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    © All Rights Reserved
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    19 views293 pages

    Endocrine Pathophysio

    Uploaded by

    Rex Decolongon Jr.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 293
    ns '48yea:ldwoman comes ote ofc br bu. of pay typomyroism ae fo ehvonic ue Heshinoto) hye. She fs wel antas no paptonns, hestalsnnerance, darheacnsipaton, cages nweght Te ptt aes lvabyraune day onan amet ‘Soma She hasno athe medca conser ane tas no oer medcaons. Tho patent ns no drug allies and das not se acc, acho erie tugs. lod esses 12070 en Ha and pulse 2m. B's 27 Kgn®. On ghia exon, te tyro isnot fipaban The ene peiphral edema Latte reste shaw a sau TStiveof <0" yim. Mainaning tie caer core ot eveyone wou pl hs patent at the grees for wh he low congas? OO Agenuccross Aral ition ns ‘2 4byarats woman cams othe oc abu. pay hypeyrodsm ae to eben aime Heshinat) yas She es wel antas no paptonns, hestalsnnerance, darheacnsipaton, cages nweght Te ptt aes lvabyraune day onan amet ‘Soma She hasno athe medca conser ane tas no oer medcaons. Tho patent ns no drug allies and das not se acc, acho erie tugs. lod esses 12070 en Ha and pulse 2m. B's 27 Kgn®. On ghia exon, te tyro isnot fipaban The ene peiphral edema Latte reste shaw a sau TStiveof <0" yim. Mainaning tie caer core ot eveyone wou pl hs patent at the grees for wh he low congas? A. parenuccyoss (13%) YB ial stn (534) ©. Ceara 2%) 1B. cater (17) Mepasoncry 6%) F Tyo anes) “Caaiovazeular feces of pero 7 Tacyeaaa palais + Atal eabon| increased conraciy| 7 {Econ facto & cardiac up + Myocardal ge demand 8 angra +1 Pumenary ater pressure 7 1 Spteme vas enstnce 7 | Dante pressure +f syste pes + 1 Po pressure + Hivouputhea are “Tos paer on hyo placement terpy fr hpeyodam and has a suppressed TSH (ral ange: 0 §0 YL cating st her cent dose fs tos high. Excess cd Mame, whether du a endogenous hypention oxaogec ver plcennt wih leveyroxe, casos increases bate aorenarge reaper expression. The resutng hyperadenerl tate canlcsd' sipiicart cardovasclar ciao. “Tyco aescted wn byerensin, acca, and neeased mystery. Atl Hilson est commen ipraventicuararhytmis and sa requent compan cthytoxieess. Thytovce ake neeases conacy, which neeeses myocar oxygen devas ae cn prelptaeanginain parts with ncerng carray disease. Ica aso cease cadac cut whe ro decresing systems ancl resitnce| andlend high output hea falure.Thrsor even thai pet els el he ae a evetnyroune shoud be eae aad ng tem cnpcaons af vec tepaceert (holes Aand E} Aarauctoss i potential conpeaon of tora rtrd gs fea. promi, methine) “This pabrt son hyo placement therapy fr hyptyociar anda a suppressed TSH ocr ange: 5 50 pin.) eating nk her cumant dose too high. Excess cd Ramone, wher duo endogenous hypentiot oxaogenc ne plac ent wih eveyone, casos increased bata acon cope expression. The sung hyperadenergl state can ead b sii cacdovascla cians “Tyco esc wih Dyers, acca, and weeased mystery. Atl Sila est commen ipravertievararhytmis and sa requent compesten cthytoxeess. Thyotovce ake neeases conacy, which neeeses myocar oxygen dome ar can relptaeanginain pars with ner cara disease, Ica bo meease cada cut who aise decreasing systemic vasculressance) and ead to gh outpt heat flue. Therefore eventhough his pat els el, he ose of Tevetnyroune shoud be eared and log em cmpesons of vec epaccvert (Choirs Aand E} Axrauocoss potential conpicaon of orange rtrd psf. propticurl ethrazcle) Propticuae can satcaue hepacionety However evan wean brad epsarerer they done nt aur hee omphcabon | (Ghote €) Thyroid ve reracement can casensermia rd afeciveSympIoN en, ane sb). Alhoush hyeertyrodem in oH aes may rarest esol wikaval ar sowed responses apa depression ese deena conve dentin in younger tenis mre kay oe een in nyporyredn her ann hypertyrciem. (Ghote D) The ge een in hypahyoksmis det cei yo smaton by TSH. Ths manesaion nerves wth he aniston cf levine (ae TSH eee re Secreaze) andi a cen ve teparaient (hole F) hyo cancers a potartal eng tem canpication of aiodine heap fr ypermycm. Educations objective: ‘Thystxcoss, what duo endogenous hypatyoism coerce with yi mone in patente nh hyptcim, causes & peraenerc stato hat can ado tial feito Neh eutpt hese and weseing of aga pecs + Carjvascar deca nd mri futon clits “Tyrtncoss seeotes win hypananion, ence andneeneed yas azestery Atl Milan he mst somman| ‘spaveticvarartytnia ands Feqvent complicate ef yrctoxcess. Thytoxcossasonereases anacy, wichnceases ‘myocar crygen demand and can precipitate anginain perth nein corona diesen ican ea ncresee cara exp ile ‘bo decreasing systans asl esstance) and ead igvoutpur haat falure. Tete eventhough is patel wl, Ne ose a eveyone shoud be reduce to vad ng em campeatons of versepacenen. (roles A and} Aarandneytss poem complication of tharamde ayo dues le, propyoieuaa, methrzzle) Propytticut can 380 case hepaconcty. However Ievorwonne wed n By facet ely does nt aus hese completo (hole €) Thyroid ve enacement can cause nse nd alecive symptoms ep ane iti). hough esti in cy tents may mane 2s Sova witraval na sowed respnsesapahehc depression) esenlng Sema coge dysurctn Mm younget Pens mare kay oe seen a nypameésm her ann hyper {hciee D) The ger sonia hyped ta can tai stmdstony TSH. The manson ingove wth he adisaton ck evetnyroune as TSH ees re decease) an a Seen ove fearement (Ghote F) Thro cacer ia ptr ena tem cocaion of raodine therapy fer pert. Educational objective: “Thyretovcoss, whether duo endogenaishypertyokism or oreeplaceret th his homorein patents with hypoyoism,causes 3 hrperaenere ate hat can ado til vation hitter sure and worsen of angina pectoris References + Cardovascar seas and ned oon, Pathopiysony Endoctin, abet 8 Netaboism ——_ Hypathokie ‘inet Sree ve a restonie 225 ame fo _ fa ‘A so.yearald man's bowie enegenydeparmet due ated mereastas. Hs wle say fathead a naggng cought eames