue
cushing .... fibers
stria alba
rubra collagen fibers skin
thin
.... underlying vascular tissue
collagen fibers ... striae alba
myopathy Osteoporosis
Na and K retention excretion

Hypo kalaemic hyper tension
... polycythaemia
acne acne acne valguris

anti fungal anti bacterial ... 4 steroid

psychatric .....depression
93

..............................................................
Investigations

54 ) (

....
) (
Provided level
cushing
phsyological

) Dexamethazone (
Dexamethazone suppression Pituitary
gland
Pituitary gland ACTH
Dexamethazone
... suppression Dexamethazone
stress
Dexamethazone suppression test

pituitary adenoma
Dexamethazone small dose
suppression Dexamethazone large dose
suppression

adenoma adrenal gland

adenoma autonomus
Dexamethazone small dose large dose
no response
94

..............................................................
)
(
3
Phsyological Pituitary
adenoma adenoma adrenal
gland
phsyological .... small dose of Dexamethazone
suppression .... Pituitary gland ACTH

normal person stress
adenoma Pituitary gland
Dexamethazone small dose ... large
dose
suppression Pituitary adenoma
feed back
adenoma ACTH suppression
Dexamethazone ... Dexamethazone small
dose adenoma .... large dose
pituitary adenoma
adenoma .... adrenal gland
adenoma cortisone

Dexamethazone no response... .
.... ectopic ACTH ectopic ACTH
bronchogenic carcinoma Lung ACTH
adrenal
cortisone cortisone small dose
large dose Inhibitory pituitary suppress
ACTH lung
Dexamethazone suppression test
95

..............................................................

test

Diagnostic flow chart for evaluating patient suscpecting of
having cushing syndrome
positive symptoms and signs

standard low dose of Dexamethazone
Low dose Dexamethazone 0.5
48
normal person cushing ......what ever
cushing
Normal suppression
suppression normal person
response suppression

shift large dose of Dexamethazone
high dose Dexamethazone
2 48
response suppression adenoma of pituitary
gland
suppression adenoma adrenal
ectopic ACTH
... ACTH ectopic

.... to search pituitary gland
.. MRI . adrenal MRI
..... bronchogenic carcinoma

over night low dose Dexamethazone suppression

dose Dexamethazone
cortisone .....suppressed Normal
96

..............................................................
... suppressed .... shift high
dose of Dexamethazone ......... over night
.... ... suppression adenoma
pituitary
adenoma adrenal ectopic
standard Dexamethazone over night

simple obesity
obese hypertensive diabetic patient ...
obese hyper tensive diabetic X-syndrome X
syndrome X diabetes
medical
metyrapone ketoconazole
medical adrenalectomy
adrenal gland
pituitary adenoma ....trans sphenoidal ...
hypophysectomy
Pituitary adenoma micro adenoma
space occupying lesion

Ectopic ACTH
adrenal adenoma
...
Pituitary adenoma
pituitary adenoma Micro adenoma

ACTH adrenal glands 2
97

..............................................................
stimulation
adrenal 2

adrenal gland ........ Pituitary gland
ACTH
Hyper pigmented ....hyper pigmented ....hyper
pigmented

endocrine
diabetes 59
diagnosis of diabetes fasting..... 127
126
post prandial 200 random 200
fasting 126
Post prandial random 200
diabetes
Impaired glucose tolerance
transient
fasting normal Post prandial normal
200
diabetes
type 1 type 1 auto immune
type 2 mody pancreatic
diseases
endocrinopathies drugs
secondary Pancreatic disease
chronic pancreatitis cystic disease of
98

..............................................................
pancreas late
endocrinopathies
cushing acromegaly anti insulin
drug thiazide beta blocker Non
selective

thiazide interfere release of insulin
thiazide release of insulin

Down's syndrome DIDMOD syndromes
gestational diabetes
type one auto immue type two

type one HLA related
HLA related rather than
HLA related HLA

HLA
HLA system

manifested ... auto anti bodies
islets cells anti body serum

.... anti bodies pancreas

some times
residual function
... residual pancreatic
function
... Honey moon ..
... .......
... .....
99

..............................................................

