Professional Documents
Culture Documents
GH
1
-
20% GH
GH insulin induced hypoglycemia IGF-1 -
3 GH
stroke
GNRH arginine
GH -
-
-
-
2
-
200 -
100 -
stalk
20 -
sample falsely low 1000 Hook effect -
dilution
falsely elevated Macroprolactinemia -
-
3
functioning pituitary tumors 50% -
10/100,000 30/100,000 -
ACTH GH mixed tumors -
250 1:1 1 20 1 -
-
5% -
4
-
-
200 1
sella 100
MRI 2
MRI 1
2
Dopamine agonists -
20%
Cabergoline
D2 ▪
70-90% ▪
bromocriptine ▪
Bromocriptine
▪
▪
intra-vaginal ▪
GI ▪
▪
▪
▪
5% ▪
▪
▪
Invasive macroadenoma ▪
50% 20% 30%
-
3
15-30% 5% -
-
5
10 -
-
frontal bossing
gigantism
-
-
-
-
-
LVH CVS -
60% Sleep apnea -
-
1/3 -
stroke 3 -
10 -
IGF1 screening -
0.4 GH 75 OGTT -
25% -
-
15%
Somatostatin analouges -
▪
30% GI ▪
pasireotide ▪
Pegvisomant GH receptor antagonist -
lypodystrophy
-
GH
6
-
7
Diabetes insipidus
19:04 Sunday, 10 February 2019
1-2% -
-
50% -
8
DI 24 -
Primary polydipsia DI -
primary polydipsia DI
DI
plasma AVP 2
9
bright spot nephrogenic DI MRI 4
DDAVP -
Central DI -
SC IV DDAVP
V2 DDAVP
flow
Nephrogenic DI -
DDAVP 10
amiloride
indomethacin NSAIDS
30-70% 3
Primary polydipsia -
10
17:23 Friday, 1 February 2019
colloid follicles
Thyroglobulin
TSH TRH -
TSH LH, FSH, hCG TSH -
TSH TRH TRBeta2 (thyroid hormone receptor beta2) -
TSH -
iodinization Tg -
NIS -
-
Cretinism -
-
IQ -
150 -
NIS upregulation -
-
Wolff-Chaikoff effect -
escape -
-
SERM tamoxifen
TBG -
NSAIDS TBG -
unbound T4 unbound T3 unbound -
TSH hCG 1
TSH -
hyperemesis gravidarum -
-
TSH -
TBG 2
3
4
45% -
250 5
Deiodinases
T3 20 T4 -
T3 T4 -
Type 1 deiodinase
Type 2 deiodinase
T3 T4 -
T3 T4 -
propanolol PTU
reverse T3 T3 T4 Type 3 deiodinase -
sick euthyroid syndrome
Massive hemangioma
11
-
Pemberton's sign -
thyroglossal cyst -
-
TSH
unbound TSH -
unbound T4 -
unbound T4 TSH 2-5% T3 thyrotoxicosis
TSH -
TSH
Biotin
T4 TSH Secondary hypothyroidism
TSH ▪
fetal thyrotoxicosis
Serum Tg
thyrotoxicosis factitia -
-
anti Tg antibodies
Toxic MNG
-
3 -
90% -
hypoechoic
isoechoic 5-10% -
3% -
12
3% -
Spongiform
13
19:18 2016 20
-
-
Hashimoto -
-
Congenital hypothyroidism
1:4,000
-
-
-
4 -
T4 TSH -
TSH 14 T4 -
IQ -
3 -
Autoimmune thyroiditis
-
Hashimoto's
Atrophic thyroiditis
sub clinical hypothyroidism -
overt hypothyroidism 10 TSH -
14
overt hypothyroidism 10 TSH -
1000 1 1000 4 -
-
60 -
5% 3% subclinical -
TPO 4%
-
-
-
myxedema
nonpitting pretibial edema Puffy face
-
-
-
TRH
-
30%
sleep apnea
-
Carpal tunnel syndrome -
-
-
tendon reflexes Slow relaxation
15
tendon reflexes Slow relaxation
Myxedema coma
TPO antibodies Hashimoto encephalopathy
EEG
-
5% Thyroid ophthalmopathy -
RA SLE Type 1DM pernicoius anemia -
TSH -
primary T4 TSH
95% TPO ▪
TBII 20% ▪
T4 TSH
16
-
CK
US MNG -
Iatrogenic hypothyroidism -
sub-total thyroidectomy 3-4
