Diabetes high blood sugar (glucose) levels that result from defects in insulin secretion Hyperglycemia "sweet urine

Etiologic Classification of Diabetes Mellitus . Type 1 diabetes -cell destruction, usually leading to absolute insulin deficiency insulin-dependent diabetes or juvenile onset diabetes

genetic predisposition (1) Sensitive factor : HLA DR3, DR4, DR9, (2) Non Sensitive factor : HLA DR2

environmental factors Inflamation physical and environmental stress Drug- or chemical-induced

autoimmune factors

. Type 2 diabetes may range from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance non insulin-dependent diabetes or adult onset diabetes

. Other specific types of diabetes A. Genetic defects of -cell function characterized by mutations B. Genetic defects in insulin action C. Diseases of the exocrine pancreas

D. Endocrinopathies : acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma , somatostatinoma E. Drug- or chemical-induced F. Infections

G. Other genetic syndromes sometimes associated with diabetes : Down's syndrome, Klinefelter's syndrome, Turner's syndrome,

. Gestational diabetes mellitus (GDM)

Diagnosis of diabetes
Fasting plasma glucose (FPG) test , oral glucose tolerance test , random plasma glucose test(casual plasma glucose test)

Fasting plasma glucose test (FPG) The FPG test is the preferred test for diagnosing diabetes because of its convenience and low cost. However, it will miss some diabetes or prediabetes that can be found with the OGTT. The FPG test is most reliable when done in the morn-ing.

oral glucose tolerance test Research has shown that the OGTT is more sensitive than the FPG test for diagnosing prediabetes, but it is less convenient to administer. The OGTT requires fasting for at least 8 hours before the test. The plasma glucose level is measured immediately before and 2 hours after a person drinks a liquid containing 75 grams of glucose dissolved in water

random plasma glucose test

blood glucose level of 200 mg/dL or higher 200 mg/dL increased urination ,increased thirst, unexplained weight loss any time test The doctor will check the person's blood glucose level on another day using the FPG test or the OGTT to confirm the diagnosis.

Complications
Acute : diabetic ketoacidosis , hyperosmolar hyperglycemic nonketotic syndrome , hypoglycemia

chronic Microvascular Retinopathy-neovascularization Macular edema Cataracts Glaucoma Cerebrovascular disease Macrovascular Coronary artery disease Peripheral vascular disease Cerebrovascular disease Genitourinary

Neuropathy Sensory and motor

Autonomic neuropathy
Peripheral polyneuropathy Diabetic foot

Drugs Sulfonylureas , Meglitinide , -Glucosidase inhibitors

Metabolic syndrome Metabolic syndrome is a combination of medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes metabolic syndrome X, cardiometabolic syndrome, syndrome X, insulin resistance syndrome, Reaven's syndrome

Diabetic Ketoacidosis In the short term, consistent high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens because of a lack of glucose entering The cells where it can be used as energy. The body begins to use stores of fat as an alternative source of energy, and this in turn produces an acidic byproduct known as ketones.

Symptoms can include: Deep, rapid breathing , Dry skin and mouth, Flushed face ,

Nausea and vomiting ,

Stomach pain

Other symptoms that can occur include:

Abdominal pain, Breathing difficulty while lying down, Decreased appetite, Decreased consciousness,

Dulled senses that may worsen to a coma, Fatigue, Frequent urination or thirst that lasts for a day or more, Headache, Muscle stiffness or aches, Shortness of breath,

Exams and Tests The rise of blood sugar levels

blood ketone (+)

metabolic acidosis

Amylase blood test(-amylase, -amylase, amylase,)

Low level of amylase in the body is mostly resulted due to consumption of high amounts of carbohydrates. hyperamylasemia may be an indication of acute pancreatitis condition gastroenteritis, severe ulcer, gallbladder problems, intestinal blockage

Arterial blood gas Analysis (ABGA)

Ph 7.35~7.45 PCO2 35~45mmHg PO2 80~100mmHg HCO3 22~26mmEq/L

Blood glucose test, Blood pressure measurement, Magnesium blood test, Phosphorus blood test, Potassium blood test, Sodium blood test

Treatment
The goal of treatment is to correct the high blood sugar level with insulin. Insulin replacement, Fluid and electrolyte replacement,

Hypoglycemia
Hypoglycemia is the clinical syndrome that results from low blood sugar. The symptoms of hypoglycemia can vary from person to person, as can the severity. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range

symptoms nervousness, tremor, sweating, intense hunger, trembling, weakness, palpitations, trouble speaking.

