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

: : : : :

endocrine

parathyroid hormone

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

... 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 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

oma pheochromocytoma medullary thyroid carcinoma parathyroid

Oma marfanoid

hyper function search for other hyper function Other endocrinal glands Parathyroid ... hyper parathyroid hyper parathyroid pheochromocytoma islets cells

secondary hyper parathyroid secondary to hypocalcaemia Hypocalcaemic parathormone hormone normal secondary hyper parathyroid calcium 6 ....hyper parathyroid .... secondary ..... 10 ... secondary hyper parathyroid secondary hyper thyroidism .....what about serum calcium Low MCQ hypocalcaemia .... secondary hyper parathyroidism Hyper parathyroid secondary to hypocalcaemia normal calcium Hyper calcaemic secondary hyper parathyroid

hypo calcaeima chronic renal failure mal absorption chronic renal failure

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

tertiary tertiary secondary tertiary ( secondary hyper parathyroid chronic renal failure chronic renal failure 15 secondary hyper parathyroid ......parathyroid gland tertiary .... tertiary Parathyroid ... parathormone hormone ..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 ... 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

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

Phosphorus .. Parathormone excrete Phosphorus

alkaline phosphatase ( ... hyper parathyroid alkaline phosphatase

secondary hyper parathyroid serum calcium Low low normal

Phosphorus .... secondary renal failure uraemic phosphorus hypophosphataemia alkaline phosphatase

tertiary secondary uraemic hypocalcaemic secondary hyper parathyroid uraemic chronic renal failure acute

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

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

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 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 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

Parathormone hormone 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

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 ( ( 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 6 items 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

secondary hyper parathyroid Hypocalcaemia Hypocalcaemia chronic persistent hypoclacaemic chronic renal failure Parathormone hormone ......Parathormone hormone serum calcium Parathormone hormone 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 secondary hyper parathyroid 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 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 ...... ( 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 .... 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

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 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 diabetes mellitus blood sugar

compulsive water intake irritable urine poly urea specific gravity 1010 1010 compulsive water intake ........ Urine concentrated urine diluted diabetes insipidus compulsive water intake

diabetes insipidus

History .... ((( water deprivation test ...... ....... specific gravity compulsive water intake specific gravity 1010 8 hours water deprivation

urine osmolality 300 Unit 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 poly urea poly depsia .........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 nephrogenic diabetes insipidus Mechanism ( Poly urea diuretic Thiazides sensitivity of the kidney tubules anti diuretic hormone carbamazepine carbamazepine anti 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

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

DIDMOD syndrome poly urea poly depsia 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 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 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

etiologyHyperplasia 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 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 200-400

( Conn's ......primary hyper aldosteronism secondary hyper aldostronism secondary hyper aldosteronism renal artery stenosis - nephrotic syndrome nephrotic syndrome -hepatic edema Interstitial tissue intra vascular

nephritic liver cirrhosis Intra vascular extra vascular edema intra vascular volume Hypo voluemic ......... renin renal ischaemia secondary hyper aldosteronsim ( primary hyper aldosteronism Mild hypertension secondary Hyper tension nephrotic liver cirrhosis renal artery stenosis

primary edema secondary Hepatic nephrotic edema

primary edema aldosterone escape

renin secondary ... secondary renal ischaemia Hyper reninism Hyper aldosteronism

primary primary adrenal aldosterone excessive aldosterone suppression renin

Problem Pheochromocytoma the commonest tumor adrenal medulla adrenal medulla adrenaline .. ( ( , . , ....... ....- , .- .... .- , , .- , .- , ; , .