os to wersen over eps! several ments andthe bean exgenencngeecatnaldzzness caer Ts week, Ove! the as coupe a ay, the oe tenth bce easing contd nay ha "dos nat rake any sara at al” He has no sincat past mda histo bithas 2 ‘Svokes a pack of ogareties dl rhe Dyers. On ghia exainaon, the pater sinecherent uthasan cers normal ewok -3 ato sus 25 fous: oa enum chet oe sosun 0m gt a Pots S0meat 2 Bloodreenivegen 12mg. bs oretane compa. om cate soma, 2 unos Bmott, ta Posra osmoty 220 mOsm = Lime arg secon regan ‘ohest xy reveals amats teat ang Which of he olla onal ndings most ly be presents aon? OO staal races tung vases OB. Sve jugar venospreseue sums site une eREN Rey ore 20m 9t 40mEat emg oamoa, omg. sro, Pasma osmalaity 250 n0smig Line arg secon egane ‘nest ay rveals amass nthe rg ang Which he follnngasitonal ndings most aly tbe presertnhs patent? OA Stara rae ae ung pases OB Stes juguar venus pressure 6 Manat ase wine 2. Apwert autora OE Petpnera edema a vy eREN Rey bee A Gail Seam 20m 9t Pots 40mEat Blooduresniiogen 12mg. Cretnne oamoa, cur omg. eunote sent, Pasma osmalaity 250 n0smig Line arg secon egane ‘het ay rveals amass te mgt ang Which he follwing asitonal ndings most aly tbe presrtn hs patent? ‘A Blatea crates ae ung Des) 5. Svat jguor venous pressure (1%) ©. Maxnaty tte une (1%) VD. Apparent eweonia 45%) . Pepnera eer (18%) onites So LW rescore Ser ts bse a vy eREN Rey ypenaeia terete | selure enn, rceseed eee Sees Teoed nar ‘rosumereaten Farhan odin ‘siume! [Exoemic hyponatremia vy ‘Te cemainatanofhypanaena nt aun mass supgetve he syndrome of inappropriate anauree hermane szreon (i) {0M sna rouces ne ryposatanus and secre om the post puta nvesponse charges in pasa ower InrovascuSrvolme. Howover smallel ung caenemas, which ae ures rarendocine ogi, fen release ADH independ of feestack ihn (preoptic eet, Thisrapsrepate screen of ADH asst hyponatema, decease asa osm are ‘evi ie carey och normaly shu be 10D mOsm given the degree hportera), The prefound hyporieiathl =csa In SIADA, eased ADH causes excessive wate abortion by he ney, leasing avast, sine hyperemia This mil ncrease le ete ee eee eee eee ‘Sedum neue fates) As ares patente wh ADH hae ancy nomial eracela vous ar ov pasa cally (euvlemie hyponatremia). Fons of lune velo (c,piher edema, pulmanaycacees, elevated jugular vercus presi) ar ot ‘szon(Cholees A 8, and) (note ) Patents wt IAD Rove mappooaaly concerted une gnealy 100 OwNg fr er eee of hypenatema ypontema win anne oso <0 mOsm muna ste une) eae appropri pressor ot AM eereton (oul 8 ‘stenin par pops) Educational objective: “he syetome of rarerepateaniurec hamone secretion S/H) charatarzed by lw ls scan esr nape cxncentated urine an crcaly real ve stats (elenichyporarena) An nparant cause of ADH apaareclstic et References + Thesystome of rapper anisuresis atophysnon, crcl management and ne tape pos + Naragement ot yporsnemi: proving vesnent and mong harm Patophyscoay Endacina, iat 8 otbolsm LAOH Co commen PH = a ‘A 2a-yearald man cores tone ofa evaluton at neck mae. Heft tend ama nein his ower nck ort pe ae a ogressivy ela since atime. The patent hes nad no changes weigh and ene feels wl, Medalist srt ot or ‘szaboal allergies, and he sks ro medications. Physical xaminabn stows a em nodule me rf be eth tyro. There are mutple {to 8-nm sof papules en he sand tongue. The arn span exceeds is eght andthe patent haslora gers. Scum calc levels ae ns ‘A 2a-yearald man cores tone ofa evaluton at neck mae. Heft tend ama nein his ower nck ort pe ae a ogressivy ela since atime. The patent hes nad no changes weigh and ene feels wl, Medalist srt ot or ‘szaboal allergies, and he sks ro medications. Physical xaminabn stows a em nodule me rf be eth tyro. There are mutple {to 8-nm sof papules en he sand tongue. The arn span exceeds is eght andthe patent haslora gers. Scum calc levels ae ceatee Which the folowing 2 met el to devel th pati? YA. Enis neaache (88) 8. Hrpecaemia (14%) ©. Hrpoalvemicensees (5) . Peper vison es 6) . Recurent peptic cers (5) Primary hyperparehyreidam (parathyroid adenomas or persia) + Pity twnos prolactin visa deers) + Panetta espa aso) we ~ Meaulsry tyra cance (sion) ‘ype 2A | + Prenctomocyema + Primary hyperparatyoitsm party hyerlsa) + Medullary thyrld cance (actor) ‘pe 28 |» Preaciromccroms “This pabent hasan enlarged noe aces wih an eevee clon vel wich i conceing fer mda hyo cancer (47), arabrancy arse he hr (partici cas, These nde n asocaton wth cos neuomas are mato ‘bins on, am soa = heat. na frst ny) svggest mule endocrine neoplsi type 28 (VENZE). NEN syndromes ae casted y gerrne muster fe RET proto-acagene. MCE present rea al fae wh NZ ans us.ly me agresiean ‘cas ta eae ape nan space MTC Pheoehromecviomss devon nou haof pate wih MEN2 snares ad cause proxsal person and tceadiadue the Intmant seceton ot catchlanes. Th abet vere netete mba pressure can prep elses headaches a en ‘accompanied by oar spams assocaed win calecolnine excess (ep acho, eer chest a). {hoie B} Hygeparattysam wh secondary hypeacemia hemes! orion marecaton fMEN. Hypa (to aca cne cet npersaie aterana trator) ao seen 10%-20 af pats wh NENZA, built MENZS (Ghoies Cand E) Wary pts wth NEN! have enone pancreatic umes that secret asin, eng beac pepticlerion ard “This patent hasan enlarge myc ne acacia wih an wevaed clon vl wich cenceng er med hyo cancer (041), arishgnaney aneng om ne yo pec) ele. Thee Scns, seocaton wen msoen morse ans marti ‘bis en, am soan= het ng rg jit oy) suggest multiple endocrine neoplasia type 28(VENZE).NENZ synomes ae aired by urine mutans fhe RET proto-oncogene. Te present ney al abet th NIENZ ani sly roe aggrecan ‘cas ta eae ape nan space MTC Pheoehromecviomss devon nou halof pate wih MEN2 snares ad cause proxeal peterson and tceadiadue the ae ee al cconpanied by car snpoms assonated win calacolarine scat ep arhoress, enor chest a). (Ghote B) Hyperprahyide with secondary hypercalcemia she most