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A review on the most common problems in the endocrine system along with its management. A PowerDev review note
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ENDOCRINE SYSTEM
PITUITARY GLAND
•Anterior•TSH•ACTH•MSH•GH•Endorphins•Prolactin•Gonadotropin
•Posterior•ADH•Oxytocin
PARATHYROID GLAND
•Ca•Parathormone
ADRENAL/SUPRA-RENAL GLAND•Adrenal cortex•Mineralcorticoid•Glucocorticoid
•Adrenal medulla•Emergency hormones
THYROID GLAND•Needs Fe and tyramine•Thyroxine (T4)•T3; calcitonin•Goiter•Poor iodine•Goitrogenic foods•Stress•T3, T4 assay; thyroid scan; BMR
Goiter •Non-toxic•Simple, colloid, euthyroid•Poor iodine•Dysphagia, dyspnea•Mgt• Supplements• Thyroidectomy
•Toxic•Hyper, thyrotoxicosis, Grave’s•S/sx• Talk rapidly•Heat intolerance•Diaphoresis• Skin moist; salmon• v/s, appetite, peristalsis• Amenorrhea• Fine tremors• Insomnia• Exophthalmos
Goiter •(+) Von Graeffe’s sign•Blindness, ulceration•Mgt•65-68 deg F•X station•Change linens, gowns• Inc. everything•Drugs
•Radioactive cocktail•Surgery
Thyroid Storm
•Low TH•FEVER•Mgt:•Cortisone
Thyroidectomy
•GA•5/6•Collar line/ curve linear•Reverse Trendelenberg; semi-Fowler’s, neck with pillows
•Cx•Hemorrhage•Tetany•Laryngeal nerve injury•Respi. Obstruction•Thyroid storm crisis•Hypothyroidism
PANCREAS
•Alpha cells – glucagon•Beta cells – insulin•Delta cells – inhibits both
Diabetes Mellitus
•IDDM•Absolute absence
•DDM•Deficiency
Diagnostics
•Benedict’s test•Blood chem•FBS•PPBS•OGTT
DM
•Hyperglycemia•Vasculopathies•Neuropathy•Retinopathy•Nephropathy•MI
How to Control
•Diet•DM 1 – enough cal to maintain normal GnD•DM 2 – control•60 – CHO•12-15 – CHON•20-25 – fats
•Exercise •OHA•Sulfonylurea•Biguanides
•Worse•Sick/infected•Upset•Stress
•Insulin•Rapid – Humalog•O – 5-10min•P – 1 H•D – 3 H
•Short – Humulin R•30m-1H•2-4 H•4-6 H
• Intermediate – NPH, H N, Lente•3-4H•4-14 H•16-20 H
•Long – H U, Ultralente•6-8 H•12-16 H•20-30H
Complications •Lipodystrophy•Hypoglycemia•HA•Blurring of vision•Confusion•diaphoresis
•Pallor•Palpitation•Tachycardia•Tremors•Food craving
Emergent MGT•Home•10-15 g fast-acting glucose• 4 oz fruit juice• 3 oz softdrink• 4 cubes sugar• 6-10 hard candies• 3 pcs Graham• 6 pcs salted crackers• 5 ml honey/syrup
•Hospital•50% glucose/IV
•Home •Glucagon 0.5 + 1 mg SQ/IM