......
Honey moon
still residual pancreatic function
restriction
sooner or later

.... lipogensis ..
..... weight gain ... very liable to
ketoacidosis

ketoacidosis prone .....
Liable Keto acidosis
... etiology auto immune

triggering anti bodies
anti bodies serum
diabetes
Inflammation mainly lymphocytes
lymphocytes insulitis
inflamed pathology
Lymphocytic infiltration Insulitis
type 1 ....
dependant
type 2 insulin ...
... resistance
resistance
....
Insulin resistance
Obese and non obese
100

..............................................................
obesity down regulation of isulin receptor
weight reduction
control

Liable to ketoacidosis type 1
Precipitating factor
Infection

type 1 keto acidosis
... ..
.... drowsy ...

.... symptoms .. Poly urea
.... Poly urea
...
diabetic keto
acidosis coma
.... ...
... ... diabetic keto
acidosis Presentation
mode of presentation
diabetic
Investigations
acidotic uraemic coma
diabetic ketoacidosis DKA
Pathology
amylin amyloid material
amylin amyloid like ...
amyloidosis

amylin substance
MODY
MODY maturity onset
101

..............................................................
diabetes In young person
18 insulin
... dependant ..... MODY MODY diet
oral Insulin
MODY
..... 25
diabetic pregnant
MODY
diabetic
...

type 1 and type 2
....
Gestational Diabetes
gestational
diabetic diabetic
diabetic
gestational diabetic ...
diabetic
reflect boarder line

growth hormone
.....
...

...
... ...
..... ......
...
curve diabetes
63
102

..............................................................

glucose tolerance test
fasting blood sugar
100 blood sugar

type 1
type 1

... ... diabetes type 1

... diabetes type
1

... .... diabetic
type 1 ...

% 97
type 2 common
type 2 diabetes family
.... history type 2 diabetes Over weight
potentially diabetic weight
reduction
compare type 1 and type 2
written
types of diabetes

types compersion
diabetes type 1 ketoacidosis ketosis prone
type 2
insulin in type 1
insulin in type 2
103

..............................................................
resistance
HLA related type 1
type 2
obese type 2
type 1 obese
type 1
type 2 oral failure
hypoglycaemic oral

potential diabetes mellitus
... obese diabetic
diabetic
latent diabetes mellitus
... .. ...
..
chemical diabetes ...
no symptoms 0000 ...
300
...

Onset of type one almost sure
type 2

Normal
... diabetic normal
diabetic retinopathy
stress
104

..............................................................
stress hyper glycaemia
stroid diabetes stress hyper
glycaemia

stress
... ..
...

concept .... ....

...
...
fever ... ...

...
... ...

....
diabetic
... ... hypo
glycaemia
... Infection

....
Pancreatic function
diabetic
... stress hypeglycaemia
....

hypo glycaemia

Metabolic disturbances diabetes

105

..............................................................

... diuresis
.... metabolized
source of energy

Lipolysis fatty acids

Liver ketogensis
keton bodies keton bodies ketosis
... keto acidosis .... acidosis Urine
ketonuria
ketosis keton bodies PH
keto acidosis
ketonuria
.... ... .....
Hyper glycaemic ketotic
Hyper glycaemic ketoacidiosis
DKA
pathogensis of complications

sorbitol pathway gycosylation
sorbitol pathway

sorbitol pathway ...
sorbitol aldole reductase
sorbitol
sorbitol
pathway aldole reductase inhibitors

endocrine
glycosylation

reaction tissue
106

..............................................................

... aldole reductase
inhibitors oral
200 ..... ....
.... ... .....
.....
.... 60
diabetes mellitus ...
collagen fibers wall
sorbitol peripheral nerves
Neuropathy...
glycosylations collagen fibers wall
capillaries wall capillaries lumen
ischaemia
Ischaemia
blood vessel
Ischaemia blood vessels
... RBCs deformability ... RBCs
Oxygen

platelets aggregation
fibrinolytic system
hyper lipidaemia
anti platelets
Hypo lipidaemic RBCs deformability
glycosylation sorbitol
...
diabetes mellitus