oraronmarecaionf NEN. Hypeparahrin (oo ares cnet cet nyperpaa ce aderana tration) a seen 18-20% pats wh MENA. ae of MENZS (Ghotes Cand E Wary patents wth NEN' have enfocine panceaic mesa secret asin, eng beac peptic leraion and Se Nae ee ee eee Tee cee can case noncema (Ghote D) Pity tuners are present in 0% of gases wih MENT. Large ptuary turers wth suprser extensions hat cause perp von ss Education objective: ile endccineneopiass toe 28s characterized by modular tyro caeephescromecromes, mis neronas and marci rants. Hyerparayroam rata eae os syne References «| Revees Armncan Thy Assocation gure fr the management of mec yi arco Paorinslony Endacina iattes &Nottoiem Mute ondocine neon o! ore ‘A 20yarald woman cms othe se duets generaizes weakness and equi Nigh vaime water. She as hanes, Nema, raadomical pan The pater’ syngtans hav been orgong fr several mans bt she caret fecal exat) when ey began Se has no ‘omer moicalcenditons. The peters sje moter ofa 2-year che Ras ne soci separ, nd orceseray uses cohol an margin Yo cope wih he sess” Vial gs ans psa examination are nema. lod gucose 835 mal ant serum sum is 132 IEGL. Unni stows nub orted ord clz. Dung iteetlston seine aly ser mearited whe rake reacted aso is subsequrtyadmnsezes 7 hous tote est. The sus ate shown bala Vasopressin seminisiered eREN Rey ble A Ginid “Tine (m) hin fhe foning isthe mos ppp longterm tener ir i pater? ‘EOL. Unaisis sows no uhior rd teed cls. Curng iter evluston, sine oss sarily messed whe ad nae ese i scores is sibsequrty administered Thos inet test. The eu re sown belo, ore soo gm bo & a 2 x0 : 5 m > 100 Da y 2 $45 6 7 8 8 = Tire (hr) Ls hence aoe te met appt ngtm ance spate lO % ble A Ginid “Tine (m) 2H vicar eg ne mt pa tm aon oe? 2 a m oI i3 (G. mdometnacin (3%) 3 0.8) as OE Yarmeisn 8) tS Ih Satan ‘at sana = crs ° aren ‘Wl deprivation wot serum | Unneosmelaity ater water | Urine osmolality wth vasopeessin sean ‘oevation Injection Neral Incas mitonalincrease Hah Ne change ori neease Lagehoeose Hoh No change cri incense tierce “This panrt has pola (une veut Lida) a ow al urine osmolality, hich sincicabc of wate euresiscausedby one of 0 fotevingcontons: 2 + Datates ius) whch cei ae to ater cient nsec harmons (ADH) rein (cet) ore na respon to = 5H (retreneni 1) oa + Pray plrpsia. bich rests fom excessive wae censumpon (nest conmon ators wih underingsechc eas or = ‘eratonlastess) 2 Inzaens wih primary poli, excessve wae irake often eadsto mi hyponatremia ncanaspreary ADH deterey Dads os ‘te air lesen wih ensuing hypemsirema. Incest pterts, wae depitabn sing maybe hall fe fleeing Pom DI = ‘urn 2 mater deprivation test ining ware nthe nd une cemoat i mre nl reaches atest lata (presetng :3 ‘he mana cenceraing ai eth nes). ier deta pales wih PP silts ADH seen ndleads a sificat iein 2 lune concentration, vars nm paterts wih Dana de Once pla cached, vasopressin ie smeared. In, = exogenous vasopressin causes an wcreasein yin aS PF, ui eancenvain emains unchanged Dazais as pt ihe est i =) Beene, a) > ee + Datates ns (), whch oes eo ther fcr asec harmone (ADH) reducan (ental lor fn espa to 20H (retreneric + Pray plysia. rich ests tom excesive water onsumpton (ot common patents wih under peychiae disease ot ‘eroonal dates) Inpatients uth primary atypia eceaate water rate en ease tomihyponatemiaInczrast perry ADH defer Dade ‘ie water ss cen wih ensungIyperarema.Incetan paerts, wal depeatn stn may Deel fa steering FE Nom DL urna @ water deprivation test ctw Low Hn cy oe) 2 Nexmat on fry 0 (28) oa Oe Namal tow Hon = (som Pathogenesis of primary hyperaldosteronism {and aldosterone eeesps) + Bote nostlar hyperplasia + yperunctioning atonal adenoma | <1 Aiosterne 1+ reabcortion > Hypokalomis 4116 eabsorpion —> Metabolic akalois Nev reabscrsion—> Hypatension —_, Renin {Blood vokme gioensin I ‘Aldosiecona.sscape Renal blood ow Limits ecema cer > tar excretion ‘Lins typematerin 4 ats nabnetic pepe 2 ome irene ove “Tis pastas mypenansion aa yoy age suggesing azecandary cause Her weaures and parses nical an assated ecaye cracetase dsumance These dogs arg wih asuppessed pass er, 30985 plmary mineralocorald excess (ypecldesteronam)_ The mest commen causes of pray hyperabostrnsm ince uaa areal adenoma (Com syne) ord biter! arena hype sa (opatichyperaoserons, wen can be difeetae on abonia CT scan. a vy aren (GPR ones stent ‘Tis pastas myparansion a2 young age sugesingasecondary cause Her weakness and paresis nical an associated ecayte cracdtase daurbarce. These fediogs, along wth asuppressed passer, 309s pinay minralocorald excess (yperldesteroniem). Tho mest commen causes of porary hyprabstrnsm induce unlatera areal adenoma (Com eyo) ard ‘iar! atonal hypelsa(@epsthichyperalcseron, wichncan be diflertiatesonabsomnalCT scan yproseonieme characters y neeseedobenponintne eral olecng tiles Te crets anepave chargeintb men ling Kar Hom ar ces ant ecg nceasod extn of nay K" and H™ Asa resut hypokalemia iscormon.neeasedH ‘excretion by erected cals proces barat poducion and ince active fe altel HOO excharge resin in Desprete increase in Na ease, hypernatemiaan peal edema are rary observed deo a phenomenon krown 2s aldosterone sezape Theincenrediniouair volume cours nreaedrena od ow thesia precete nature) andar tear taint pepade. Ths ent Sogn feterton aa prevents he developmen of ve voune vetoad an Sania hypemavena. (hole A) Duelo alosteene escape, serum Ns" conceiaions romain ypeadceeroisn. nceasedless ‘and Hin theurne ‘aus hyptalema are ngn (tow serum emonae (Ghote B) Fars it par ateral inser have nese rer Nass ad edies uit exzetin of" ad Hea on cortetane acaty Aaarecl hyperemia Mypanaten hyperacms and meistos acco deep. Hyponlema see ata 2 onosotie sims fo ans rrmone (ADS sett, tuber accertuatig ie ryponaera (hole ¢) Loop or haste dec use con case hypovdemia,hypoatea (ne vi tases), ypoalenia, and metabo akaless due four nse ofNat and Hypa can seo ercatinte hyena (eo creased