cushing's syndrome

DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY Endocrinology Department Ministry of Health, Ukraine
CONCEPTUAL ENDOCRINOLOGY
Lviv - 2014 Methodical Guide of practical lessons for English speaking students of
medical faculty, fourth year of study / edited by prof. O. Kikhtyak, MD,
Ph.D., Dr. Sc (Med).. - Lviv, 2013. - 87 p.
Methodological materials were considered and confirmed by profile meeting
of the methodological committee in, the 25th of November, 2013 (protocol N
2). Authors:
O.P.Kikhtyak, MD, Ph.D., Dr. Sc (Med), professor;
O.V.Safonova, PhD, associate professor;
A.M.Urbanovich, PhD, associate professor. .
Editor-in-chief:
Deputy Rector of Studies, Prof. M. Gshegotskiy.
Reviewers:
Head of Internal Medicine Department #1 at Danylo Halitsky Lviv National
Medical University, academician of The National Academy of Science of
Ukraine, MD, professor O.O. Abrahamovich Contents |Introduction | |
|Part 1 | |
|(fourth year of study in "Basis of diagnosing, treatment, and | |
|prophylaxis | |
|of the main endocrine disorders") | |
|1.1. Classification of diabetes mellitus. Etiology, pathogenesis, | |
|clinical presentation, diagnostic tests of type 1 and type 2 diabetes | |
|mellitus. | |
|1.2. Type 1 Diabetes Mellitus. Modern treatment approach. | |
|1.3. Type 2 Diabetes Mellitus. Modern treatment approach. | |
|1.4. Diabetic acidosis, hyperosmolar coma, and lactic acidosis. | |
|Cardiovascular complications of diabetes mellitus. Diabetic neuropathy. | |
|Diabetic nephropathy. Diabetes and the eye. The diabetic foot. Diabetes | |
|mellitus and pregnancy. Gestational diabetes. Surgery in diabetic | |
|individuals. | |
|1.5. The iodine deficiency disorders. Hypothyroidism: classification, | |
|etiology, pathogenesis, clinical picture, laboratory diagnosis, therapy.| |
|Thyroiditis: classification, etiologies, pathogeneses, clinical | |
|presentation, laboratory evaluation, treatment approaches. Thyroid | |
|cancer: classification, etiology, diagnosis, treatment approach. | |
|1.6. Thyrotoxicosis: disorders that can it cause, clinical appearance, | |
|diagnosis, therapies. Thyroid storm. Hypoparathyroidism and | |
|hyperparathyroidism: clinical pictures, diagnostics, therapies. | |
|1.7. Primary adrenal insufficiency (Addison disease): etiology, | |
|pathogenesis, clinical presantation, diagnosis, therapy. Acute adrenal | |
|insufficiency. Itsenko-Cushing syndrome. Primary aldosteronism. | |
|Pheochromocytoma. |88 |
|1.8. Acromegaly and gigantism. Itsenko-Cushing disease. Diabetes | |
|insipidus. Prolactin and its disorders. Growth and development disorders| |
|in children and adolescents. Obesity. |88 |
|Part 2 |104 |
|(sixth year of study in "Endocrine emergencies") |112 |
| |121 |
|2.1. Chronic complications in Diabetes Mellitus. Hypoglycemic comma. | |
|2.2. Decompensation state in Diabetes Mellitus. Diabetic ketoacidosis. |137 |
|2.3. Thyroid goiter. Thyroid storm. |147 |
|2.4. Arterial hypertension in patients with endocrine pathology. Acute | |
|adrenal crisis. | |
|2.5. Metabolic syndrome | |
|Bibliography | |
Introduction Although every organ system secretes and responds to hormones (including
the brain, lungs, heart, intestine, skin, and the kidney), the clinical
specialty of endocrinology focuses primarily on the endocrine organs,
meaning the organs whose primary function is hormone secretion. These
organs include the pituitary, thyroid, adrenals, ovaries, testes, and
pancreas.
The medical specialty of endocrinology involves the diagnostic evaluation
of a wide variety of symptoms and variations and the long-term management
of disorders of deficiency or excess of one or more hormones.
The diagnosis and treatment of endocrine diseases are guided by laboratory
tests to a greater extent than for most specialties. Many diseases are
investigated through excitation/stimulation or inhibition/suppression
testing. This might involve injection with a stimulating agent to test the
function of an endocrine organ. Blood is then sampled to assess the changes
of the relevant hormones or metabolites. An endocrinologist needs extensive
knowledge of clinical chemistry and biochemistry to understand the uses and
limitations of the investigations.
A second important aspect of the practice of endocrinology is
distinguishing human variation from disease. Atypical patterns of physical
development and abnormal test results must be assessed as indicative of
disease or not. Diagnostic imaging of endocrine organs may reveal
incidental findings called incidentalomas, which may or may not represent
disease.
Endocrinology involves caring for the person biology as well as the nucleus
the enzymes as well as the disease. Most endocrine disorders area chronic
diseases that need life-long care. Some of the most common endocrine
diseases include diabetes mellitus, hypothyroidism and others. Care of
diabetes, obesity and other chronic diseases necessitates understanding the
patient at the personal and social level as well as the molecular, and the
physician-patient relationship can be an important therapeutic process.
Emergency medicines (also called emergentology) is a medical specialty in
which physicians (DOs and MDs) care for patients with acute illnesses or
injuries which require immediate medical attention. While not usually
providing long-term or continuing care, emergency medicine physicians
diagnose a variety of illnesses and undertake acute interventions to
resuscitate and stabilize patients. Emergency medicine physicians practice
in hospitalemergency departments, in pre-hospital settings via emergency
medical services, other locations where initial medical treatment of
illness takes place, and recently the intensive-care unit. Just as
clinicians operate by immediacy rules under large emergency systems,
emergency practitioners aim to diagnose emergent conditions and stabilize
the patient for definitive care.
Physicians specializing in emergency medicine in the some countries (for
instance US and Canada) can enter fellowships to receive credentials in
subspecialties. These are palliative medicine, critical care medicine,
medical toxicology, wilderness medicine, pediatricemergency medicine,
sports medicine, emergency medical services, and undersea and hyperbaric
medicine.
Endocrine emergencies represent a group of potentially life-threatening
conditions that are frequently overlooked, resulting in delays in both
diagnosis and treatment, factors that further contribute to their already
high associated mortality rates. As such, the true incidence of primary
endocrine emergencies is not well defined, which is likely because the
disease process is often not recognized. Although endocrine emergencies are
often encountered in patients with a known endocrinopathy, the emergency
may be the initial presentation in previously undiagnosed individuals. If
these endocrine disorders are not rapidly identified or if specific
treatment is delayed, significant complications or even death may occur.
English speaking students of medical faculty will be allowed to learn five
topics. The fifth one is dedicated to popular endocrine diagnose -
metabolic syndrome which is of course not a part of an endocrine
emergencies but usually accompany them as some scientists believe. Each practical lesson is organized in a certain way (table 1)
Table 1
Structure of the practical lesson
|N |Main stages of practical |Estimation |Facilities for |Duration |
| |lesson and tasks | |better study |in % |
|I Preliminary stage |
|1. |Previous learning |Oral quiz | | |
|2. |Acquired knowledge |Multiple choice |Tables, schemes, | |
|3. |Integration between |questions |graphs |10% |
| |disciplines | | | |
|II Main stage |
|4. |Formation of professional | | | |
| |skills in the clinical