the difference between Hashimoto encephalopathy and myxedema coma粘液水腫性昏睡は高度の甲状腺機能低下症の状態に感染・外傷などの誘因が加わって,低体温・呼吸不全・循環不全および中枢神経系機能障害をきたす病態である.一方,橋本脳症は自己免疫異常を基盤とし,抗NAE抗体と呼ばれる自己抗体が中枢神経系を傷害することで意識障害や精神症状をきたす疾患であり,甲状腺機能と関係なく発症することが注意点である.粘液水腫性昏睡は甲状腺ホルモンの補充で改善するのに対し,橋本脳症はステロイドが奏効する endocrinology国試過去3回 HirotoShishido
causes of primary hyperparathyroidismIncreased PTH secretion commonly due to parathyroid adenoma, lithium therapy;
less often due to parathyroid carcinoma or parathyroid hyperplasia endocrinologyUWorld step2CK HirotoShishido
management of DKA(During DKA, serum glucose exceeds the threshold for reabsorption by the kidneys, resulting in glucosuria and an osmotic diuresis.
→ This diuresis is accompanied by a net renal loss of potassium with depletion of total body potassium stores.)
Treatment involves gradual fluid repletion and insulin administration. Insulin promotes potassium redistribution to the intracellular fluid compartment. Therefore, intravenous fluids are ★supplemented with potassium to prevent hypokalemia. endocrinologyUWorld step2CK HirotoShishido
causes of hypokalemia・decreased intake
・intracellular translocation
insulin, β-adrenargic activity(dobutamine, ☆stress-induced(eg. alcohol withdrawal, acute MI)), alkalosis
・GI loss
diarrhea, vomiting, hyperaldosteroeism
・urinary loss
hyperaldosteroeism, diuretics, RTA (type Ⅰ, Ⅱ)
・sweat loss renalendocrinologyUWorld HirotoShishido
GI manifestations of diabetic autonomic neuropathygastroparesis, GERD, ☆diabetic diarrhea
Loss of autonomic input to the GI tract results in abnormal peristalsis, leading to ☆disordered small-bowel and colonic motility, which can result in rapid intestinal transport.
→painless, secretory-like diarrhea that persists with fasting(eg ☆nocturnal diarrhea)
Fecal incontinence is particularly common in patients with long-standing diabetes, resulting from both a large volume of watery diarrhea and decreased anorectal sensation. endocrinologygastrointestinalUWorld HirotoShishido
thyroid antibodies・thyrotropin(TSH) receptor antibody (TRAb) → highly sensitive(97%) and specific(99%) to Graves disease
・thyroid peroxidase (TPO) antibody
→ chronic lymphocytic (Hashimoto) disease, silent thyroiditis, postpartum thyroiditis, some patients with Graves disease
・thyroglobulin antibody → nonspecific (most common in autoimmune hypothyroidism)
・antibodies to thyroxine and trliodothyronine (anti-T4, T3)→ variety of autoimmune thyroid disorders, but are rare endocrinologyUWorld HirotoShishido
hyaline renal arteriosclerosisdeposition of eosinophilic hyaline material (☆homogenous, glassy material that stains pink with PAS stain) in the latima and media of small arteries and arterioles, which is characteristic ☆diabetes mellitus or poorly controlled hypertension renalendocrinologyUWorld HirotoShishido
Nelson's syndromeEnlargement of pre-existing ACTH-secreting pituitary adenoma after bilateral adrenalectomy for refractory Cushing disease(??)
↑ACTH (hyperpigmentation), mass effect (headaches, bitemporal hemianopia).
Nelson's syndrome was observed in 20-40% of patients who had a bilateral adrenalectomy with a pituitary adenoma. endocrinology HirotoShishido
diagnosis for Cushing syndromemeasure serum ACTH
if elevated, ACTH dependent Cushing syndrome