TSH unbound T4
cretinism -
-
13%
-
30 100-150 1.6 -
-
TSH -
AF T4 -
TSH -
TSH 3-6 -
7 T4 -
TSH -
-
17
tyrosine kinase inhibitors PPI SERM
TSH>10
suggestive symptoms TPO
3 TSH subclinical -
25-50 -
TSH -
-
4
2.5 TSH
45%
12.5-25 20% -
-
Myxedema coma
20-40% -
TSH T4 -
-
-
-
-
MI
GI
Stroke
-
dilutional -
hyponatremia
-
1.6 200-400 levothyroxine IV
IV 25%
IV
8 2.5-10 5-20 liothyronine IV (T3) T3 T4
cardiovascular 30
collapse
6 50 IV hydrocortisone
water retention
18
18:23 Saturday, 2 February 2019
-
-
60-80% -
2% -
20-50 -
TSI -
TBII assay
TSI
TSI
80% -
anti TPO
anti Tg
-
T
IL-1 TNF IFNgamma
19
-
-
-
-
-
-
hypokalemic periodic paralysis -
-
SVT
pulse pressure
atrial fibrilation 50
▪
▪
onycholysis Palmar erythema -
40% -
steatorrhea -
-
20% -
firm 2-3 -
-
apathetic thyrotoxicosis
10%
TPO
75%
US CT
10%
EUGOGO NO SPECS
20
Thyroid dermopathy
5% -
pretibial myxedema -
-
orange skin indurated -
Thyroid acropathy
clubbing -
1% -
-
clubbing -
TSH -
borderline iodine intake 2-5% T3 T3 toxicosis -
T4 toxicosis -
-
MNG
destructive thyrotoxicosis factitious
thyroiditis
TPO TBII -
MRI CT TSH Secondary hyperthyroidism -
-
21
10-30% -
-
10-15 15% -
-
12-18 3-6
5%
-
1-2
-
-
Thionamides
Carbimazole Methimazole PTU -
-
TPO
thyroid antibodies
T3 T4 deiodination PTU
6-8 100-200 90 PTU -
8-12 10-20 6 -
titration regimn -
22
block-replace regimn -
4-6 -
unbound T4
6-8
TSH
-
12-18 30-60%
-
1-5%
-
PTU
▪
thyroid storm ▪
▪
PTU
Methimazole
drug induced lupus ANCA
1%
▪
Propanolol
6 20-40 -
T3 T4 -
1 -
thyrotoxic periodic paralysis -
-
fixed dose -
-
5-7 -
2-3 -
interval
thyrotoxic crisis 1
6-8 tapering 30
23
5
2% -
reference range T4
Thyroid storm
-
-
30% -
-
DKA stroke
PTU
4 250 500-1000 PZ PR PO IV ▪
T3 T4 ▪
6 SSKI 5 PTU
▪
wolff chaikoff effect ▪
4 IV 2 4 60-80 Propanolol
8 100 300
Cholestyramine
IV
-
-
100 selenium
corneal damage chemosis -
250 6 IV 500 pulse steroids
6 IV
Orbital decompression
24
Orbital decompression
-
rituximab external beam radiation -
-
octreotide -
Acute thyroiditis
-
piriform sinus fourth branchial pouch -
-
-
PMN FNA -
PCP -
-
-
25
-
T3 T4 0-6 1
6-12 2
12-18 3
-
-
FNA -
-
NSAIDs 4-6 600
TSH
-
15%
▪
TPO
-
Drug induced
tyrosine kinase inhibitors IFN-alpha -
-
anti TPO -
Chronic thyroiditis
Hashimoto -
Riedel's thyroiditis -
26
rec. painless
Laryngeal
FNA
compression
IgG-4 related Diseases
T3
reverse T3
low T4 syndrome -
T4 T3
T3 T4 type 3 deiodinase
T4 TBG
-
TBG total T3 T4
total + unbound T4
T3 T4 HIV
T3
rT3 -
-
-
27
18:01 2016 21
39% -
40 -
6 -
-
T3 T4 deiodinase activity
1
T4 -
Wolff Chaikoff effect -
-
deiodinase
rT3 T4 T3 20 TSH
TSH 3
13% 2
6% 13% -
Wolff Chaikoff effect -
anti TPO -
-
T4 TSH -
Type 1 AIT -
Nodular goiter pre-clinical graves
Jod Basedow effect
▪
6 200 potassium perchlorate ▪
Type 2 AIT -