ADH ect) ad aa eto cessed Deatonaleetsoton, (holes D) Me ocricot receptor antagonists o,srroacore) Hock aos recep anima unary excton of and A ‘Sie ets induce Mypertlona and eaboe ass Na exci any my wseasd and serum Ne" cnconeae uA Sores stece, Education objective: ‘cae. teases reaver v cases wre eal Bond (th eaig pesaienatet) and are eae val naurts pope. Thi int nt sodium retenton and prevents the dvelepment of vet volme vecad and sarsicaehypemavemi (note A) bie alone exc, serum Na cancetaton somalia yperddoeroism. nceasad es ot and Hin eure ‘caus hypalema aig (tou) serum embers (reiee 8) Patent ut pray ateral neuer have inresed nN ss and educes uray oxen 6K" and cea ow ‘caste aay. Ase rypovdemia ryponstiema Iyperaema, and menos andes deveep. Hypowclema also atsa5@ rout simul fant hamene (ADH ett, fuer accertutig te hypontemia. (reiee ¢) Loc or nanae aut use con cause hypovlema,rypanatema est win zd) ypc, and metabo tales Ae tourna esses oN ard Hypovolma can so anatase hyponaema (eo creased ADH sect) and aos (ase 10 Ineeaeed estan esvnten (rete tneoceracol rece antagonits (69, sprouts) Hock aston feces at ipa onary exon ofan ‘Side fects inde ypertaoma and metabo acu. Nat exces onl my ncseasd and serum Ne cencenratn usa st Sarco ec Educatona objective: -Prmary hyperaistrone cases increased Na eabserpton nthe renal coloring ube, easing increased uray extn ok" and Hr Patereswoaly rave secondary hypertension as elas hyotalemia and metabo akaloss. The serum concen emans roma duet aceon eseace References + Minerlocsrtcol perro and palma, Patopiysony Entoctin, lattes 8 Netaboism ——_Hyperalosteerism ‘inet Sree ve ..5.yealdwoman cms othe ofc ce tones fatgaily and a 4.544910‘) weigh gan ov the as ew mons Te pate seta sum daly but na does oe ceo ce a eek due age, Se akes @ diy multaon ard an ovrhe courte medcaon forcoreipaten. Blo pressures 14098 mm Hg and pus is Simin. Phycal extn shows hares nvr he toa ido he cyetons. There's delayed elacaen ofthe dee tendon reflexes oftekre and arke. hich of hefoloing tora ests the mest spercprate rot tpn else fhe patents syne? OA 24 hour unary cael exten est © & Dexarattason suppression tot © 6. Fasina sma ues eve D. Seumion sts OE Seumtatohyraine and hyroine eves ‘2 55.yearald woman cams othe flee ae to tcteasgfatgaly an a 4544910‘) wei gan oe the ae ew manne The pater seta sum daly but na does oe ceo ce a eek due age, Se akes @ diy multaon ard an ovrhe courte medcaon forcoreipaten. Blo pressures 14098 mm Hg and pus is Simin. Phycal extn shows hares nvr he toa ido he cyetons. There's delayed elacaen ofthe dee tendon reflexes oftekre and arke. hich of hefoloing tora ests the mest spercprate rot tpn elaine patents syne? ‘A. 24 our nay creo exon es 3) 8. Dorarathason supresin ast 2) ©. Fasing plasma gros evel) . Semon sce (5) EE Seuminodathvorine an tyrosine ves (16) : YF Seu 18) vs — Tr | cacpnens yom oe met gant nt arin mang ges beeen, Wo Wy Se ms | eee rege ee S| eum etgtnonag ste esiper ans pets Sd aa tasty ne sapsoncrenmmant . “Ths pants symtoms (fave, wight ein, conspaton and examination fangs sigeat hypothyroid. Vis gs yall how ‘racaria and yperensin (ef rcveased vascular resistance). patos can ao case sowed ha prove and aerabens nha south ces leading othr ofthe scalp sir anneal ects. Slowed ee of cle he arcclaemc ream macs at dyed easton asec deo enon reones Most ates wth hypotyodism have primar hypothyolsm e. sunconwtinthe thyroid gand). The thos releases tyra homones (osathyonne[T] a rir Tn resparasto TSH forthe pata In tur TSHzenebon epted by yrtope ‘easing harmane(TRH) fame ypstalanus. rye homave suppresses TSH ana Tea negate eedbck and smal changes ‘tyrekdnomene eves aed large changes in TSH eves As hyd aaonepoaicon slows, TSH seretan insases apt esive ‘hyo sent een fore Tae a belo anos oronyrtrnce anges. Tater, srum TSH she most selva fr prirarhyotrorism (hetes Aand B) Th 24ou wirary coisa assy andthe dexanthacane suppression test axe used secon fx Cushing yndone ‘Attouah he patents hypetanshe, ve coe othe tet Cumsngod festires (eer ones sense, ral mice wakes). (rete ) neal eit dabetes metus ncae ast cose, hemaycbin Al er ol gues oetace tess Dabeles can case erpnaa neuropathy (a paeshenas es itl eereton,decesad ane eee) bt benayarsa asic ypetension, an asaya rebeaen otrefeees we mee siagesive ot hypethyrosm (hoieD) The inal evan ofheedtanyhenectrmaiels nclades seu ron dude (6, serum ron, fei, nnn tuto) ‘Athouth ptr oysuncon wih Seconda (ental hypetyodsm can ecu, ets cree co hae ars, daboes mel, trom sn parertaten, andhepteza (tote) TSH ismre sense thn eter 3 or 74 fo dagnsing primary ypubycéam. TSH sc eaten pty or hypaalanc ieee (o socanayhypnnyose), bt hse a mich es conmen aie of rypayoksm (6% cass) in ado pets wth ‘second hypahytidem vay hae cher cnc enes ofhyptaic aay ashen Edueatonsebective “The tet leases hyo hormone eohyrorne [2 aed throne 4 in esponse to TSH fom the pan wich reputed by {type eesenghorane (TRH) femthe hyphae. Thyrod hamane nipteseshe zero of SH and TRH i negeve feodback anasmal charges vod harmaneleves caus age charges it TSH. Serum TS sth oss st pny DypoEAC Seo neRemanng er 5 aon ‘sanaugh Dis patents ypetensve sre dos rathate er Cusngod tees (c, ctl ones si Sia, rowel muse WeakeSs). (hole €) Intl es for dabetes mattusincae farina glucose, hemogcin Ae, and orl coe lerace tess. Diabetes can cause perp neuopany (9, pesesis os ef tal sersaton, deceased ane ext bu eaycarda Gast ypetenson, an deayed ‘ela ofretene are mar sugoesbe ot hypatyaais. (GhoieeD) The inal evan of heredoyremechromazisincues seu ton sues (en. serunfon, fern, anserin stun) ‘aanaugh pty eytunon wih Seconda (ata hypo can acu Pte arena aso have ars, sabes mel, ‘ora porentaten, and neptnegaly (hciee E) TSH sere seve than ete 3 o To dsgasing primar ypobyrism TSH st eleatdin pty orhypthalaic ‘deca o secondary hypnosis a mich ee corcn cae hyped (SR cas). ation patients wth ‘second ypayide usally