....
... ...
...
....
107

..............................................................
clinical pictures
acute presentation
diabetes ...... poly urea , poly depsia , poly phagia
sub acute blurring of vision

convextity eye lens
controlled

... ..
..... controlled
Normal blood sugar
normal sugar
normal blood sugar

complications

asymptomatic
tingling and numbness ... diabetic
diabetes mellitus
.. large size ...
diabetic
X-large
.. ..

diabetic

complications of diabetes
complications written problem
diabetes complicated
complicated infection coma retinopathy
108

..............................................................
nephropathy neuropathy
diabetes hyper glycaemia
diabetes
skin complications
fungal bacterial

... blood sugar
boils .. blood sugar and blood
pictures
Xanthomas hyper lipidaemia
specific diseases diabetes necrobiosis
lipodica erythema tibia
diabetic dermopathy Patches pigmented
Lower limb
diffuse granuloma annulare
rings
granuloma annulare MCQ
necrobiosis lipodica MCQ
diabetes mellitus
ocular complications
retinopathy
retinopathy background retinopathy
Proliferative retinopathy

glycosylation ..... arteriole
narrow ... ischaemic retina
ischaemic
retina Ischaemic angiogensis
new vascularization
retina ischaemic ... ...
retina .... blood vessel .... blood vessels

vigorious heamorrhage retinal
detachment
109

..............................................................
new vascularization harmful
New vascularization harmful
... ... vessels 3
disease in coronary ...
) (
narrowing
angiogensis Myocardial New
vascularization ...

clinically ...
tight coronary artery stenosis
angiogensis of benefit
harmful blood vessel

laser blood vessels new vascularization
vitroeaus
... proliferation Proliferation
glycosylation ... narrowing ....retinal ischaemia
... new vascularization proliferation growth of
abnormal new blood vessel
back ground retinopathy
blood vessel wall diabetic
abnormal leakage haemorrhage
exudates
blood vessel wall wall
dilated aneurysm

diabetic
renal neuro coronary
...

.. ) (

110

..............................................................
... ... ... ...

kidney fuction ... ..

neuro neuro neuro
vascular
microvascular disease macro vascular disease
macro vascular disease atherosclerosis
micro vascular disease small blood vessel

... ... gangrene
dorsalis pedis artery diabetic micro
angiopathy distal
diabetes dorsalis pedis artery.
atherosclerosis

diabetes small blood vessels
microangiopathy
gangrenous dorsalis
pedis artery palbale
renal
diabetic nephropathy
urinary tract infection
GIT
constipation diarrhea
autonomic neuropathy
diarrhea autonomic neuropathy nocturnal
) diarrhea (
Liver
type 1 glycogen infiltration
111

..............................................................
type 1 .... Insulin glycogen
liver
Type 2 fatty liver
Genitourinary complications
impotence
due to autonomic neurpathy and vascular complications
Diabetic foot

diabetic foot diabetic
foot ischaemia + Neuropathy + Infection

... ... .... dry
... diabetic
foot

ischaemic ischaemia neuropathy

ischaemia claudication pain
pain
Palpation ischaemia cold pulse
worm Pulse
ulcers ischaemia heal and toes
say
...
...
...
... ...
...
...
112

..............................................................
amputation diabetes
blindness diabetes

diabetic

.. ... ...
..

diabetic infection
problem
Lung pneumonia .T.B
Rhinocerebral mucormycosis fugus MCQ
nose para nasal
sinuses brain
lactic acidosis
lactic acid
lactic acid biguanides
lactic acid hepatic person renal person
diabetic acidotic
hyper osmoalr
keton bodies
keton bodies ...
blood sugar 1000

blood
Hyper osmolality serum

Plasma osmolality
2 )
113

..............................................................
.... ( 18
....
hypo glycaemic coma
big doses of insulin with uncorresponding
amount of diet (isulin shock ). It usually occurs in patients
under insulin therapy, also it can be caused by oral hypo
glycemics
DKA
pathogensis
dehydration ..... Osmotic diuresis ...
dehydration osmotic diuresis
fat ... source of energy
liver fatty acids ..... Lipolysis
keto acidosis acidosis ketosis keton bodies
keton bodies
Urine
Precipitating factor
operation Infection ... illness stree
surgery
clinical pictures
( hyper ventilation (Kussmaul breathing
abdominal pain
gastro intestinal mucosa irritant keton bodies
keto acidosis acute abdomen

dehydrated poly urea
dehydrated
diuresis keton bodies
hypo kalaemia
complications
dehydrated thrombosis Infections
diabetic keto acidosis diabetic
DVT dehydrated
diabetes DVT
114