28
Near total thyroidectomy -
-
-
-
-
-
-
-
QT -
CYP 450 -
Type 1 Type 2
Underlying thyroid disease Yes (Multinodular goiter, Grave s) No
Time after starting amiodarone Short (median 3 months) Long (median 30 months)
24-hour iodine uptake Low-Normal (may be high in iodine deficient Low to Suppressed
regions)
Thyroid Ultrasound Diffuse or Nodular Goiter may be present Normal or small gland
Vascularity on Echo-color Doppler Increased Absent
ultrasound
T4/T3 ratio Usually <4 Usually >4
TgAb / TPOAb/ TSI May be present Usually absent
Circulating interleukin-6 Normal to high Frequently markedly
elevated
29
12:31 2016 21
-
30 US -
1
TSH-R TSI -
TSH -
TSH -
5% endemic goiter
sporadic goiter
-
-
thoracic inlet
30
TSH -
3
3-7% -
US 50% -
1 US
-
Jod-basedow effect
50%
5% ▪
-
T4 T3 TSH
FNA -
▪
▪
3 75% ▪
31
▪
45 10% ▪
32
13:50 2016 21
-
-
-
65 20 -
MEN2 2 -
Cowden, polyposis, Carney
-
-
-
-
-
TSH -
33
34
80-85% Papillary -
orphan annie eye psammoma bodies
80%
1%
2 ▪
25-30% 2 ▪
5% Follicular -
capsular\vascular invasion FNA
CNS
hurthle cell histology 4 50
35
T1b 1 1
near total 4 1
thyroidectomy
near total thyroidectomy
4 ▪
▪
▪
vasuclar invasion ▪
US
TSH TSH suppression therapy 2
TSH 0.5-2
TSH 0.1-0.5
TSH< 0.1
3
4 ▪
▪
▪
▪
1-2 ▪
recombinant TSH TSH ▪
whole body scanning
serum thyroglobulin -
US -
WBS -
PET CT US Tg
-
stage IV -
-
36
-
-
immune check point inhibitors -
-
-
diffuse large cell lymphoma -
ATC small cell lung cancer -
-
-
5% -
US 50 50% -
-
TSH 1
TSH -
US TSH -
US 2
US 15% -
-
US FNA 3
1 -
size cut offs FNA -
US -
AUS\FLUS -
85% 10-30%
37
38
16:55 Friday, 18 January 2019
100,000 1-2 -
-
cushing disease 90% -
1 90%
MEN1
POMC ACTH EFG USP8
15% Ectopic ACTH -
carcinoid tumors
Small cell lung cancer
medullary thyroid carcinoma
-
11betaHSD2 -
-
FSH LH
TSH
-
easy bruising
1
39
ectopic ACTH -
VTE -
-
-
-
-
1
24 1
overnight dexamethasone 2
- false positive
rifampin CYP2A4 Inducers ▪
4-6 total cortisol ▪
diurnal variation 3
4 2 -
3
CT ACTH independent -
ACTH dependent -
MRI
40% ▪
T1 ▪
Ectopic ACTH pituitary Cushing 2
CRH test ▪
High dose DEX test ▪
IPSS
MRI inferior petrosal sampling ▪
IPSS ▪
IPSS ▪
Ectopic ACTH production
40
Ectopic ACTH production
high resolution CT ▪
T2 MRI ▪
octreotide ▪
chromogranin A ▪
-
ACTH Independent -
Cushing's disease -
70-80%
Ectopic ACTH -
2
▪
Bilateral adrenalectomy ▪
severe Cushing's -
6 500 11 beta hydroxylase Metyrapone
1200 200 Ketoconazole
adrenolytic agent Mitotan
11 beta hydroxylase Etomidate IV
41
11 beta hydroxylase Etomidate IV
SST5<SST2 Pasireotide 373
GI ▪
-
HPA
-
relapse -
80% Ectopic ACTH
40% adrenal's cushing
60% Cushing's disease
Nelson syndrome
-
ACTH -
-
42
10:52 2016 23
5-12% -
hypokalemic HTN -
1
bilateral micronodular hyperplasia
2 Conn's syndrome
