---------------------------------------------------------------最新资料推荐------------------------------------------------------(临床助理专业综合部分)——内分泌系统（(Clinical Assistant General Section)(临床助理专业综合部分)内分泌系统（(Clinical Assistant General Section) - endocrine system） (临床助理专业综合部分)内分泌系统（(Clinical Assistant General Section) - endocrine system） endocrine system Endocrine and metabolic diseases The diagnosis of endocrinopathy includes three aspects: (1) qualitative diagnosis; pathological location diagnosis; etiological diagnosis. Among them, functional qualitative diagnosis (2006) includes: (1) clinical: medical history, symptoms and signs. (2) laboratory examination: metabolic disorder, blood sugar, blood electrolyte, blood lipid, etc.. Hormone secretion state (2003): T3, T4, cortisol and so on. Endocrine dynamic function test: TRH stimulation test and DXM suppression test. Hypopituitarism 1.: the primary cause is the most common cause of pituitary tumor infiltration and near compression (2019/2004); the most common etiology of pituitary stalk is secondary to various causes damage, such as surgery, radiotherapy and trauma of the sellar region (2003). 2. clinical manifestation: (1) gonadotropin and prolactin were the earliest manifestations of sexuality, hypoplasia or1 / 10degeneration (2019), postpartum no milk, amenorrhea (2019), infertility, male impotence, etc.. (2) ACTH deficiency: secondary adrenal cortical hypofunction. (3) TSH deficiency leads to secondary hypothyroidism. (4) hypopituitarism crisis: the most important manifestation is hypoglycemia (2007). 1. Sheehan syndrome (Shee-han) (2004/2006): pituitary hyperplasia and hypertrophy of pregnancy, abundant blood supply, if the perinatal period for placenta previa, placental abruption, retained placenta, uterine atony caused by bleeding, shock, thrombosis. Make the most of pituitary necrosis and fibrosis, clinical called Sheehan syndrome (Shee-han). Hyperthyroidism Hyperthyroidism, referred to as hyperthyroidism, is a group of common endocrine diseases caused by a variety of causes of excessive thyroid hormone secretion. 1. clinical manifestation: Typical signs are diffuse and symmetrical enlargement of the thyroid gland, which may have tremor or vascular murmur, which is of diagnostic value (2019). 2. laboratory examination: the thyroid hormone examination is the most reliable examination for the diagnosis of hyperthyroidism (2019/2003/2004/2005/2006). 3. treatment: hyperthyroidism treatment is a comprehensive treatment. /fudao (1) calm, rest, and---------------------------------------------------------------最新资料推荐------------------------------------------------------ replenish enough calories and nutrients. (2) using antithyroid drugs, the treatment mechanism is to inhibit the synthesis of thyroid hormone (2004). Commonly used drugs 6-methyl-2-thiouracil (MTU) and propylthiouracil (PTU) and methimazole (MM, methimazole) and carbimazole (CMZ, Jia Kangping). Indications: mild disease, thyroid gland is small; the age below 20 years old, pregnant women (2007) with severe lesions or difficult surgery; the subtotal thyroidectomy preoperative preparation; adjuvant therapy before and after the 131 of the radiation treatment. Adverse reactions: mainly the decrease or lack of granulocytes (2003), WBC below 3 x 109 / L, or neutrophil below 1.5 x 109 / L, should be discontinued treatment; drug eruption is more common, antihistamines control, do not have to stop the drug. (3) iodine: it is only used in two cases: preparation before thyroid surgery (2007) and rescue of hyperthyroidism crisis. Simple goiter 1. causes: soil water food iodine in low endemic goiter is caused by the most common cause (2019). 2. clinical manifestations: except for goiter, there are usually no other symptoms (2019). Mild or moderate diffuse goiter, soft texture, no tenderness.3. diagnosis: the main basis is goiter, and its function is3 / 10basically normal (2006). The blood T4 and T3 were normal or high; the rate of 131I uptake by thyroid increased mostly, but the peak was not inhibited by T3. The radionuclide scan of nodular goiter could be a warm nodule or cold nodule. The prevalence of endemic goiter in the region is helpful for the diagnosis of this disease (2019). Diabetes Diabetes mellitus is a common endocrine metabolic disease. Is due to absolute or relative deficiency of insulin (2019) caused by sugar, fat, protein and water and electrolyte metabolism following. 