..............................................................
Pulmonary embolism gangrene

...
complications dysequilibrium syndrome

hypo glycaemia ketotic
Onset hypo glycaemia acute
ketotic coma gradual
Pulse hypo glycaemia
cate cholamine hypo glycaemia
dehydrated
... hypo glycaemia keto acidosis
skin hypo glycaemia ....
dehydrated
tongue dehydrated keto acidosis
Under surface of the tongue

comatosed Intravenous
Intravenous
urine analysis
invetigations of a case of Diabetes mellitus

Dipstick methods
Dipstick keton bodies
blood sugar
fasting 126
post prandial random 200
blood sugar curve
fasting urine and fasting blood 75
.. ... ... ...
115

..............................................................
....

blood sugar and urine

flat curve
abnormality flat curve fasting
Peak 20
fasting 50
peak 65 flat curve
flat curve
Malabsorption insulinoma
glycosylated Haemoglobin control blood
sugar
steroid

infection stress
stress stroid induced diabetic
glycosylated haemoglobin
fructose amine glycosylated
haemoglobin
glycosylated plasma protein blood sugar
control
Monitoring
differential diagnosis of glycosuria
renal glycosuria
fasting normal Post prandial
Normal
Lag-storage curve
gastrectomy
... stomach
fluids fluids
intestine
Intestine rapid absorption glucose
116

..............................................................
rebound hypo glycaemia
curve fasting normal
200 rebound Hypo
glycaemia
curve Normal
fasting 80 Post prandial

180 curve

glycosuria
curve curve
fasting zero ... .... 180.... 80
glycosuria

abnormal
.... glycosuria renal glycosuria
curve
curve
... fasting Normal
Post prandial ...
rapid absorption rebound hypo
glycaemia
lag storage

40 80
fasting say 80
curve
curves
curve
curve say 50 curve
peak
117

..............................................................
fasting curve flat
flat curve curves

Pro isulin
C-peptide
C-peptide
action entery of amio acids

.... fat stimulation lipogenesis

mechanism of action alpha sub unit beta
subunit
alpha subunit
alpha subunit beta subunit
alpha beta
alpha subunit beta subunit
... tyrosine kinase
glucose transporter

insulin receptor

Preperation of insulin
crystalline neutral insulin routes
intermediate NPH NPH Neutral protamine
hagedron
neutral crystalline
neutral intermediate
118

..............................................................
Intermediate ... protamine zinc
long acting
Intermediate .... neutral neutral
crystalline
Protamine zinc
Indication of insulin

special problem

infection diabetes problem
...
diabetic
Infection pneumonia ...
... Infection
crystalline tight control
Oral

... fracture neck
femur diabetic
diabetic Infection
short acting insulin
tight control blood sugar
complications
Hypoglycaemia - allergy resistance
weight gain lipogenesis
somogyi phenomenon
hypo glycaemia hypo glycaemia
hypo glycaemia mild
.... growth hormone

... insulin resistance
anti insulin ..
119

..............................................................
... .. ...
somogyi phenomenon
Pheripheral edema due to salt and water
retention

Insulin resistance
Infection
60
... 60 resistance stress
anti insulin insulin

obesity down regulation insulin receptor
acromegaly cushing
insulin resistance

human insulin
...
endocrine
Pan hypo pituitarism addison
replace ment myxoedema coma thyrotoxic crises

Insulin anti body
Insulin antibody
anti insulin Immune suppression

syndrome X
obese hyper tensive
diabetic Hyper lipidaemic
Dawn phenomenon
120

..............................................................

.... growth
hormone growth hormone
growth hormone
growth hormone Hypo
glycaemia
growth hormone

Dawn phenomenon

oral hypo glycaemic
sulfonylurea release

advers effect hypo glycaemia
GIT upset
Biguanides Intestine
Insulin sensitizer recetpor
Biguanides

sulfonylurea
biguanides
Biguanides

biguanides
biguanides ..