GRA Glucocorticoid-remediable hyperaldosternism
ACTH crossover mutation
early onset HTN & strokes
Non aldosterone related 2
Cushing's syndrome
DOC Adrenocortical carcinoma
11-beta-HSD2 SAME
11-beta-HSD2
CAH
17 alpha hydroxylase 11beta hydroxylase
Deoxy-corticosterone (DOC)
MR Progesteron-induced HTN
Liddle's syndrome
ENAC
Hypokalemic HTN -
volume expansion ▪
▪
▪
▪
-
hydrogen depletion ENAC activity
tetany
43
tetany
-
Remodeling
2 -
Connshing syndrome mild autonomous cortisol access MACE -
40
3
ARR aldosterone-renin ratio 1
-
4
FN ACE\ARB FP
CT 3
5 CT -
-
AVS selective adrenal venous sampling -
CT ▪
40 ▪
Vena cava 3
2
GRA -
early onset HTN
44
adrenalectomy -
40
AVS
-
AVS CT
postsurgical hypoaldosteronism
- Spirinolactone
400 15-25
Eplerenone
200 25
5-10 Amiloride
GRA
45
46
11:59 2016 24
CT 2-5% -
70 7% 40 1% -
-
mild autonomous cortisol excess MACE -
1 -
1
CT 2
▪
60% 80% ▪
tumor density
47
tumor density
HU<10 ▪
HU>20 ACC ▪
▪
lobulated ▪
Intermediate MRI -
-
6-12
UH 10
CT FNA -
1
2
outcome 3
25% -
1-2 -
90% IGF2 overexpression 25% TP53 -
48
90% IGF2 overexpression 25% TP53 -
ACC 25% Li-Fraumeni syndrome -
FNA -
Weiss score -
60-70% -
GC
Mixed production
-
-
Ki67>10%
-
Mitotane -
8 ▪
Ki67>10% ▪
▪
▪
mitotane
GC
mitotane ▪
CYP3A4 ▪
CBG ▪
-
mitotane cisplatin etoposide Mitotane -
15 5 30-40% -
49
10:29 2016 24
10,000 5 -
10,000 3 Secondary adrenal insufficiency
10,000 2 Primary adrenal insufficiency
▪
CAH ▪
0.5-2% -
Addison's disease - -
isolated autoimmune adrenalitis 30-40%
APS Autoimmune polygalndular syndrome 60-70%
chronic mucocutaneous candidiasis 10% APS1 ▪
-
-
Sheehan's syndrome -
-
Isolated ACTH deficiency -
50
-
40% 80%
ACTH
-
SIADH ADH
51
bitemporal hemianopsia
ACTH Alabaster like paleness
GC
GC -
GC TSH
▪
central hypothyroidism TSH ▪
ACTH DHEAS
52
-
GC -
-
acute abdomen -
-
-
GC
adrenal crisis -
53
Adrenal crisis
1L\h
24 200 100
50
2-3 15-25 -
IV
50%
30
▪
▪
0.025 0.25 0.2 1
fludrocortisone 100-150 -
▪
▪
fludrocortisone 100 40 GC
DHEA 25-50 -
GC
premature ovarian failure -
-
54
13:03 2016 24
-
carotid body -
SDH NF1 VHL MEN2A/B 25-30% -
1 2-8 -
hypertensive patients 0.1% -
40 -
10% 10% 10% -
-
5%
hypertensive crisis
-
flushing
▪
▪
▪
▪
bladder pheochromocytomas ▪
TCA ▪
-
PTH
ACTH
EPO
24 -
fractioned metanephrines and catecholamines
assay 3
-
FP
FP
▪
55
▪
TCA ▪
FP -
MRI CT -
CT T2 MRI
adrenal incidentalomas 5%
MIBG -
PET DOPA -
-
160/90
volume constricted ▪
▪
prazosin / phentolamine
ACEI CCB
beta2 unopposed alpha ▪
-
intraoperative nitroprusside nitroprusside
-
5-10% -
-
-
-
-
MIBG nucler medicine therapy
thalidomide sunitinib
30-60% 5 -
15 -
RET MEN2B MEN2A -
MTC MEN2A
multiple mucosal neuromas MTC MEN2B
50% MEN MTC
MTC
PGLs Paraganglioma syndromes -
SDH
VHL -
clear cell RCC retinal and cerebellar hemangioblastomas
20-30%