( (

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 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 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 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 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 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 8.5-10.5 50% serum calcium albumin ionized calcium active hypoalbuminaemia hypocalcaemia tetany .... Ionized form free

Parathormone hormone bone .... osteoclast bone resorption Intestine absorption ........ kidney tubules calcium reabsorption , phosphorus excretion

vitamin D main action ....intestine .....absorption of Calcium and absorption of phosphorus absorbed D

calcitonin serum calcium anti parathromone hormone ... calcitonin tumor marker medullary carcinoma thyroid gland

thyroxin serum calcium bone turn over MCQ hypercalcaemia hyper thyroidism ... mild hyper calcaemia

Parathyroid function serum calcium albumin 0.8 Liver cirrhosis hypo albuminaemia nephrotic syndrome hypo albuminaemia Hypocalcaemia albumin tetany

alkaline phophatase

Phosphorus Hyper phosphataemia Hypo parathyroidism 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 parathormone hormone ......... nephrogenous cyclic AMP kidney tubules respond parathormone hormone

parathormone hormone ... tubules nephrogenous cyclic AMP ......... nephrogenous cyclic AMP urine kidney tubules respond parathromone hormone

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

Hyper parathyroidism primary secondary tertiary Primary hypo calcaemia ... Hyper parathyroidism hypo calcaemia Hyper plasia -adenoma ... gland hyper activity search for other glands Hyper parathyroid part MEN MEN Multiple endocrinal neoplasia MEN 1 P Hyper function p Pituitary pancreas parathyroid

MEN 2 OMA pheochromocytoma medullary carcinoma parathyroid

MEN type3 MEN 2 marfanoid features

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

tertiary autonomous Long standing secondary hyper parathyroidism chronic renal failure .. Para thyroid hormone autonomous feed back autonomous ....hyper plasia adenoma Para thyroid MCQ chronic renal failure serum calcium 14 tertiary hyper parathyroidism tertiary hyper parathyroidism serum calcium

clinical pictures Primary tertiary 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 alkaline phosphatase 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

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 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 pseudo hypo parathyroid ( () urine nephrogenous cyclic AMP tissue resistance pseudo pseudo hypo parathyroid Pseudo normal calcium , normal phosphorus Pseudo Pseudo Pseudo pseudo 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 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 10 mins 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

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 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 (

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 ( 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 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 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

differential diagnosis 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 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 20-30 adrenal gland 30 Hydrocortisone

growth hormone thyroxine replacement therapy aroung 100 100-150

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

hyper prolactinaemia amenorrhea glactorrhea syndrome hyper prolactinaemia 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 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 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 hyper prolactinaemia

clinical pictures glactorrhea , amenorrhea glactorrhea Milk production breast Post partum Milk !!!! glactorrhea

glactorrhea significant amenorrhea glactorrhea amenorrhea sub fertility

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 gigantism giant 190 190 giant minimum 190 190 190 Never

gigantism causes differential diagnosis

Pituitary gigantism hypo gonadism familial racial marfan ........

pituitary gigantism hyperplasia Hyper plasia Hyper plasia ... violent ... ... 11 behaviour .......... ... ... .... ... ... 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

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 .. ...... 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 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

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 1003-030 water deprivation specific gravity 1025-1030 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

nephrogenic diabetes insipidus desmopressin thiazide .... thiazide kidney tubules sensitive ADH carbamazepine anti epileptic

causes of poly urea chronic renal failure ...chronic diuretic phase .....Interstitial nephritis Diabetes mellitus diabetes insipidus excessive water intake psychogenic poly depsia cushing conn's

psychogenic poly depsia compulsive water intake

DIDMOD syndrome DI diabetes insipidus DM diabetes melliutes O Optic atrophy D deafness

approach Poly urea and poly depsia ... specific gravity specific gravity high ....diabetes mellitus specific gravity low diabetes insipidus compulsive water intake water deprivation test urine specific gravity compulsive water intake diabetes insipidus

diabetes insipidus nephrogenic pituitary desmopressin desmopressin pituitary desmopressin Nephrogenic cause

