Presentation is loading. Please wait.

Presentation is loading. Please wait.

24 VITILIGO VERSUS HYPERPIGMENTATION VITILIGO-30% AQUIRED THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO AUTOIMMUNE DISEASE-DM PERNICIOUS ANEMIA ADDISON.

Similar presentations


Presentation on theme: "24 VITILIGO VERSUS HYPERPIGMENTATION VITILIGO-30% AQUIRED THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO AUTOIMMUNE DISEASE-DM PERNICIOUS ANEMIA ADDISON."— Presentation transcript:

1 24 VITILIGO VERSUS HYPERPIGMENTATION VITILIGO-30% AQUIRED THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO AUTOIMMUNE DISEASE-DM PERNICIOUS ANEMIA ADDISON DISEASE- HYPERPIGMENTATION

2 25 DM-BP BP-120/80 ACE TARGET-CHF CRF

3 26 Hypercalcemia+malignancy 80%-MTS-bone destruction 20%-PTH like substation Most-ca of breast lung renal MM-lytic mts-hypercalcemia Most-paraneoplastyc syndrom Secondary hyperparathyroidism- hypocalcemia-hypephosphatemia-high pth

4 27 No family history of graves or hashimoto for ca of thyroid Solid nodules more malignant than cystyc Nodule hyperactive non malignant 70% pappilary cancer 15% follicular cancer 5% anaplastic 5% lymphoma Medullary carcinoma-0,5% Men 2-medullary cancer+pheochromacytoma Men 1- hyperparahyroidism+prolactinoma+glucagonoma Calcitonin-marker of thyroid cancer threatment

5 Dopamine lower prolactine level 28 Bromocriptin/dopamine agonist/ for microadenoma threatment Neuroleptics = high prolactine Only high doses of estrogen=high prolactine Microadenoma less 1 sm macroadenoma more then 1 sm Threatment- bromocriptine’surgery’radiotherapy’pergolide

6 Hyperthyroidism More female Graves d.-most common 90% before40 Ophtalmopathy,pretibial mixedema after therapy,vitiligo,gynecomasty,onycholysis thyroid enlarged +bruits Reversible cardiomyopathy Toxic multinodular goiter-elderly,long standing goiter,cardiovascular symptoms,weight loss,constipation,

7 HYPERTHYROIDISM Single hot-toxic nodule T3 high t4 high,threatment elthroxin anr then surgery Transient hyperthyroidism-subacute or After viral infection esr high,zahvat joda nizkij- Lymphatyc Hashimoto-female middle age antiperoxidase ab Subacute pospartum thyroidit –transient.mild,like hashimoto Subclinical hyperthyroidism-low tsh normal t4 t3

8 Hypethyroidism Goiterogenic medications-jod contrast,amiodaron,lithium Diagnostic-thyroid scan Lab-hypercalcemia,anemia,lymphocytosis,GOT GPT high Treatment-bb,methimasol,ptu Methimasol-agranulocitosis Elderly-ablation with radioactive jod,young-surgery Side effects-hypothyroidism,laryngeoparalysis Treatment of oftalmopathy-high doses iv steroids

9 hypothyroidism Female,most hashimoto,primary –thyroid function secondary-hypophisis function Severe-mixedema+cts+amenorrhea+hypotension Hdl-decrease ldl-increase Anemia normo-normo B12 def anemia Elthroxin-dexa Cabg-chf-severe cihd-not replacement of elthroxin

10 Diabetes insipidus Plasma osmolarity more 290—adh secretion— reabsorbtion of water rise--sensitivity H2O rise in distal canals Water diuresis/di/ versus solution diuresis/dm/ Water diuresis-low osmolarity of urine Nephrogenic di-lithium or amphotericin Di-high osmolarity of plasma

11 Addison disease Primary adrenocortical insufficiency 100%weakness,weight loss,hypotonia, Na low k high bun high ca high acth high Hyperpigmentation Causes-tb cancer Therapy if acute-iv hydrocortison