1% NF1 -
NF1 RET, VHL, SHD -
56
MEN
9:41 Friday, 12 April 2019
MEN1 -
Pancreas Parathryoid Pituitary -
-
60% Pituitary -
90% Parathyroid -
4
20%
57
Sipple's syndrome MEN2
RET -
MEN2B MEN2A -
Medullary thyroid carcinoma -
MEN2
5-10%
RET
flushing
FNA US
TKR inhibitors
-
50%
RET 11-16 screeing
58
Autoimmune polyendocrine
Tuesday, 19 March 2019 11:03
59
10:30 Friday, 12 April 2019
-
wheezing 5HT
wheezing flushing
90-100% -
Midgut carcinoid
-
GI
80% Flushing -
flushing -
SSRI
-
30% -
200 5-HIAA
flushing
60
5-HIAA 24
L DOPA SSRI FP -
synonym -
flushing -
nicotinamide -
loperamide -
-
Pasireotide lanreotide octreotid
5-HIAA
carcinoid crisis
GI
-
Serotonine receptor antagonists
methylsergide 5HT1, 5HT2 receptor antagonists ▪
ondansetron 5HT3 receptor antagonists ▪
H1+H2 receptor blockers
telotristat tryptophan hydroxylase inhibitor
interferon alpha
hepatic artery embolization
61
11:43 2016 18
ESRD 1 -
-
7 -
-
-
HgA1C -
glucose intolerance -
HgA1C FPG
3 45 -
25 BMI -
pre-diabetes -
62
cAMP GIP GLP1 -
fasting level -
-
Alpha cells L cells -
T1DM
70-80% -
T1DM 30 5-10% 20 -
insulin deficient 1-2 honeymoon -
c peptide -
-
40-60% concordance
5-15% 3-4%
IL-2 PTPN22 CTLA-4 HLA DR3, DR4
T -
GAD, insulin Islet cell autoantibodies -
1 85%
15 80% 5 1 70%
5 1 50% 1 1 3-4%
GDM 5% 2 5-10%
-
63
T2DM
-
70-90% -
T2DM 40% -
obese 80% -
-
2 IL-6 CRP -
50% 2 -
GLP1 lipotoxicity glucose toxicity -
- -
-
IGT -
IFG overt diabetes -
10-20 T2DM 35-60% GDM -
-
-
5 Diabetes Prevention Program study
58% 2
31% -
pre-diabetes
35 BMI 60 IFG IGT
GDM
pre-diabetes -
64
65
14:42 2016 18
200 -
-
-
2 1 -
140-180 -
HgA1C
120 RBC 2-3 non-ezymatic glycation -
HgA1C 50% -
28 126 6 -
HgA1C -
0.4%
-
glycated albumin fructosamine -
6.5% HgA1C<7% -
8%
6% HgA1C
1
Intensive insulin therapy -
C peptide 1
66
amylin Pramlintide
-
2 1 -
-
30-60 15 1
120 60 2
-
-
-
HgA1C -
-
-
GI motility
hypoglycemia unawarness
CHF A1C
1-3% Medical nutrition
therapy + physical
activity
GFR<45 - GI - 1-2% -
GFR<45 - FPG
- -
(30 - B12 - cAMP
- -
-
CV -
-
-
-
- - 1-2% Insulin secretagogues SU
- - ATP K Glimepiride -
Glipizide -
- Glyburide -
-
67
-
acrabose ketoconazole
fluconazole
-
glyburide FPG -
GLP1
Pioglitazone -
Rosiglitazone -
CV
Canagliflozin -
68
type 2 DM
250-300 FPG
-
fasting hyperglycemia
NPH Glargine
basal bolus -
69
A1C -
DPP4 inhibitors
acrabose
SGLT2 inhibitors
-
TZD
SU -
-
-
canagliflozin empagliflozin SGLT2 inhibitors
GLP agonist liraglutide
TZD -
-
-
-
HgA1C -
-
140-180
110-140
Regular IV -
ICU
SC
1
insulin deficiency 2-4 SC IV -
Basal\bolus -
sliding scale
-
TPN
TPN IV -
SC total enteral nutrition -
-
steroid induced diabetes 5 -
200
2 GDM -
GDM -
-
HgA1C<6.5%
HgA1C
70
DKA HSS
19:54 Saturday, 18 May 2019
DKA
2 1 -
T1DM -
250
DKA
71
-
20 1-3 2-3
0.45%
▪
250-500 ▪