hae cer crcl eats of hype pula dshacton Eduestons objective: ‘The mya teases yd homonefedoyonne 3} 2nd hyroneT4 in espnse a TSH Nom he pay, whch epate by ‘hype ceasing hemene (TRH) fothehyptalanus. Tyrol harmanesupreses he seston of SH and TRH va negavefeetback ‘andsmal charges in thyrod hormene levels cause age charges in TSH. Sv TSH sth mos senstve est er pay hyporyadsm. {+ Cineal racice pens trypan m ait’ eepaneore ye Arnon Aeeocaton fines Enaaemnlogts athe merce Thyra Asston Pathopiysony Endoctin, abet 8 Netaboism ——_ Hypathokie ‘inet Sree ve Co 2 twee clby eeu the regency epatimen th recirertvoring an pear feeding. Te ‘elation. Pyscal exariaton snows the dey and ype Lato resus ae 25 alws: seventy sot ‘neat rm 87 2 doesn 25m05 2 cite cam S ‘Further evaluation wil most Ikely show which ofthe flowing? eO) ore ‘webby seu the regency department wth eure voritng ar per feeding Te nat was torn ult itt ry platens. Phscal exarintinshors hath is dehyted and hypotensive a county Sunn ~ meine 2 sectieniogm 280g - (Creatinine Oe mgt BL roteromatr nt rete) sow tebe oa? ? ee 2 Indonsenemre = : : : : 21-Hydroxylase deficiency Zona plomersoes ona acstelta Zona rteuats J itrantocrtcie {| 6vexeoaee tatoos ‘Congest sens nypensea (Cad rere ta a gr ot aoseal acsene eaters hat ret om celectsn he asym ics Crist bosmess. Defer of 21-yceaylase sth mos conmon cause cf CAH, acouing fr Sof a cases 21 meronyasedetency te srenal gant cana yess deseroe andar cert Tas causes ceased poate of acrenalanroges because the acura corso an lostaene prec’ are eed war ater antogenBesyese, The resting corel eves suite tay eoducon of ACTH whieh fer nereases he adic tera aogens. 21-ncoane etc) a auras incesced sumlevel 17 hyckanpopeleane atscawemen 0 "ecnyatanl erp bythe enzymate Increase androgenleelslead to antigucusgevitsiainfrvaes (vlienon) bu males wilhave arma genitalia. Sak-wasing occurs wih more seve enya ances Go ck uc mune of mipetlocerteid nd presets wih vorteg, hype, ypenarent, ananyperaiema Severe ery dels can aso res n Sar coisa defcency, wc can case ypolyema an sepa eed pressre martenance eating oct colape) Edueations objective Pencrs win lac, sat-asing tyrone dency Nave dent asl and alate ythess combed wih eden artogen ‘verraticton. Mas inf Rave nome gontaa and present 2 week ater bith wih orig. ypoeninmyponsem, nd hpeskiema, Feraks present bh wih arbguaus genta Patopiysony Endoctin, abet & Metaboism Congenital atenal mpepasia ‘inet Sree Toe eREN Rey ore Eo +L r7hydronyprogesterone Hormonal abnormalities Symptoms ~ [CortsolBaldosterone | ~ Ambiguous genitalia gts + Prestosteone + Sat wasting vomiting trypotenson, JN 1) Tip-hytronase + {Consol aldosterone + Ambiguous genitaiain gts vrorhysroxiase + fTestosterone + Fld salt retention, sf itdeoryenteosterone | — hypertension (weak mineralocortici) 11-deoxyontsl = |conot testosterone | + Allpatients phenotypically * fMinerslocortioids ferale * Ncorcosterone weak |» Fld sat retention, slucocorticoid) hypertension Q zonin Q eam out CP reset Aa To New cat | Exsang Ca Pre ':3yeacldvoran cams othe flee baseus amereiea. She tepan hag eegur menses? yer ao and heat mens pod was 9menns age. Fam rsa s uvemanabe. Labora stutes show an ness serum roacn ev, anarmal TSH ee and 20 ‘nacectbl ACS eancenraten. Serum cium ror. WA evels arm pear adenoma. The pater ehses modal and sueal therapy as shes hay about net hang renseal eos. ie uneae, hs lets ateaest ko deweepng whch fe flonng? ‘A. Corea seohe ©. Game uler ©. Los oftone ase OO. tocar intarcton OE Seoandry dates metus ns '4,yearald woman cams othe oles eases ameneinea She tegan hap egUar menses? yer a an Na st mens pores was 9menns age. Fam rsa s uvemanabe. Labora stutes show an ness serum roacn ev, anarmal TSH ee and 20 ‘nacectbl ACS eancenraten. Serum cium ror. WA evels arm pear adenoma. The pater ehses modal and sueal therapy as shes hay about nethaing renseal eos. ie une, hs lets ataeaest riko deveeong whch fe felon? ‘A. Corea seo 12) ©. Gemeuler 2%) V6 Lossof bone mass (76) 2 0. toc ion ” E. Secondary diabetes metitus (7%) 2 oom a ee ecieae aren ~ Premenopausl women Ciponenoriealananouhea, Wily Glaaea, tical | not tases, decesced bone deny ‘eares. | + Posomencpausal wemen asst symptoms (heatace, sal el dees) + Man frit, deceased It, mpsierce,ayecamaess * Seum plan in “200 nan) eset: Sns nls outn rnory (nai) rye (yn ‘imaenanpamy earl Seed Aree reer ‘The patets anal pituitary adenoma ih a elevated postin vel and zncondry amanorhen onsite uth pon seceing acerca polsetinoma).Hih lela supra GOR acatn for Hypa, lading radiedsecretonofL (and 2 lesser eer FSH) and euteouet ypogonacam. Nereetlay nef) aderomss can locas il hyperplane due to pressure th tak, but thse uers rma cause masse symetons e,hypoptutarsn heaface, bemralhemianopi2 duo ressre on sureadng seers Esvogen maintains bone mats in pronsnopausl ween. Low estope lvl ado neased poten ofintanmaayeykres (especialy and nor necrosis factor-a), increasing expression of io recetr aca of ructa face kappa band (RANKL) ae resiing increased eects acrty. Loss of estogen wheter fem menozause, owt dsr ofsugkal renova ofthe oars, Ineeass ere benelos and enteoporesie (Ghote A) Adeneas re assocated wih tutor apace (Remorhage no tke pa). Hower hs eects mee commen wit a= seroma andl peal sede wih stokes betes he cat (Ghote B) Mutip enone neoplasia (MEN) ype 1 characteraed by puta aéeomss, hypaparahrokien, ad enocine mes of he parca. Goein secreting pancreatic turers are conronandmay lap recure pep ces Zlinge zon yee) Hove, aren “This parts sr par adenoma wih an elevated prolactin vlan secondary amenorha is consort wth pac seceing _aderama polstinoma). High ewes rion cupres GrAH secretion fo he hpatalarus, lead reves secretion ofLH (ad 98 loser eer FSS and supsaquet ypogonscsm. Nersetelty Cefn) ademas ean a caus i hyprpoacneni due Pressure one ta, but hese ers pana cause mas-fec Symes, RyppeuarsReatace,binprel ening) de