symptoms progress
confusion, drowsiness, changes in behavior, coma, Seizure

1) Fastive hypoglycemia
A) Hyperinsulinemia (1) (2) (3) (4) (5) insulin response, overdose of sulfonylurea, autoimmune hypoglycemia, penta-induced hypoglycaemia, beta-cell tumors of the pancreas

B) No hyperinsulinemia (1) (2) (3) (4) (5) (6) (7) severe liver failure chronic renal failure extreme hunger, hypoglycemia in children Hypocortisolism Alcoholism hypoglycemia by extrapancreatic tumor congenital glucose abnormal metabolism

2) No Fastive hypoglycemia
A) abnormal of the digestive tract B) latent diabetes C) Alcohol D) Hereditary fructose intolerance E) Galactosemia G) diabetic motherss infants

treatment 4 teaspoons of sugar , juice , pice of fruit, Intravenous glucose, decreases dosage Sulfonyl urea

Hpoglycemic unawareness A situation in which the usual epinephrine-induced symptoms of a fall in blood sugar are, for a variety of reasons, either not felt or not recognized. This situation may be dangerous, as the patient may go from functioning normally to unconscious within a short time

spontaneous hypoglycemia A. FUNCTIONAL HYPOGLYCEMIAS 1. 2. 3. 4. 5. Functional hyperinsulinism, Hypoglycemia associated with mild diabetes mellitus, Acute alcoholism with starvation, Severe muscular exercise, Spontaneous hypoglycemia of infancy and childhood,

B. ORGANIC HYPOGLYCEMIAS
1. 2. 3. 4. 5. Pancreatic islet cell tumor, Hepatic disease, Anterior Pituitary type of hypoglycemia, Adrenocortical hypofunction, Central Nervous System diseases,

hyperthyroidism The term hyperthyroidism refers to any condition In which there is too much thyroid hormone produced in the body. In other words, the thyroid gland is overactive. Another term that you might hear for this problem is thyrotoxicosis, which refers to high thyroid hormone levels in the blood stream, irrespective of their source

cause Graves' disease, subacute thyroiditis , painless thyroditis, nodular toxic goiter, it occurs more often in young women

symptoms 1) nervous system: neural sensitivity, depression, anxiety, lack of concentration, ability to work and class sense , shakes 2) Cardiovascular: tachycardia, atrial fibrillation, cardiomegaly, congestive heart failure (high output failure), 3) Musculoskeletal: muscle atrophy and weak, Hypokalemia, hypercalcemia, hypercalciuria, no treatment of osteoporosis

4) Gastrointestinal: increased food intake, increased appetite, weight loss, increased defecation frequency of bowel movements , liver disorder 5) eye: eyelid retraction, external orbital edema, proptosis, ocular motility disturbance, diplopia, 6) Skin: warm, moist, sweaty palms, nails problem , edema

7) Reproductive System women: infertility, reduced menstrual flow male: sperm loss or impotence gynecomastia 8) metabolic: weight loss (more frequent in the elderly), hyperhidrosis , polydipsia

diagnosis
enlarged thyroid gland and a rapid pulse moist, smooth skin tremor of fingertips, eyes abnormalities

laboratory tests thyroxine (T4) triiodothyronine (T3) thyroid-stimulating hormone (TSH) thyroid scan

TREATMENT drugs antithyroid drugs (Thionamides) -adrenergic blockers ( Propranolol) Sodium ipodate , ipanoic acid adrenocortical steroid radioactive iodine therapy surgery

complication Thyroid storm

thyroid storm
dangerous state of thyrotoxicosis Risk factors: infection, surgery, trauma, hypoglycemia, childbirth, mental stress, cerebrovasculardisease, cardiovascular disease, diabetic ketoacidosis, radioactive iodine therapy,

Symptoms tachycardia, fever, agitation, anxiety, nausea, vomiting, diarrhea, coma,

treatment fluid and electrolyte supply, treatment of aggravating factors

antithyroid drug ,
Sodium ipodate, -adrenergic blockers (Propranolol), Corticosteroids

subacute thyroiditis Cause : A virus Symptoms fever, malaise, thyroid enlargement, pain and tenderness, sore throat , irregularly growing thyroid stiffness

lab test ESR increase, Negative antithyroid antibodies, Reduce of radioactive iodine uptake, treatment thyroid propranolol, aspirin

hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.