5% 250
3-5 24
-
0.1 0.1
0.02-0.1
2-4 IV basal bolus SC
-
5-5.2 20-40 IV
3.5
3.3
potassium phosphate\acetate
5.2
-
PH<7
▪
10 200 sodium bicarbonate 50
▪
7 PH ▪
1 -
DKA -
24 4 1-2 -
precipitating event 1% -
UGIB ARDS VTE -
-
72
HHS
-
2
oral intake
-
DKA -
15% -
DKA
-
MI
water intake
1000 -
350 -
Pre-renal azotemia -
-
-
-
2-3 0.9% 1-3
▪
0.45 % saline 150 ▪
▪
▪
9-10 ▪
200-300 D5W 0.45% ▪
1-2 9-10 ▪
-
-
-
-
-
0.1 IU/Kg IV
IV 0.1 IU/Kg/Hr
0.02-0.1 250
SC IV
73
74
14:07 Thursday, 7 February 2019
-
2 -
-
20-74 -
cotton wool spots blot hemorrhages nonproliferative -
vitreous hemorrhage Proliferative -
3 25% macular edema -
-
6-12 ▪
Laser coagulation
Fenofibrate
Anti VEGF therapy
75
20-40% -
-
diabetic nephropathy -
-
diabetic nephropathy
GFR GFR mesengial expansion GBM GFR glomerular hyperfiltration -
hyporeninism hypoaldosteronism Type IV renal tubular acidosis -
contrast induced nephropathy -
60 GFR Diabetic kidney disease -
-
140/90 ▪
130/80 ▪
CKD 130/80 CKD ▪
ARBS ACEi ▪
0.8
-
20 30 GFR
-
50% -
-
-
BMI
76
Distal symmetric polyneuropathy 1
Autonomic neuropathy 2
GI
GU
hyperhidrosis anhidrosis
hypoglycemia unawarness
Mononeuropathy 3
carpal tunnel
CN III
IV, VI, VII
Diabetic radiculopathy 4
diabetic amyotrophy
B12
TCA pregabalin dulexetin
GI\GU
-
▪
radiolabeled C labelled gastric emptying breath test ▪
-
1 -
-
-
10
PAD
Infected ulcer -
wound probe
debridement
arterial bypass
contact casting orthotic devices Off loading
77
contact casting orthotic devices Off loading
-
Rhinocerebral mucormycosis
Emphysematous cholecystitis
Emphysematous cystitis \ pyelonephritis
Malignant invasive otitis externa
TB S.aureus Pneumonia
-
Pigmented pretibial papules - diabetic skin spot -
78
19:50 Thursday, 15 February 2018
Whipple's
-
70 -
-
-
-
-
GH 4 prolonged hypoglycemia -
-
shift -
shift recurrent hypoglycemia -
-
-
TIA -
2 -
glinides Sulfonylurea -
-
140-180 -
2-3 hypoglycemia unawarness -
79
1
-
Insulin secretagogues -
-
glycogen depletion
Critical ilness 2
-
-
-
-
3
-
-
GH -
1
fasting hypoglycemia -
inappropriately normal C peptide -
IV -
critical sample -
C peptide
-
250,000 1
2 99% 90%
3 MEN1 50
C Peptide
70-80% MRI CT ▪
90% EUS ▪
50% ▪
▪
80
▪
US ▪
Diazoxide ▪
Octreotide ▪
Everolimus ▪
intra-gastric ▪
insulin receptor -
-
ectopic insulin secretion
gain of function
Sulfonylureas factitious 2
factitious disorder
C peptide
C peptide SU
SU
15-20 -
IV 25 -
1 IM glucagon -
1
2
SUs Octreotide -
-
81
11:14 Saturday, 9 February 2019
9-11 12 -
-
1
2
500 TGs -
-
-
1
-
-
-
-
Fibrates 2
PPRAalpha -
-
TG LPL
apoC-III
VLDL TG
-
severe hyper TG LDL
CKD
LDL-C -
-
Familial hypercholetaterolemia 1
LDL CVD 2
LDL 7.5% 10 CVD 40 CVD 3
CVD lifetime risk 4
-
-
-
LDL
82
▪ 5-10% HDL -
gemfibrozil
CK -
CK -
AST ALT
2-3 ▪
ULN 3 ▪
3 ▪
▪
2
60%
LDL