fo pressure on sureasingceucues Esvogen maintains bone mass in prensnopassl wen. Low estoge vel ato eases protic othtanmaaycvkres (especialy and nor neces faco-apa), easing express of eee aca crue facta kappa 8 and [RANKL) ae resting nincessod seecas scot. Lose of stogen, whether fom menozais, owt dstnctin, oF sual renova fh ovens, Inceases trerskof boneless nd osteoporosis (ete A) Adenomes ar soca wih tut apepoe(hemorhage othe put). However ths ccc mae comment wih ge deren and iret Np associated wih svokos locaton reco (hoieeB) utp endoote neoplasia (MEN) ye 11 caracterzed by lay aéeomes,typetparayosn and endocsine umes prcess. Gast seeing pancreatic tuners ae conmonandmay lado recurer pep ers Zalinger son yee), Hwee, aes: pater wath MEN ype 1 have hyperparabyrsm wth hyperacema (oie D) any manopause ape 40) scot wh an intend rk of ardovacular events, bute elec ofteprlactnansinsiced low estogine sat on earoraeeat sein oer women urcear (Chote €) Excess gouinnarmane sein fom aSonatroph pay anor can la label eis due a eased nn ‘alae n peerless. However, ate pay preset wh 2), Edueatons objective: ypeprclacinema suppresses section of GnRH which ads to eauced estogenin women. Lon stopen ewes ae ak ctr or sccalate onoloes + Ther eszopena inpremonopausal women with vafous status, = Q zoomin Q zeomon reset Asstonew car | E > oe = Q zoomin Q zeomon reset Asstonew car | E > oe aren ‘rescue on sureundng seus Esvogen maitins bone mass nronsnopausl ween. Low esrege lvl ads nesses protucin otntanmsory eves (especialy ad nor necrosis facomaha), increasing ess of receptor acres face kappa 8 gan (RANKL) ae ‘esting mincemed enact acy. Laws feogen wheter menopaie, endo dancin or ugeal em the vais, ‘cesses eo onelos and exteoporosts (Ghote A) Adenoras associ wih tury apepeaChemorhage noth sian). Hower ths ecouts mae commen wit a= sera and set pea asscted wih stokes bead e cares. (Chote 8) Mutip enone neoplasia (MEN) ype 1's characterzed by puta aéenomss, hypaparahrokisn, ad enocine mes of he frceas.Gaetin secreting pancreatic turers are conmonandmay laoreet pep ces (Zlinge zon year). However, Aim! al pater a MEN ype * nave ryprarabyrodsm wen hypereacema {cnoieb) any menopause (one <0) associated wh em inctemed rt of andovascilar events, bth elect ote parame lowettgen tt on earareat atin ler werner ura (ChoieeB) Exess rourthhormona sertin fom a sonatoroph tut adoora can lado dab mei due ineo3sed un resstncsin peripheral esus, Howe, cits pica preset wih cre Educational objective: typeprlcinema suppresses section of GnRH, which eadstoecuced estogenin women. Low estogen lees are ask factor acre toneloss Reterneos + Therakot ostorenia msreenapasal trie th aro sles Pathopiysitony Entoctine,labetes 8 Netaboism Puta aderema ‘inet Sree Te @ zoomin Q zeomou rest aatronewcar | ns 3 ‘1a gis rg oe chy hr maar to cance taut ence weg ss, The pat i ot 4S (101) vere pas 2 ments, bur neks Se sil appears vente ans woes abou grin We. She Coes at use bao alee, ce ds. Hermener nas ypehyrsism. loo pressure 13070 nm Hg, and pues 15min androgusr. Thee sore omhsttc changes. Shs 22tg)n*. Onexarnnaon, te pat arpeat ansius. The hyd smal ard wit papaberedles. Theresa ine tenor fused tarde. Oesp tenon flees te 2+ any. The sin war rd ct Laban rn show decensed TSH, leva ee hymen (8), sndundeectablthyonuln lsh ote eon ost Hat be seen on yey eins sen? OA Oise avohy of te tid fetes win deceased eas B. Extesivehmphoctciniate wth genial certerfomaton © © infantry depton the oes and ruta int cali 1, Sal esters of spn as anon of Cea ypapaia Tal counma ft eptatan win scatoped argc he cl ‘1a gis rg oe chy hr maar to cance taut ence weg ss, The pat i ot 4S (101) vere pas 2 ments, bur neks Se sil appears vente ans woes abou grin We. She Coes at use bao alee, ce ds. Hermenerna pens Sloss presi «12070 nm Hp apes Smnansragiar Thee aera omhestte changes. Sie 22tg)n*. Onexarnnaon, te pat arpeat ansius. The hyd smal ard wit papaberedles. Theresa ine tenor fused tarde. Oesp tenon flees te 2+ any. The sin war rd ct Laban rn show decensed TSH, leva ee hymen (8), andurdeecabletvogebun eves. Which ote long mast aly be Seen an yl psy Ns patent? YA Oise ator othe trot ois wn deceased tod 4) 8B. Exteivehmphoctiniate wth geminal center fomaton (128) Cannan dariptonfthe alles and ulate incl (8%) 1. Sal ster of spn als non of ct pra 28) Tal couma tear eptetam win scatoped args he cal 36%) plostin ‘This parts symptoms (6, weight ss, ayes, and remo), seated fe Myronne (74, and soprossed TSH are indcsbe of ‘tyretoxeoss. Honeve: er tyros salad serum tyrepobulin is undetectable, wc svgess an exogeneusSouree of yok homone. Thyelabunisaghecerlan produced by thoi cas al mses up 2 tant component of ir cleansers asthe stereos tomato of yrcidhomone_ Aral aot ess by fe yo inne un, Low tvs 8 pte, Co “This patorts symtoms (en, wonht ss, acca, and roma), deve fe Byrosne (7, andsugossed TSH are indicabe of tyretxeoss, Honcre: er Byoiis salad serum thyrepobuin is undetectable, wc egess an exogenous souree of ck mone. Melanie agyoprtan produced by yoda cele a maces up a subtnta companert areal and srs ‘2sthe strate ore mato of yd hamane. Asal ant sessed by fe yoda un Low vel, 8 ns ptr, ‘suggest nnintanmatory supresson of thyred acy. nag ter momers hyper vein supgast a posse source eevcthyokne tabs. his patti aly surety tng yd namone pealy nan afta lose eit orhave creased energy. Exogeneus thyoscss can so ocr nates aig vee ‘cnurersupiements corti ania hres ann enone dosing ori epacesnt herapy Excess sppiementston ‘suppresses TSH hich decreases eine gancaan and cole oration resting atrophy of tyre oles (hele B) Histone ncroric adoinurs (Hashite) yi is charatarzed by ammonnucer irate caning of hphecys| ansplasma cos, fen wih anal corer. Hashimoto tyros peal reser mh prnay rpomadsm (vated TSH low eT) ands. (rein ¢) subacute randonatous (Se Guenainthyroi & charatrzed by drpion ffoldes anda mad clara wih ‘ccasonal