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24 VITILIGO VERSUS HYPERPIGMENTATION

24 VITILIGO VERSUS HYPERPIGMENTATION. VITILIGO-30% AQUIRED THYROID PATOLOGY MOSTLY THYROIDITIS HASHIMOTO AUTOIMMUNE DISEASE-DM PERNICIOUS ANEMIA ADDISON DISEASE- HYPERPIGMENTATION. 25. DM-BP BP-120/80 ACE TARGET-CHF CRF. 26. Hypercalcemia+malignancy 80%-MTS-bone destruction

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24 VITILIGO VERSUS HYPERPIGMENTATION

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  1. 24VITILIGO 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-lyticmts-hypercalcemia • Most-paraneoplastycsyndrom • 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 level28 • Bromocriptin/dopamine agonist/ for microadenomathreatment • Neuroleptics = high prolactine • Only high doses of estrogen=high prolactine • Microadenoma less 1 smmacroadenoma more then 1 sm • Threatment-bromocriptine’surgery’radiotherapy’pergolide

  6. Hyperthyroidism • More female • Graves d.-most common 90% before40 • Ophtalmopathy,pretibialmixedema after therapy,vitiligo,gynecomasty,onycholysis • thyroid enlarged +bruits • Reversible cardiomyopathy • Toxic multinodular goiter-elderly,long standing goiter,cardiovascularsymptoms,weightloss,constipation,

  7. HYPERTHYROIDISM • Single hot-toxic nodule • T3 high t4 high,threatmentelthroxinanr then surgery • Transient hyperthyroidism-subacute or After viral infection esr high ,zahvatjodanizkij- Lymphatyc Hashimoto-female middle age antiperoxidaseab Subacutepospartumthyroidit–transient.mild,like hashimoto Subclinical hyperthyroidism-low tsh normal t4 t3

  8. Hypethyroidism • Goiterogenic medications-jodcontrast,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,mosthashimoto ,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 • Nephrogenicdi-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 • Igtifg • Pregnancy diabetes • Pco • Htn • Hdl<35 tg>250

  16. Metabolic syndromx-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 12.06.08 NEJ of Medicine • 11 .400 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 • И 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

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