TG - - Bile acid
sequestran
- ts
ezetemibe (Resins)
- cholestyra
LDL upregulation mine
intolerance LDL colespitol
colesevela
m
injection site reaction - 50-60% LDL - - PSCK9 - PCSK9
Lp(a) - FH inhibitors
LDL receptor
ezetemibe LDL-R
-
2-4
LDL
- apheresis
PSCK9
inhibitors
200 LDL
160
300 LDL
FH
FH LDL -
PCSK9 -
LDL -
last resort -
83
84
18:21 2016 18
5 3
150 o
50 40 HDL o
85 130 o
100 o
88 102 o
85
11:27 Wednesday, June 1, 2016
PTH
MEN1, MEN2A PTHrP
1,25 (OH)2 D
Calcium overload
hyperparathyroidism -
-
Myeloma - lytic 90% -
12
GI -
PUD
-
Tertiary hyperparathyroidism Nephrogenic DI
Recurrent nephrolithiasis
TPN Nephrocalcinosis
-
Adrenal insufficency, pheochromocytoma
Osteitis fibrosa cystica
cancellous
-
Short QT AV
endothelial dysfunction LVH
11.6 -
12.8 -
14 Severe hypercalcemia -
primary hyperparathyroidism -
-
overt
-
-
-
-
-
hemoconcentration
FHH
Ca/Createnine clearance ratio <0.01 ▪
CaSR ▪
PTH -
PTHrP ▪
bone scan CT ▪
86
inappropriately normal PTH
1
1% 60 0.2% -
3-5 -
14
PTH -
-
-
-
-
CVS -
-
bone mineral density
PTH
Guidelines -
5-6
-
24
3-5
8 -
-
-
IV -
2-3 IV -
Lithium 2
10% -
-
-
CaSR -
PTH shift
PTH
PTH -
87
-
sensing -
inappropriately normal PTH
excessive reabsorption
PHT -
99% 99%
Uca+Pcr\Pca*Ucr<0.01
PTH-dependent
10
PHT PTH
family screening
CaSR FHH -
PTH
1
20% -
-
-
occult tumor -
2
MM
TNF IL-1 Osteoclast activating factor ▪
T cell lymphoma\leukemia
D 2
40,000-100,000 40-100 -
100 25OHD -
inappropriately normal -
-
D
100
TB 3
-
1-25OH2D -
-
bone turneover
A 4
dietary faddism
periosteal calcification A
A
5
Tertiary HPT Severe secondary HPT 1
2
CKD
D
Milk alkali syndrome 3
calcium carbonate
burnett's syndrome
renal calicum retention bicarbonate retention
Jansen's disease 6
PTH PTH -
-
-
12
13
88
13
-
24 4-6
-
extreme diuresis
-
-
6-12 2-8 IV\SC\IM
-
24
-
IV
multiple myeloma
increased bone turnover
24-48
60-90%
7 pamidronate
pamidronate sustained effect Zolendronate
▪
jaw necrosis ▪
MM ▪
Denosumab -
NFKappa B RANK RANKL
4 1,8,15,29 SC 120
-
3-7 40-60 IV 100-300
MM ▪
D ▪
A ▪
FHH CaSR ▪
ketoconazole -
89
11:24 Tuesday, 5 February 2019
-
D -
PTH
1
-
APS1
-
autosomal dominant hypocalcemia
G protein CaSR ▪
FHH ▪
Di George syndrome
2
PTH 0.8 -
PTH
-
alcohol abuse -
IV -
D
D -
D3 D2
24-hydroxylase -
-
D
-
VDR
▪
RANK ligand ▪
PTH ▪
▪
90
D
-
25% -
short bowel syndrome -
-
-
FGF23 -
-
D CYP450 anti-convulsant -
D Type II
Pseudo-hypoparathyroidism 3
-
-
PTH -
PTH overwhelmed
1
Osteitis fibrosa 2
-
-
twitching facial Chvostek's sign
circumoral
20 Trousseau's sign
3
Carpopedal spasm
QT
D
-
-
Rickets
-
ionized calcium -
PTH -
inappropriately normal
▪
▪
91
▪
secondary hyperparathyroidism
D ▪
▪
D -
50nmol\L 20ng\ml 25-OHD
bone turnover ALP
1-25 OHD
PTH D ▪
D ▪
1-25 OHD D ▪
-
1000-1500
40,000-120,000 D
D ▪
0.25-2 ▪
