2. • There is six classes of Graves' ophthalmopathy which is:
• I. Class one: spasm of upper lids with thyrotoxicosis.
• II. Class two: periorbital edema and chemosis.
• III. Class three: proptosis.
• IV. Class four: extraocular muscle involvement.
• V. Class five: corneal involvement.
• VI. Class six: loss of vision due to optic nerve
involvement.
3. • When you actually measure these thyro-globulins, in
thyroid cancer for example, it should be not present after
the treatment of surgery and ablation. Thus,
thyroglobulins are used as a marker later on.
4. • we suspect that the normal response of GH > 10ng/ml at
any time of the stimulation study means that we have
enough GH in the pituitary gland not deficiency.
5. • prolactin: usually clinically we don’t have to test for
prolactin deficiency but if you need to stimulate it you can
use TRH or metoclopramid.
Doubling of the base line means we have enough
prolaction.
• -TSH :stimulated by TRH , usually clinically we don't need
to stimulate this axis.
• - ACTH
• this axis is stimulated by Insulin Hypoglycemia Test or
direct by Short ACTH stimulation test, and we see the
response in the renal by having peak serum cortisol >20
mcg/dl.
6. we have GH excess. we try to suppress it, by
• - Glucose suppression test: we give glucose, glucose will
stimulate the insulin & will suppress the counterregulatory
hormone which GH is part of, so you suspect that the
normal response to glucose is suppression of GH. so if
there is no suppression of GH that means there is excess
GH.
• -another way is to check IGF-1 level if it increased then
we have acromegaly, which means that the substrate of
GH has been circulating for a long time.
7. -low ADH level (Central DI)
- high/normal ADH level but the kidneys
aren't responding well and this is called
Nephrogenic diabetes insipidus.
8.
9. Radioiodine
uptake (RAIU)
We don’t use this test in hypothyroidism
cases”
see how much of the dose we gave had
been utilized and taken up by the thyroid
and that make us think how the thyroid is
active
10. • Thyroid scan is only used for nodular disease---useful for
determining whether a nodule is hot or cold.
• RAIU produces a number, scan produces a picture.
11.
12. • stimulation or breast examination does not increase
prolactin levels in nonlactating women or in men .
Hyperaldosteronism: Causes:
- Adenoma (most common)
- Bilateral adrenal hyperplasia
- Adrenocortical carcinoma (rare)
13. • A dopamine agonist drug should usually be the first
treatment for patients with hyperprolactinemia of any
cause, including lactotroph adenomas (prolactinomas) of
all sizes, because these drugs decrease serum prolactin
concentrations and decrease the size of most lactotroph
adenomas
14.
15.
16.
17.
18.
19.
20.
21.
22. • Diabetes mellitus - The diagnosis of diabetes, based on one of
the following findings, must be confirmed on a subsequent day
by repeat measurement, repeating the same test for
confirmation. .FPG >=126 mg/dl (7.0 mmol/L) .A1C >=6.5
percent .Two-hour plasma glucose >=200 mg/dl (11.1 mmol/L)
in an OGTT .Random (or "casual") plasma glucose >=200
mg/dl (1 1.1 mmol/L) in the presence of symptoms
• The most common tests used to screen for type 2 diabetes are
measurement of fasting plasma glucose (FPG), two-hour
plasma glucose during an oral glucose tolerance test (2-h
OGTT), and glycated hemoglobin (A1C).
23.
24.
25. • eosinophilia as a consequence of cortisol deficiency.
• •Patients with adrenal insufficiency may go into crisis
when stressed by infection, trauma, or surgery
• The insulin–glucose tolerance test is the gold standard for
testing the entire hypothalamic-pituitary axis.
26. • Treatment of Addison in crisis includes : intravenous 5%
glucose with normal saline to correct volume depletion
and hypoglycemia and administration of corticosteroid
therapy.
• •Hydrocortisone usually is given intravenously at doses of
100 mg every 6 to 8 hours, or it can be given as a bolus
followed by a continuous infusion.
27.
28. • Normal thyroid cannot easily be palpated on physical
examination.
• As in all endocrine glands, the interstitium has a rich
vascular supply into which hormone is secreted.