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

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

general features nose lips thick horseness cry constipation abdomen pot belly abdomen

tachycardia Heart rate 140 beat per min Motions defecation

brady cardia constipation defecation Mental retardation

cretinism nervous system Mentality T3-T4 TSH very high

juvenile myxoedema juvenile myxoedema juvenile myxoedema 4 10-14 adult .... Hypothyrodism

hypothyroidism cretinism early childhood juvenile myxoedema

Normal person adult myxoedema thyroxine children

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 pituitary gland pituitary gland thyroxine hypo thyroidism pituitary gland function features of hypo thyroidism general features face Mask face bloated with puffy eyelids differential diagnosis puffiness puffiness problem solving Puffiness face differential diagnosis nephrotic and nephritic superior vena caval obstruction superior vena caval obstruction ... thrombosis, mediastinal syndrome ... mediastinal syndrome Lymphoma ... medistinal syndrome constrictive pericarditis constrictive pericarditis fibrous tissue superior vena caval Neck vein congested non pulsating superior vena cava neck vein congested neck vein One line right atrium superior vena cava problem puffiness Problem constrictive pericarditis Puffy puffiness constrictive puffiness cardic superior vena cava

Puffiness face Hypo thyroidism

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 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 (

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 ......... 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 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 Pernicious megaloblastic

thyroxine bone marrow proliferation Hypo thyroidism Normochromic normocytic anaemia of chronic disease

anaemia of chronic disease chronic inflammatory condition rheumatoid chronic infection T.B. bronchiectasis malignancy disseminated Hypo thyroidism normocytic normochromic anaemia of chronic disease normo cytic normochromic

Prolactin TSH TRH TRH release prolactin ECG Low voltage complexes limb leads

differential diagnosis anaemia ... anaemia edema face Pallor false nephrotic syndrome weight gain depression

complications heart Heart acromegaly susceptible to coronary heart disease diabets

cretinism 100 per square surface area L thyroxine 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

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 pregnancy Hypo thyroidism hypo thyroidism pregnant 50 pregnancy thyroxine level thyroxine globulins TSH TSH ultra sensitive most sensitive .... hypo thyroid TSH TSH TSH normal ...

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

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 basic .... pathology Oral

post graduates ... 5 International thyroiditis thyrotoxicosis ( ) ... thyroid

Graves' disease definition triad (

... .... !!!!! .... ... ... generally generally ... curve 1/5 curve 10 years ..( (((() reliable ... ( ) 97 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 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 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 .... 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 thyroidectomy exophthalmos producing factor

external ocular muscles Lag of convergence medial recti Mobius sign

Mono symptomatic one symptom thyrotoxicosis atrial fibrillation thyrocardia thyrocardia thyrotoxic cardic manifestation

Investigations T3 and T4 TSH suppressed thyrotoxicosis radio active iodine uptake technetium thyroid scan ...high uptake Graves' disease

differential diagnosis anxiety mal absorption hyper dynamic ...hyper dynamic ...arterio venous fistula Hyper dynamic circulation anxiety

thyrotoxic differential diagnosis other causes of hyper dynamic circulation beri beri anxiety

medical medical first attack ... ... refuse contraindication goiter - malignancy sedation beta blocker 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 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 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 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 ... 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 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 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 4 ...anti fungal anti bacterial steroid

psychatric .....depression

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

( )

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

standard Dexamethazone over night

differential diagnosis 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 2 adrenal glands stimulation 2 adrenal 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 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 ... .. ... ....... ... ..... ...... 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 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 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 ..... ... ... ... ... ..... ...... ... ( (((

gestational diabetes curve diabetes 63 glucose tolerance test fasting blood sugar 100 blood sugar gestational diabetes

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

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 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 new vascularization harmful New vascularization harmful ... ... 3 vessels 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

... .. ( ( ) ... ... ... ... 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 nephropathyurinary tract infection

GIT constipation diarrhea autonomic neuropathy

diarrhea autonomic neuropathy nocturnal diarrhea ( )

Liver type 1 glycogen infiltration 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 ... ... ... ... ... ... ... 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 ( 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 ... Osmotic diuresis ..... dehydration osmotic diuresis dehydration