▪
urinary calcium reabsorption ▪
1,84 (Natpara) PTH
▪
▪
-
IV
D -
100,000 ▪
IV ▪
PTH 100-300
92
17:56 Monday, 8 April 2019
93
94
11:17 Sunday, 19 May 2019
1
PTH\PTHrP
FGF23
2
Shift 3
4
95
Tumor induced osteomalacia
FGF23 -
1,25 (OH)2D
PTH
96
PTH
-
-
Octreotide
nadir 1-2 ▪
cardiac dysfunction
rickets
IV 2 -
IV
6-12
1.5-2.5 -
octreotide Tumor induced osteomalacia -
1
PTH -
-
PTH -
Massive ECF phosphate load 2
97
Klotho
proximal tubule FGF23 co-receptor -
FGF23 Klotho inactivating -
PTH
-
tumor calcinosis
focal hyperostosis
-
tetany
-
Volume expansion -
-
Sevalamer
Aluminium hydroxide antacids
-
98
99
Refeeding
13:43 Tuesday, 9 April 2019
-
TPN 5
-
IV
Zinc
wet beri beri Acute thiamine deficiency
-
Redistributive hypophosphatemia
DKA -
IV -
-
-
EPO leukemia blast crisis -
D Paget -
-
-
100
18:10 2016 29
-2.5 -1 T score -
50%
BMD 10 FRAX score -
FRAX -
10 20% FRAX
10 3% FRAX
-
50
RANK RANKL -
RANKL Osteoprotegrein -
101
RANKL Osteoprotegrein -
Wnt pathway Sclerostin -
BMD screening
-
-1.5 T Score 70 65
-1.0 T Score 80 70
-
▪
▪
▪
102
-
24 -
75 30 25OHD level -
TSH -
-
▪
▪
▪
20-30% 1000-1200 ▪
▪
▪
1000-2000 D
-
1
-2.5 T Score 2
10 3% FRAX 10 20% FRAX 3
-
- FDA - PO Raloxifen SERM
DVT -
Stroke -
-
70 -
- - - Alendronate -
Esophageal irritation pyrophosphate (Fosalan)
- Risedronate -
steroid induced - (Actonel)
Zoledronic acid osteoporosis - Zoledronic acid -
2-3 zoledronic acid (Aclasta)
Zoledronic acid (Aclasta) - Ibandronate -
GFR<30-35 Renal toxicity 28% 15 5 IV -
103
50% ▪
▪
MRI ▪
5
-
ONJ - - Denosumab
Atypical femoral fracture fully human
D RANKL
Denosumab -
-
Rebound increase in bone turneover
- -
denosumab
- denosumab - Teriparatide PTH
18 osteogenic sarcoma - (Forteo)- 1,34 PTH
-
denosumab
-
Abaloparatide PTHrP
PTHrP
Romosozumab
Sclerotin
BMD -
6% 4% -
BMD -
30-40% -
Collagen C-telopeptide
osteocalcin P1NP
-
-
-
3 -
-
24 -
DXA BMD 3 -
spine 60
hip 60
D -
D3 1000 1200 -
-
-
-
104
alendronate recombinant PTH Teriparatide -
Denosumab -
105
12:00 Friday, 12 April 2019
-
-
Copper transporting ATPase ATP7B -
1% 30,000 1 -
-
hepatic decompensation
20
-
20
5 50%
-
sunflower cataract
Kayser-Fleischer
-
Fanconi's syndrome
serum ceruloplasmin -
90%
10%
KF rings -
99%
30-50%
24 -
50-75% -
Gold standard -
FP
106
-
pyridoxine penicillamine
Trientine
-
-
7 9 Nazer prognostic index
Trientine
-
Tetrathiomolybdate
trientine -
107
-
-
6-24
-
108
20:21 Friday, 12 April 2019
3-4
1.5 1
expression
40-60
Hepcidin
20
secondary iron overload -
ineffective erythropoesis
-
-
95%
HCC
30%
1
-
109
-
Bronzing
-
65%
Arthropathy -
25-50%
50
2,3 MCP
-
15%
10%
-
high index of suspicion -
-
-
-
-
MRI -
-
100 1-2 500
100
PO deferasirox IV deferoxamine -
110
PO deferasirox IV deferoxamine -
C -
End stage liver disease -
HCC
-
89% 33%
40%
111