1. typing Table 5-39 classification of diabetes mellitus project Type 1 diabetes mellitus Type 2 diabetes mellitus (2019/2003/2004) Pathogeny Pancreatic islet B cells damage and cause an absolute lack of insulin Mainly with insulin resistance accompanied by insufficient insulin secretion Crowd More common among adolescents More common in adults Clinical features Acute onset, metabolic disorder, obvious symptoms, patients need to inject insulin to maintain life, tend to have ketoacidosis Most of the patients are overweight or obese, and they do not need insulin treatment at the early stage of the disease or even for life, and tend to have no tendency to ketoacidosis 4. laboratory examination and its diagnostic significance: (1): positive urine urine is an---------------------------------------------------------------最新资料推荐------------------------------------------------------ important clue to the diagnosis of diabetes, but not diagnosis.(2) blood sugar: fasting and postprandial blood sugar elevation (2019/2019) is the first choice for the diagnosis of this disease, which can monitor the disease control. /fudao (3) oral glucose tolerance test (2019): for suspected diabetes mellitus, fasting or postprandial blood glucose levels are higher than normal, but the diagnostic criteria for diabetes should not be carried out. OGTT should be done early in the morning and fasted for at least 8 hours. WHO recommend adult oral glucose 75g (2005), dissolve in 250 ~ 300ml water, drink in 5 minutes, and then test the plasma glucose after 2 hours. Children according to 1.75g per kilogram body weight, the total amount does not exceed 75g. (4) glycosylated hemoglobin reflects the comprehensive level of blood glucose in the last 2~3 weeks (2019), which can make up for the shortage of blood glucose measurement which reflects only the instantaneous blood sugar value, and is an important indicator to monitor the condition of diabetes. (5) insulin release test: it is helpful to classify diabetes mellitus (2019). 5. acute diabetic complications Insulin therapy: a small dose of insulin should5 / 10be followed by intravenous infusion of the drug (2007) (2) hyperosmolar nonketotic diabetic coma: Clinical manifestations: most of the patients were in the middle and old age group of 50~70 years old. Most patients had no history of diabetes or only mild diabetes symptoms. The laboratory examination showed a marked increase in blood glucose, usually 33.3mmol / L (600mg / dl), the increase of serum sodium reached 155mmol / L, and the osmotic pressure of plasma increased significantly, generally 350mmol / L. Strong positive urine, but without ketosis or lighter. (2019) 7. chronic diabetic complications (1): large artery atherosclerosis mainly aorta coronary artery and cerebral artery, renal artery; limb peripheral artery following limb artery mainly manifested as lower extremity pain, paresthesia and intermittent claudication. (2) microvascular disease: diabetic nephropathy (2019/2019/2007) syndrome, proteinuria, edema, hypertension, nephrotic syndrome; diabetic retinopathy, which can cause proliferative retinal detachment is a major cause of blindness in diabetes mellitus. (3): peripheral nerve neuropathy (2019/2004), see more performance for symmetry, lower than that of the upper limb, first acroparesthesia, gloves, socks like distribution, may be associated with---------------------------------------------------------------最新资料推荐------------------------------------------------------ hyperalgesia. Then there is pain. Finally, the motor nerve was involved and the muscle tension decreased. 8. treatment (1) diet therapy (2019): diet treatment is the basic measure of diabetes treatment, and needs long-term strict implementation.