12 Conn’s syndrom Primary hyperaldosteronism Mineralcorticoids excess Weakness Hypertension Adenoma or hyperplasia Na high k low renin low High kalium in urine Treatment-surgery,spironolactone

13 hypoglycemia Whipple triade-glucose low 50 +neuroglycopenia/confusion,letargy,blurred vision/ +adrenogenic stimulation- anxiety,sweating,palpitation/+symptoms dissapearance with glucose level Normalization Thrue reactive hypoglycemia-after gastric surgery- not demping syndrome Non-isled cell tumors-hepatoma-insulin low c- peptide low Insulinoma-insuline high c-peptide high

14 DM DCCT-DIABETES CONTROL AND DIABETES COMPLICATION STUDY-TYPE 1-GLUCOSE CONTROLE LOWER MICROVASCULAR COMLICATIONS UKPDS-UNATED KINGDOM PROSPECTIVE DIABETES STUDY GLUCOSE CONTROLE LOWER NEPHROPATHY AND RETINOPATHY IGT -5% EVERY EAR-DM DRUGS-THIAZIDES BB ZYPREXA A-MIMETICS FENITOIN LADA-LATE AUTOIMUNE DIABETES OF ADULTS-AB TO INSULIN

15 Risk factors for dm Недостаточность упражнений Этнические –азиаты.эфиопы Вес при рождении более 4 кг Igt ifg Pregnancy diabetes Pco Htn Hdl 250

16 Metabolic syndrom x-syndrom Fg>110 Abdominal obesiry -102\88 Tg>150 hdl<40 htn >130\85 3 criterions

17 ACCORD –Action of Control Cardiovascular Risk in DM No significant decrease in cardiovascular events with intensive glucose control Trial ended after 3.5 years because of significant increase in death in intensive glucose control group

18 ADVANCE –Action in Diabetes and vascular disease Published NEJ of Medicine patients with DM type 2 There was no evidence that intensive glucose control reduce new retinopathy,nephropathy,polyneuropathy or risk of major cardiovascular events

19 Reduce Hb A1C to 1% Microvascular complication reduce to 37% MI risk less 14% All diabetes related complications 21% Amputation 47%

20 VADT INVESTIGATION- vascular complications in Veteran with type 2 DM Median Hb A1C in standard group 8.4% Median Hb A1C in intensive group 6.9% 1791 military veterans Median follow up 5.6 years No significant difference in retinopathy, neuropathy, nephropathy and major cardiovascular events

21 Сульфонуреа Глибенкламид – Глюбен - 5 мг Глипизид - Глюко Райт – 5 мг Глимеперид – Амарил -1, 2. 3 мг

22 Бигуанид Глюкофаж, Мерформин,Глюфор 850мг

23 Репаглинид Новонорм 0.5, 1, 2 мг

24 Инкретины GLP 1- Glucagon Like Peptide выделяется В тонком кишечнике Л клетками и стимулирует выброс инсулина на пищу -Подавляет секрецию глюкагона -Замедляет опорожнение желудка -Вызывает чувство сытости, меньше потребность в пище -уменьшает апоптоз в бета клетках

25 Баета – эксенатид и Виктоза -липаглутид Иньекции баеты дважды в день Первый месяц 5 мг дважды в день и далее по 10 мг Перерыв между первым и вторым уколом не менее 6 часов - Виктоза 6 мг – раз в день

26 GPP4 – энзим ди пептидил пептидаза 4 разрушает GLP 1 GPP4 inhibitor – sitagliptin- Januvia Таблетки 25, 50, 100 мг 25И 50 мг при почечной недостаточности -Metformin + Januvia = Januet Metformin500/50, 850/50, 1000/50

27 Розиглитазоны и пиоглитазоны Авандия, Россини 4, 8 мг –розиглитазон Новопиоглитазон


Download ppt "24 VITILIGO VERSUS HYPERPIGMENTATION VITILIGO-30% AQUIRED THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO AUTOIMMUNE DISEASE-DM PERNICIOUS ANEMIA ADDISON."

Similar presentations


Ads by Google