mutnuceses gartcts. Paes nay have perros but ypcaly havea pee thyrod gare ad hich evel of (hyn dco detuctv ci, (noe D} Mec tyro canara newroendecne tira ares fom calor seria parsfalicia cls. cos5y shows ness or shes of pehperal or sprie-shaed ees wth extacellar aid deposi ved for clon) Clncaleatuesincloe lates fusing and tyridraddes, but TSH ee Te anormal (Gnoiee 8) Graves daze resorts wih 3 fussy anlaged Syed gard assorted with perros, xphhsins, a pra rmpedera. The rod lcs hem ta and cowded with peace reabsarton, causing sealopng around he ees ofthe cle However igh sun evs or yoni wal be een vets erased ys mabe educations objective: ‘ogous hypertyaida'schractrze by elevates te thynin (14) supresed TSH andSnwundeletatie gil ean occa wn surgi vctyxne suse, see arma seurced Myr suppeneis an eons sng Myo enlace Reapy. Ove Co Gmanicnee 8 Mk ent rer ‘A at-yearald woman epatences naisea addon gan, ard dz te undergo apn tedutan an na atone ate ‘rau One year go she was dagnsed wih s)temc pus enhematsus wih gent en matemert ard she has sine been an ‘rene gucocricod meray wi prednsone. The patent was marian on her sl daly dose of prednisone troughauthepaoperatie erat lord pressure 's$060 nm yas pues 120mm. Compare oe normal hysiiogeresorse suger, hs ates mes el ha whch fe flowng tes of hypasamc pi area es chy? ‘Conictropinraessng acm Cconiot a) Incresoed Deceased c sncresnas Deoasses Deveseea Oo oecreaset Deceseea Incest De Cccrasee Derenses Decensed — A ‘A at-yearald woman epatences naisea addon gan, ard dz te undergo apn tedutan an na atone ate ‘rau One year go she was dagnsed wih s)temc pus enhematsus wih gent en matemert ard she has sine been an ‘rene gucocricod meray wi prednsone. The patent was marian on her sl daly dose of prednisone troughauthepaoperatie erat lord pressure 's$060 nm yas pues 120mm. Compare oe normal hysiiogeresorse suger, hs ates mes el ha whch fe flowng tes of hypasamc pi area es chy? ‘Conictropinraessng ns) a) 28) « sncreseas (os) DOxcrasea ey VO Deceased (ow Deoasses Dereseed Deresea Deceased Deveseea Deveseed Seeaacorc, lot aren “This posers sufeing fon scuearenal insfcleney arena eri) dct tppresin ofthe hyo iian- aera (PA) longer gucoaicas meapy. Cucoconnd sipqess he syness an cease eocatopnfkaseg hamane CR) em e ypamatamus and alo toc s ACT shalt) elect a the arte pty, Log em suppression ads oavophy a ypabwlonc CR ‘asosng urns pian cece cls nd tn arama zon ean (ancrogen-rosueng er ne) ond 2en ees en Producing mite zone) ‘Chuo ucocoriad uses characze by low CRH, ACTH, and cris ees that eamet Hise in espns ses shuts ep, Intecions surgery (Chole A). The nk a sass ressose can eeu mreatieglusocortced elleney even wren ho paent's basing jucoeoncne egmenismartained. Because gucoarcods hep marta renal vascular oe (e, by increasing reeipegtie rer 2 angefensin ascent sch) gcscoriaid define an pecs ypotenionshock, In sch casa, higher stress doze needed compensa for Pe eased syslog demands and event Ne Gevopment fala css (Ghote B) nese levels of CRH and ACTH wih decreased cori cums! ira akealinsufieney. asmay be seen ausrmune erat orbital avena Yamermagowsaicen, These patens wil dso rave messi decency anda a vty High 6k (rote €) need Ct th deneasadleves of ACTH and cota ages! = pur cedar ACTHis sce carecboph calf the err puta, darage tothe pty by ane narcon or iecton can cause deceased rlase cf ACTH, uhh nn es 2 ‘decesced corel pod, ee ee ere eT eee eto snap espace [Educational objective: ‘Sipprsson oe ypiiarus putary areal ks by gusacetcld therapy ae mot canon cause of ena nitiancy, In tase Pes, anal ess can be preaptated by svessia Stuatense,Hecbes, sugary) fhe gucocaricol dose ot nto ppp, 1 Bierone experi nerdoenolgy. tonal rss Qzoonn Q zaman CZ racet GF rss tonew cad | besmg Cas Pre ‘A tou otis is stung te machanns sgl vansducioninohed he pamogenest ype 7 aad mains The ‘esearch focuses cn We acs alg caste at begs when nsun tres ote nul cele, Ina sens epee, hy \fenerstate nt re-renment wih or neces face eiph NF} resutsn decreased sunset cos pate, This ecto “TFs esi meciated tous ureguaton of hich fe olowig processes? ‘A. ic AUP hyetohzaton 5, Phoepessinsta caage ©. Pan asia hytos/on © 0 Seine reside posrhenaon OE Striatin of peroxisome preter activates recep aren ‘A tou otis is stung te machanns sgl vansducioninohed he pamogenest ype 7 aad mains The ‘esearch focuses cn We acs alg caste at begs when nsun tres ote nul cele, Ina sens epee, hy \fenerstate nt re-renment wih or neces face eiph NF} resutsn decreased sunset cos pate, This ecto “TFs esi meciated trough ureguaton of which fe lowing processes? A. Ocic AUP hytoyzabon 2%) 5. Phorpasoyinostl care (1%) ©. Pain sito hystowfation (6) YD. Satna reste phosthrfaton 31) . Simatonfperonisome prefer acraed cet (18) 2 ene UM 2c om aeres = Instn & glucose wanspor 2 Ss oy = ccamenn 8 Mek Translocation ofcLuTs OTIRS RASIVAP Kinase pathway | = ccamenn 8 YP Mek aren “The insu receptor (Rs a tevamerc since consisng of alpha nd 2 tea svbuws. The aba subunts ae extaceiaand roe the ‘ring te ferinain. The bly aunt re racellar an cortanfrerine Kinase ders hl ae achated when inde aaches othe pra swans sees af downstream signing then renee Sarin wth aloehesshryon ot R plasponfaen RSs 1 2n42 (S12, and uma, vandocaton of lucoseranspr-4 (GLUT) thecel manana ‘Tumar aces tc lpha (TNF) peatammaay cyt hat ues sun esistance ugh he aebatenoeene Knakes, ch nen shoagoryesene esiaes one beta subunits RandIRS-1. Th as yous phosphono F-1by and sueecuenty hinders somensim snag resutng nresacs othe renal ten tien. Phosphonsaon ef heonne esis na marc Catecaamins,gucooricis, and ucagen can ao incu sn resstance ty Ps same mechan. (choie A) Cyc ANP (CAMP) sinacvatd a yy ty pospodlesease.Phoschoesterase can hereby dampen ihe eects ‘areushamones og. ucaon) hat ce cAVE ata second messenger cANP sabia minelnrokes by pancreatic beta cle butt oeset priate mR downsteam sarang, (hoje B} Sem namenes (a, nase, enadaopn-siesn Homers) aon tansrenbrane recess could wih a Gx poten fat = ‘achat prosplrase , whch han deaves posprabyirsilithoschae te wo porta secorary Messengers: nostol WEho=Phe 2 andiocayer DAG) sto ipbosthate meats acen by neaing races cléurinx ard DAG activates oth Kase C > (hole €) Hyernprine a maj corgonet cf bos and sin calagen fomed bye hyoaaion of proline, whch requires amin: S Ins pays no rn be herniation of ron. ta (Chole) Peroismepifrtr actuated cpt ganmna (PPAR) as gene ans by bind othe promeerein ef aget = {gere8.Acbaten of PPAR esis in groves main eee 2 Edueatons objective: Phosphonlatn of ef and tveanne residues onl cept ad insulin recep substete by sete kinase ads osu eine, “Tse of hosphston can be nce by TNF catechciamnes, gcoarces, na ica + neinrisstane neues tineeneci actrapha n yoy and bron apace RC) ‘Tumor neces tat alpha (TNF) pentanmaarycykr hat ces sn sistance tough he acbaten of setine Kinases, wich thon sheaghonate seen resiies on teeta sibunts oR andi. Th nn yosns pepnennon oR hy and sbsenuenty hinders comsream sprang. resiteg inressince to he neal acters finsun. Posphoniaoneftivecnneescues as sa fe Catechtrines, gurseaticad, and guragan can azosndue ren recta ty te same mechan (Chole A) Osc ANP (CAMP) is achat va ys ty phesphotesirse.Phoschatestease can hrby danpan the fects of ‘eroushamones fa cago tat use cAVE as asecard messenger cANP is aa ines in inelnreease by pancetta cls butt oes nt pagate IR downstesm sarain, (hoiee 8) Some hemenes (a, angetersin I, oradorepnseasng homens) a on tansranbrane resco could with 3 Groton at sivas phosoelzase C, utc then dems posptabyinsitl ithosohae ino wo important secondary messengers: nest ehosphe| andaacigyeer (DAG) nesta uphosprae madates fs acten by neasng iacedaclcum mn 4 DXGacats pot nase C (Ghote ¢) Hycronproine amar coreonet of toe an skin calogen sees byte hon f pine whch requires Wain. Ins play nln he erin of oie. 7 (Ghote @) eros profi atiated eco ganma (PPAR) ata gene arson by bing othe rome eon of age cy eres Ativan of PAR ecusininprved sin ses » Educational objective: 2 Phosphoniatn of seine and tyeane esis of insuln receptr ad isin eestor subset by see ras ads sun estar, 22 “This tie of hospholsion can be inured by THF ctecsamines, groan glucan 2 References 22 + lnsuinressionce nde ter necoss aca-aphan myocytes and roan adpactes 2s Paopinsony Entoctin,labetes 8 Netaboism Diabetes retis le ‘inet Sree Toe 0 rss ran > ins -4.yearal revousy tatty rz comes ace due o wasenieg muss pan an weakness ove te past 6 mnths. Caryn neary "ems suchas ronereshas become nresingy eu ard any prolnged act causes fuse muse camps. Hees also has a4 549 ((o.b)wegn gan ouerns ine. The patertakes no miseaons and os notes esc, sleno. eit gs nea peesre 14000 | rm ad use is S0rin. BM is 25 kym®_ Physical examination sows muscle weakness pedoriary ef be sour and oes. hen the nee fers sci the quschceps muscle ceracs bl ut ization kes lege than normal Thre are pt ad peeing cf tmenais. Seum eatne erases vated Wht he alg ts us alt erat cass cf Ns patents muscle WeaNSS? OA 2a heuranay cso exretn -4.yearal revousy tatty rz comes ace due o wasenieg muss pan an weakness ove te past 6 mnths. Caryn neary ams suchas rocnes has become eres acu ard ay prlngedacoty causes ase muse aps. Hehas also had a4 5x9 ((o.b)wegn gan ouerns ine. The patertakes no miseaons and os notes esc, sleno. eit gs nea peesre 14000 | rm ad use is S0rin. BM is 25 kym®_ Physical examination sows muscle weakness pedoriary ef be sour and oes. hen the nee fers sci the quschceps muscle ceracs bl ut ization kes lege than normal Thre are pt ad peeing cf tmenais. Seum leatnekrasels vated Wachee alg ts mus alt erat ne cass Ns patents muscle WeaNSs? ‘A. Deu way creo extn (128) 8B. Acovehine receperanibody tes (108) ©. CTscanct the ches (5) 1D. mse psy 228) VY © Seu Tate on) | Pearestive proal maid weakness Inoveed | arcohy whoutpain Nomal myopathy [+ Lower enteity muscles mre inves * Muzzle pin tities shale neck ar amnion |" Ceoncorae seat a oneness 78 Inftammatory | + Proumal muscle weakness: x myopathies | + Skin rash & inflammatory arthritis. ; = lex vormcat | pssty oso * sary) Q a era ‘wes ane ar : — ° | tn + Wade pa aps & weakness vena Hypotnrotd | the proximal muscles Imyopaty | Daayed tendon eoces& yocdema + Feaures of payor ‘An elevated retin nae (CX) ero sues 2 myopatc poss myocyte damage ani eas of muscle erzymesino te Crain. Conmor causes of mropaty wih elevated CKinckde hypothyroid, musi dystoptes,ifarmatoy mace diseases, nd “This pasert' asue weight ain bradycarda_ a brie nals hay sages hypathyolé myopathy Cceased cd horas ‘An leaned creatine nase (CX) eve! sues a yopatc process th myocyte damage ani eease of muscle ereymesino te ‘resin. Connon causes of mopaty wih elewied CK nce hypoyred, muscu dyophes,farmsioy mesciedezsees, and ‘Thispaserts fave weight gain bradyeard, a bite nals hay suazesve ofhypathyrolé myopathy. Deceased ad horrre levels pak masse ghesgen and yeti use and cease ouate ess, esr A myecyieNAry. Pane yea rsens malgas prosmalrusce weacess, dexreaset recs nerace andcranpng Myoedema(oca muse caacten athe te! [eruenon and elaye relation of deoptncon esos are rete cng at ra caused by mpare rego calum by he srceplsicredum pata myopathy and elevations CK cane est sigs of hypo nd can precede et manfesttons by mort oye. “he eapraiscan ba corte wth a loated TSH lve. (rote A) £24 nou une const sed san tales fr Cushing syarome. Tis dsc can preset wn plat muscle ‘wees and opty dota he deck cable of corsa an skeletal uae. However, ae no aeocitd rcp arin CK, rots are noma andethercushnge fetes os, dorsocenca fay hyperphy) ar@usualy presen. (roies B and c)iyasbena yan caused atcarteodes aarst nxn ocectkne recep one possyapt membrae othe neurites incon proses wth cnntng wenkres at worsnethaugh he dy. Lamba Ean syndrome paraneapneie

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