.........

sulfonylurea
Glibenclamide long acting
........
121

..............................................................
short acting Gliclazide Diamicron

Biguanides
Metformin
recent
Glimepiride Glimepiride
Amaryl exhaustion
release insulin
One dose

Amaryl ...
.... ... .. 6
cidophage
...
Amaryl
recent oral hypo glycaemic
Acarbose liver disease
Novonorm Repaglinide
Pioglitazone Insulin sensitizer cidophage
lactic acidosis

Biguanides hepatic
renal lactic acidosis
Glustin
Avandia
Glustin
Avandia
Avandia Amaryl
.... insulin sensitizer cidophage
Avandia lactic acidosis
treatment of type 1 diabetes
122

..............................................................
diet carbohydrates fat

insulin therapy
doses
0.5 uint per kg 0.8
....

60 ) ( Unit per kg
..

Mixed insulin
Insulin Mixtard 70% NPH %30
crystalline

60

... Mixtard 20

0.3

Insulin
safe side ....0.3 0.5

% 70 Intermediate
crystalline %30

+ NPH
regular insulin
+ NPH regular insulin
123

..............................................................

Mixtard

30 mixtard
15 mixtard

... NPH
cyrstalline

45 ... mixtard
15 mixtard

45
30
5
diabetic
muliple subcutaneous insulin injection
techniques

inter mediate insulin
Long acting insulin one injection

regular insulin crystalline

Insulin pump

diabetic
cytotoxic drugs
Islets of pancreatic tissue diabetic
nephropathy
124

..............................................................
Perfect

Liver kidney
Liver kidney
Liver cirrhosis renal failure perfect

normal

treatment of diabetes type 2
oral
Oral
Amaryl
cidophage
maximum oral
flow chart
type 1 .... type 2 diet and
exercise
control diet exercise

... ...

Oral hypo glycaemic
obese biguanides
non obese sulfonylurea
biguanides
sulfonylurea
sulfonylurea ..... biguanides

Diabetic Keto acidosis

125

..............................................................

diabetic keto acidosis ... ..
... 15

Poly urea
dehydrated
... ...

encephalopathy
dehydration

keton bodies

hypo kalaemic
acidotic ...

acidosis
acidosis

acidosis Hyper kalaemia
false
... ... acidosis

false hyper kalaemia
Hypo kalaemic appears as hyper
kalaemic acidosis
acidosis shift
Insulin
insulin keton bodies
126

..............................................................
keton bodies acidosis
hypo kalaemia
supplement
hyper kalaemia false hyper kalaemia

dose
dose unit Intra venous
.... ....

250 3
saline

saline 250 % 5
saline extra cellular
dehydration
%5 intra cellular dehydration
dehydration intra cellular
dysequilibrium rapid hypo glycaemia

...

diabetic keto acidosis
problem solving
management
insulin therapy
insulin therapy
hyper glycaemia ketosis
127

..............................................................
Infusion hypo kalaemia
saline followed by glucose 5%
rate

excellent

Insulin subcutaneous
shocked
absorbed

... acidosis Na bicarbonates
Na bicarbonates acidosis
... keton bodies keton bodies
bicarbonates bicarbonates
PH 7
hyper osmolar
more sensitive
rate
dysequilibrium
thromboembolism
dehydration
Brittle diabetes

brittle ...
recurrent hypo
glycaemia recurrent keto acidosis
causes of recurrent hypoglycaemia
Over treatment
endocrinal cause
gastroparesis ...

128

..............................................................

...
gastroparesis

system
gastroparesis
gastroparesis early satity

.... Motilium Motilium

recurrent ketoacidosis
infection insulin combination
hypoglycaemia
def triad
40 45 50 Hypo
glycaemia

hypoglycaemic causes
fasting Hepatoma insulinoma
Addison Pan hypo pituitarism oral hypo
glycaemic
Addison liver cirrhosis oral
hypo glycaemic
Hypo glycaemia
Hypo glycaemia Post prandial
alimentary lag storage curve
alimentary hypo glycaemia
129

..............................................................
reactive hypo glycaemia

Insulimona C- peptide
C- peptide

insulin therapy C- peptide
Oral hypo glycaemic release

C-peptide Oral hypoglycaemia
Hypoglycaemia
clinical presentation of hypo glycemia
secondary to catecholamine release adrenergic
effect sweating tremors anxiety

coldness cutaneous
vasoconstriction
...
....

diabetic Hypoglycemia

......... fluids
secondary to CNS dysfunction
Headache
Headache

130

..............................................................