A. Primary hypothyroidism 1) goiter Autoimmune thyroiditis : painless thyroiditis, Hashimoto's thyroiditis

thyroid hormone production disorders : iodine deficiency, congenital thyroid hormone production disorders, dosage antithyroid drugs thyroid infiltration: amyloidosis, scleroderma
subacute thyroiditis

2)no goiter
autoimmune atrophic thyroiditis surgery (thyroid cancer, Graves' disease) thyroid hypoplasia

B Pituitary hypothyroidism( secondary) Pituitary tumors surgery, radiation therapy, Trauma, Sheehans syndrome

C hypothalamic hypothyroidism (Tertiary)

Trauma, Tumor, invasive lesion (sarcoidosis, histiocytosis)

frequency
Hashimoto's thyroiditis (70%), Graves' disease after treatment, Myxedema , painless thyroiditis , thyroid tumors after surgery

Symptoms and signs

1) nervous system: memory loss, depression, tingling hands and feet, loss of thinking skills 2) Cardiovascular: bradycardia, decreased cardiac output, decreased heart sound , pericardial effusion, edema, and cardiomegaly 3) Gastrointestinal: constipation, appeasement of nephropathy, pernicious anemia, ascites

4) renal system : hyponatremia, decreased GFR and renal blood , serum creatinine 5) Respiratory: hypoxia ,hypercapnia, pleural Effusion 6) Musculoskeletal: arthralgia, joint swelling, muscle spasms 7) Hematologic: Anemia (normocytic) 8) skin , hair : hyaluronic acid accumulation, facial swelling, skin dry and rough yellow discoloration of the hair, loss of eyebrows outside the 1/3

9) reproduction: menorrhagia, ovulation disorders, Hyperprolactinemia 10) Growth and Development: delay, growth hormone deficiency
11) metabolic: Hypothermia, hyperlipidemia, weight gain

Lab test primary hypothyroidism : FT4 , TSH

Pituitary hypothyroidism : FT4 , TSH or

hypothalamic hypothyroidism : FT4 , TSH or

tretment Thyroid hormone drug

Sodium levothyroxine, Synthetic triiodothyronine, Synthetic T4-T3 combination,

Myxedema coma Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood. Myxedema coma is considered a life-threatening complication of hypothyroidism and represents the far more serious side of the spectrum of thyroid disease

thyroid cancer Classification benign neoplasm :Thyroid adenoma, nodules malignant neoplasms: papillary thyroid cancer , follicular thyroid cancer , medullary thyroid cancer , anaplastic thyroid cancer, thyroid lymphomas women are more affected than men

nodular differential diagnosis test

Fine Needle Aspiration, FNA * , Fine Needle Aspiration Biopsy, FNAB * , Fine Needle Aspiration Cytology, FNAC ,

Thyroid adenoma
Pathophysiology and genetic background irradiation(external): the collapse of chromosomal gene rearrangements and defection of tumor suppressor genes The thyroid-stimulating hormone and growth factors tumorgenes and suppressor tumor genes of mutations

papillary thyroid cancer The most common thyroid cancer cytologic features: psammoma body, orphan-Annie nuclei eye" (empty or "ground glass") , intranuclear inclusion body , Papillary structure formation multiple metastases to the thyroid gland within the thyroid capsule and the main Involvement of all structures transition: lung, bone, brain

Follicular thyroid cancer

development at iodine deficiency area difficulty of diagnosis by fine needle aspiration cytology Transition: blood (bones, lungs, central nervous system)

Follicular thyroid cancer is poor prognosis than papillary carcinoma.

medullary thyroid carcinoma This cancer has a much lower cure rate than does the welldifferentiated thyroid cancers (papillary and follicular) parafollicular C cell Calcitonin More common in females than males Regional metastases occurs early in the disease (liver, bone, brain, and adrenal medulla)

Anaplastic thyroid carcinoma Anaplastic thyroid carcinoma is one of the most aggressive human malignancies. It is a rare malignancy. Anaplastic thyroid carcinoma is formed from differentiation cancer metastasis: lung , bone , brain, gastrointestinal tract Microscopically: spindle cell, giant cell, squamoid cell

thyroid lymphomas classification non Hodgkin lymphomas (NHL) of the B and T cell types Mucosa-associated lymphoid tissue (MALT) most common location is the mucosa of the gastrointestinal tract. However, they may also occur in the lungs, salivary glands, skin, subcutaneous tissue More common in females than males