By Ramzi Ajjan
Masking circumstances from Addison's sickness to osteoporosis and diabetic foot ulcer, and an introductory part explaining the molecular and physiological features of endocrinology, Endocrinology and Diabetes: scientific situations Uncovered has all of it. Reflecting the numerous nature of the uniqueness, the situations hide a variety of endocrine stipulations and handle the scientific presentation, diagnostic workup and strength problems, whereas the self-assessment part, comprising 30 MCQ, 10 SAQs and 10 EMQs, might help clinical scholars, junior medical professionals, and nurses training scientific reasoning and get ready for all times at the wards.
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Additional info for Endocrinology and Diabetes: Clinical Cases Uncovered
This is also known as renal tubular acidosis type IV, which can be seen in renal disease (such as diabetic nephropathy), and it is a condition that is probably underdiagnosed. PA R T 1 : B A S I C S Adrenal failure • Primary adrenal failure results in glucocorticoid and mineralocorticoid deﬁciency (commonly described as Addison’s disease) • Secondary adrenal failure results in glucocorticoid deﬁciency only Causes of adrenal failure are summarized in Table 18. Table 18 Causes of adrenal failure.
Useful for investigating extra-adrenal tumours • Adrenal venous sampling ᭺ Reserved for difﬁcult cases ᭺ Presence of bilateral pathology Treatment • Surgery: removal of the tumour is curative • Patient should be prepared before surgery with adequate α-blockade to avoid a hypertensive crisis, which may be fatal • Medical treatment is not an option The ‘rule of 10’ should be remembered when considering pheochromocytomas: MEN II Von-Hippel Lindau Neuroﬁbromatosis Hyperparathyroidism Cerebellar and retinal haemangioblastomas Multiple neuroﬁbromas Thyroid carcinoma Renal cell carcinoma Café au lait spots Pheochromocytoma (50%) Pheochromocytoma (around 20%) Pheochromocytoma (rare) PA R T 1 : B A S I C S the treatment of choice, which cures hypertension in two-thirds of cases • For bilateral adrenal hyperplasia, the aldosterone antagonist, spironolactone or potassium-sparing diuretics, amiloride or triamterene, are used 34 Part 1: Basics • 10% are malignant • 10% are extra-adrenal (arising in the sympathetic or Clinical presentation parasympathetic chain) • 10% are familial (in which case screening should be preformed) that described under pituitary failure except for the presence of pigmentation (secondary to high ACTH) and this can be seen in: ᭺ Palmar creases ᭺ Scar tissue ᭺ Buccal mucosa • Aldosterone deﬁciency, resulting in: ᭺ Postural hypotension ᭺ Hyponatraemia ᭺ Hyperkalaemia ᭺ Metabolic acidosis Isolated aldosterone deﬁciency may be secondary to impaired renin secretion (hyporeninaemic hypoaldosteronism).
The hypothalamus produces gonadotrophin releasing hormones (GnRH) in a pulsatile fashion • GnRH stimulate the pituitary to release follicle stimu- lating hormone (FSH) and luteinizing hormone (LH) • FSH results in: Growth and maturation of ovarian follicles (which contain the oocyte) ᭺ Stimulation of oestrogen production by follicular cells • LH results in: ᭺ Ovulation (a surge in LH production is responsible for ovulation) ᭺ Maintenance of progesterone production by the corpus luteum • Inhibin, secreted by the ovaries and under FSH control, has a negative feedback effect on FSH production • Oestradiol has a negative feedback effect on FSH production but has a positive effect on LH surge (necessary for ovulation) ᭺ Physiology • Ovaries have two functions Endocrine: production of oestrogen and progesterone ᭺ Reproductive: storage and release of oocytes • Testicles have two functions ᭺ Endocrine: production of testosterone ᭺ Reproductive: production of sperms This section will mainly concentrate on the endocrine function of these organs.
Endocrinology and Diabetes: Clinical Cases Uncovered by Ramzi Ajjan