....
extra

....

Nocturnal hypoglycaemia
, , ,
grades mild

Moderate

sever

%25

infusion % 10 Long
acting Oral long acting
close observation
enumeration
Hypo gonadism
Primary

.... viral orchitis ... granuloma ..
spironolactone
secondary hypothalamus pituitary
gland

131

..............................................................
clinical pictures of hypo gonadism
hypogonadism adult

Hypo gonadism
adult
after puberty

Male male

Impotence
male infertility

gynaecomastia
enlargement of male breast
Male
male obese
Male obese breast
glandular element
gynaecomastia
gynaecomastia drugs
Physiological hypo gonadism estrogen producing
tumors
drug spironolactone tender
gynaecomastia tender
sexual differentiation

chromosomal sex Male
female

132

..............................................................
... genitalia ...
........

gonadal sex gonadal examination
gonads

Ovary testicles
genitalia
gender social sex
Personal history as regard sex
gender ...... gender
sex
sex sex genotype phenotype

features
genitalia gender

social orientation

... male
male features ...
gender genitalia
sex chromosomal ...phenotype
gonads
Official sex male
female
female amenorrhea

133

..............................................................

menopause

menopause

clinical pictures
avaso motor Hot flush
diabetes

endocrine
:
.. ..
diabetes mellitus

diabetes

diabetes
endocrine diabetes

diabetes
) (

134

..............................................................

diabetes

hyper glycemia
definition of diabetes hyper glycemia

clinical syndrome
In which there is an error of carbohydrates metabolism
clinical syndrome error in
CHO metabolism
error of CHO metabolism due to insulin
deficiency

ending in error of CHO metabolism
ending in Hyper glycemia
Hyper glycemia
diabetes hyper glycemia
hyper glycemia
Hyper glycemia glycosuria

180 Urine
neuropathy
Neuropathy vasculopathy
vasculopathy neuropathy + glycosuria hyper
glycemia
diabetes hyper
glycemia
Hyper glycemia
clinical syndrome
clinical syndrome in which there is an error of CHO
metabolism , due to isulin deficiency , resistance or both ,
ending in : chronic hyper glycemia + or glucosuria ,
vasculopathy and neuropathy
Neuropathy
135

..............................................................

500
190- 180 neuropathy
vasculopathy complication
Hyper glycemia

clinical syndrome in which there is an error of CHO
metabolism , due to isulin deficiency , resistance or both ,
ending in : chronic hyper glycemia + or glucosuria ,
vasculopathy and neuropathy

etiology
Primary secondary
secondary
Primary
primary
Type 1 Type 2

type 1 ... insulin dependant diabetes
mellitus

type 2 ... Non insulin dependant
type 2 Non
insulin
non insulin dependant

type 1 type 2
type 1
juvenile diabetes mellitus
type 1
Most propably auto immune
viral infection auto immune
most propably auto immune
Islets
136

..............................................................

type 1 insulin

type 2

anti insulin
hormone glucagon
receptors

Oral hypoglycemic

type 1 type 2
type 1
type 2
type 1 type 2
type 2
type 1
type 1 diabetes type1 diabetes
type 1 diabetes
type 2 ...
oral hypoglycemic
type 2 40 70

diabetes type 2 95- 90

type 2 type 1
type 1
complications
type 2 complications type
1 type 1 ..
137

..............................................................
complications
type 1

etiology
secondary diabetes
secondary diabetes

Pancreatic causes chronic pancreatitis

... drug Hyper glycemia
thiazide
contraceptive pills Hyper glycemia
Others DIDMOD syndrome
DIDMOD syndrome diabetes insipidus , diabetes
mellitus , optic atrophy and deafness

. endocrine cushing acromeglay
hyper thyroidism secondary
diabetes
primary type 1 and type 2
MODY mature onset diabetes in

young patient
MODY type 2

..

stages of diabetes mellitus

pre diabetic impaired
glucose tolerance
impaired glucose tolerance
138

..............................................................
Normal fasting blood glucose
Normal 110
fasting 126
120

Normal 110 126
..... .....

pre diabetic
impaired glucose tolerance

Pre diabetes
.....