(2) oral hypoglycemic agents: oral antidiabetic drugs should be used in patients with type 2 diabetes who can not be controlled by dietary therapy. Sulfonylurea (2003): this kind of medicine directly stimulates insulin B cells to release insulin, which is suitable for non obese type 2 diabetes mellitus. With this kind of medicine, special attention should be paid to severe hypoglycemia adverse reactions (2005/2006). The biguanide drugs: promote peripheral tissue glucose uptake and inhibition of gluconeogenesis, inhibit or delay in glucose absorption in the gastrointestinal tract, mainly suitable for obese or overweight patients with type 2 diabetes, commonly used drugs for metformin (2003/2007). Lactic acidosis is easily induced by hepatic or renal dysfunction and hypoxia (2005). Insulin sensitizer: used mainly for type 2 diabetes mellitus with poor efficacy of other antidiabetic agents, especially those with insulin resistance (2007). The main drugs are rosiglitazone, pioglitazone and so on.7 / 10/fudao The above hypoglycemic drugs in the single application can not achieve the purpose of treatment, or clinical can not use insulin treatment (2006), may consider the combination of medication. The combined use of small doses could also reduce the side effects of the drugs (2019). (4) indications for insulin therapy (2019/2019/2004): Type 1 diabetes mellitus (2019/2019). Type 2 diabetes mellitus has not been well controlled by strict diet control and oral hypoglycemic agents. Ketoacidosis or hyperosmolar nonketotic coma occurred in any type of diabetes. Gestational diabetes mellitus and diabetes mellitus combined with pregnancy and delivery. Severe infection, consumptive diseases, retinopathy, kidney disease, acute myocardial infarction, cerebrovascular accident, etc.. The perioperative period (2005). The whole pancreas resection caused by secondary diabetes. Surgical treatment of hyperthyroidism 1. categories: according to the causes of hyperthyroidism can be divided into primary, secondary and high functional adenoma three categories. (1) primary hyperthyroidism: the most common (2004), more common in women aged 20~40. 2. surgical treatment of hyperthyroidism: subtotal thyroidectomy for moderate is still the most common---------------------------------------------------------------最新资料推荐------------------------------------------------------ and effective treatment, can make 90% to 95% (2007) of the hyperthyroidism was recovered, the disadvantage is that there are certain complications and recurrence. 3. preoperative preparation The commonly used preparation is compound iodine solution (Lu Geye) (2006), Can operation indicators: the patient emotional stability, improved sleep, increased body weight; pulse rate less than 90 BPM (2003); basal metabolic rate is less than +20%; thyroid gland harden shrink. 4. postoperative complications and Prevention (1) dyspnea and asphyxia: treatment: removal of incision sutures, removal of hematoma (2006). (2) hand foot convulsion: treatment: intravenous injection of 10% calcium gluconate (2004). Two thyroid carcinoma According to the pathological types of thyroid carcinoma, thyroid carcinoma can be divided into papillary carcinoma, follicular adenocarcinoma, undifferentiated carcinoma and medullary carcinoma. The clinical features and treatment principles can be listed as follows: /fudao Table 6-11 pathological types of thyroid carcinoma according to tumor Papillary adenocarcinoma Follicular adenocarcinoma Medullary carcinoma Undifferentiated carcinoma Age 30~45 years old About 509 / 10years old middle age old age Gender Women are more common More women Male and female alike Male and female alike Transfer pathway lymph Blood circulation is the main factor Lymph and blood flow Lymph and blood flow Malignancy Low moderate moderate height Clinical manifestation A solitary mass characterized by rigidity, irregularity, and limited motion, and symptoms of compression of the trachea and esophagus in the later stage (2006) The mass is hard and the border is not clear, and it develops very fast A family history that produces calcitonin and has low calcium levels Extensive invasion, rapid growth, and even the first neck and lung metastasis Treatment Radical operation Operation and radiotherapy Operation radiotherapy prognosis good Poor Fair range。