Pre diabetes
positive family hisoty type type 2
diabetes type 2 category
Pre diabetes 0000

obesity obesity
fat fat
Obese fat

obese
female macrosomia
.....

.....

139

..............................................................
renal glucosuria
renal glucosuria Urine
180
urine
180
Category
pre diabetes
latent diabetes
latent diabetes
latent
diabetes
chemical diabetes
chemical diabetes clinical
pictures poly urea Poly phagia poly depsia

chemical diabetes

diabetes definition
clinical diabetes
clinical diabetes
manifestations
triad classic triad
P P

Poly urea Poly depsia poly phagia
Poly urea poly urea
poly depsia
Poly depsia Poly
urea
Poly urea Moderate poly urea
moderate poly urea sever diabetes
140

..............................................................
insipidus
Poly urea , poly depsia and poly phagia
Poly urea nocturnal
Poly phagia with weight loss
hyper thyroidism
diabetes
poly phagia with weight loss
classic triad classic triad

triad
complications
classic triad

complications
Poly neuropathy

poly urea poly phagia
complication
complications

endocrine complications of
diabetes

.....

.... definition vasculopathy
Neuropathy Infection
complications
complications
141

..............................................................

vasculopathy Neuropathy
Infection
infection
Infection
Infection vasculopathy
neuropathy
... ....

fate

fate

blood vessel

... blood vessel
wall of blood
vessel glycosylation gylcosylatio
vasculopathy
vasculopathy

vasculopathy blood vessel
fate

sorbitol neuropathy
neuropathy sorbitol
sorbitol
sorbitals neuropathy

vasculopathy Neuropathy Infection
infection vasculopathy
Neruopathy
142

..............................................................
sorbitol pathway
complications
......... neurological
complications

common Neurological complications of
diabetes

non neurological complications of diabetes
complications
neurological non neurological
complications
complications
neurological
complication
skin
skin ) (
Infection

curbancles infection
recurrent abscess
infection
itching Infection Itching
I
Itching female .... Pruritis vulvae
pruritis vulvae Investigation
pruritis vulvae
delayed healing of wound hyper
glycemia delayed healing
143

..............................................................
Xanthelasma
Xanthelasma Hyper
cholestrolaemia ...... deposition of
cholesterol Xanthelasma

Xanthelasma
Necrobiosis lipoidica diabeticorum

tibia patch tibia
patch
..... patch tibia
characteristic
patch ulcers
Itching
vasculopathy
vasculopathy blood vessel ulcers
ischaemia
vasculopathy gangeren

diabetic foot
skin
cardiovascular
cardiovascular complications
micro angiopathy macro angiopathy
Micro angiopathy angiopathy

144

..............................................................
macro angiopathy angiopathy
micro anigopathy atherosclerosis
micro angiopathy micro
angiopathy and macro angiopathy
specific micro angiopathy
atherosclerosis atherosclerosis

atherosclerosis
micro angiopathy atherosclerosis
atherosclerosis cerebral atherosclerosis
Ischaemia ... stroke coronary
ischaemic heart disease ....... silent
silent silent diabetic
..... neuropathy
intermittent claudication
renal Kidney atherosclerosis
renal renal artery stenosis hyper
tension
Hyper tension

micro angiopathy

opathy nephropathy , retinopathy

and neuropathy
mechanism
micro angiopathy
neuropathy nephropathy
retinopathy
micro angiopathy complication of diabetes
Opathy
retinopathy , neuropathy and nephropathy
145

..............................................................
Chest
cutaneous... skin
cardio vascular chest
chest infection
infection specific infection .T.B
.T.B diabetes
diabetes .T.B
Immuno compromised
Infection ..... pneumonia
chest
G Gastrointestinal Genital
Gastrointestinal
GIT
.....
.... diabetic neuropathy diabetic neuropathy
autonomic neuropathy sympathetic para
sympathetic
sympathetic Para sympathetic

diarrhea constipation
diarrhea constipation

Para sympathetic
sympathetic
GIT

delayed emptying of stomach
fatty liver
fatty liver
GIT
diarrhe
constipation
.... nausea vomiting
146

..............................................................
Genital
Impotance
Impotance
Impotance

vasculopathy erection
neuropathy
impotance psychological
Impotance
psychological
.......
Impotance
...
Impotance

Impotance

impotance

Impotance
Impotance

complications

complications
)
I think ( I believe
complications
complications
Eye
147

..............................................................

retinopathy

infection Infection why not
Infection

)
( Inception

.................

error of refraction ......... repeated error of
refraction

....... .......

....

.... error of refraction

............ ... ....
error of refraction

error of refraction

cranial nerves
neuro peripheral neuropathy
148

..............................................................
cranial nerve
6-4-3-2 cranial nerves
complication diabetic retinopathy

diabetic retinopathy diabetic
retinopathy
diabetic retinopathy sudden

error of refraction
type 1 diabetes

type 1
15 retinopathy
sudden

... .... ....

chronic
...

.....

.
retinopathy
retinopathy retinopathy
149

..............................................................

non proliferative
Proliferative

non proliferative vasculopathy
retina blood vessel
Micro angiopathy retina blood vessel
...... ischaemia ischaemia edema
Proliferative proliferative
retina .....
neovascularization
blood vessel blood vessels anatomical
blood vessel ) (
rupture ........ ruptured
proliferative
kidney
Kidney kidney
Nephropathy pyelonephritis Infection
pyelonephritis Infection
pyelonephritis Nephrology

dysuria
loin pain
fever Infection
Pyelonephritis
fever , loin pain and dysuria
Loin pain fever
pyelonephritis
papillae Kidney
Haematouria
Pyelonephritis
Haematouria
150

..............................................................
papillae anuria
Pyelonephritis pyelonephritis
Pyelonephritis
pyelonephritis

Renal complication

... ... type
1 diabetic nephropathy


:

.
15

Diabetic nephropathy
afferent glomeruli
efferent
vasculopathy Micro angiopathy

efferent afferent
afferent
efferent

afferent
efferent
151

..............................................................
efferent
efferent
glomeruli glomeruli

glomerulosclerosis

Pathology

glomeruli
..... glomeruli

....
nephrology urine
urine 150

tubules

..... tubules tubules

reabsorption
reabsorption
.....

urine

fibrosis
fibrosis chronic renal failure
chronic renal failure diabetes
proteinuria
proteinuria glomeruli
glomeruli efferent
diabetes

152

..............................................................
.... efferent
efferent glomeruli
Proteinuria

....

Hyper tension
140/90 diabetes 130/80

130/80


long standing diabetes

long
standing diabetes clinical pictures
diabetes
protein uria chronic renal
failure Proteniuria

153

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..............................................................

.. thyroxin hormone bone turn

Liver cirrhosis serum albumin

primary hyper parathyroid Primary hyper

differential diagnosis of hyper calcaemia

......... Hyper plasia

congenital tetany absent thymus gland

... ... phosphorus

.... suppression calcium

..... tetany carpal

emergency............Ca gluconate intravenous very

acquired kidney tubules

poly urea poly depsia

diuretic phase of acute tubular necrosis

kidney tubules not responding to aldosterone

B-blocker Block of beta receptors

tetany .... Ionized form free

anti parathromone hormone

Long standing secondary

roughness punctuate holes

causes of hypo pituitarism

... extrapyramidal side effect

... MRI sella turcica

tall stature - too strong - intelligent

diabetic diabetic neuropathy

trans sphenoidal hypophysectomy

diabetes insipidus problem

congenital hypo thyroidism

cretinism written stunted

auto immune disease thyroid

skin dry carotinaemia

iron deficiency anaemia

adenoma adrenal gland

type one auto immue type two

.... drowsy ...

concept .... ....

ischaemic ischaemia neuropathy

invetigations of a case of Diabetes mellitus

action entery of amio acids

short acting Gliclazide Diamicron

Liver cirrhosis renal failure perfect

dysequilibrium rapid hypo glycaemia

Oral hypo glycaemic release

MODY mature onset diabetes in

stages of diabetes mellitus

Necrobiosis lipoidica diabeticorum

opathy nephropathy , retinopathy

long standing diabetes

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