Chapter 1
Pathogenesis of Diabetes mellitus
PATHOGENESIS OF TYPE 1 DM
Relation of Insulin with body weight
Occur at Age-
B- cell mass at the time of diagnosis-
Concordance in identical twins -
body wt
PATHOGENESIS OF TYPE 1.5 DM
LADA -LATENT AUTOIMMUNE DIABETES OF ADULTS
If s
3 ÑEDM
TYPE 3
Rapid autoimmune
destruction B cells
of
iiiiiniii.im
Tee the hipogenesis
ee the weightgain
TYPE I
19.8.1am
Y inginsulin
LADA Slowversion
qt I Dm
Type II DM QOF TYPE Post
PATHOGENESIS 2 DM receptor signal defect
3591Sandeep smoker stress farily history of Type II DM
1 decline in post receptor signal
Bloodglucose
opening of GLUT 4 Level
So to compensate β cells will overwork
insulin secretion
Blood
will compensate Control the
Blood glucose level
more
fat synthesisType your tex
Body weight
aloud 45 years old
50
of
β cells will
Body wt
be exhausted
so there is compensatory work of β cell
PATHOGENESIS OF Maturity onset of diabetes (MODY)
slow gradual in glucose level
Type I MDM
Sensesglueinblood tosecreteinsulin
HNF-1-ALPHA
Blood totissues
Endoplasic reticulum
Inheritance pattern -
So
physiology kt inulin hates eachother
µAge of Of
Types. MODY
onset -
B-cell mass-
Rx-
BRONZE DIABETES surfaceofβ cells
Caused by -
Iron deposition - skin
- liver
- pancreas
So manifest as
Pyruvate
Summary
stops
extraca to
Type Of DM Pathogenesis
helppush
1
insulin out
1.5
Insulin Ky y
2
Mody
Bronze
Overall M/C type of DMto -
Overall
ca
is
most req
rare type ofout
DM-
insulin
the
push
Also know copent
Gene associated with insulin production - CTL4A
chromosome for MODY type 3- chromosome 12
MOD X
continues 3 generations
for
Chapter 2
Diabetes Presentation , diagnosis and Complications
C/f
Diagnosis
Normal Impaired glucose Diabete
tolerance
Fasting
Post prandial
HbA1C
Random
Post prandial means -
Best test for
HbA1C
Sugar level Sugar level
95 mg/dl 95 mg/dl
Hb - 15 gm/dl Hb - 5 gm/dl
Glycated albumin ( s. Fructosamine ) -
Shows average blood sugar of -
Oral glucose tolerance test (OGTT)
4pm 6pm
Extra point
Healthy So
4pm 6pm
DM So
4pm 6pm
Mechanism for Fasting hyperglycemia
healthy Meal
Fasting sugar at 8am
DM
Fasting sugar at 8am
7pm
Mechanism for Post prandial hyperglycemia.
healthy Meal
DM
Meal
Complication of DM
Myocardium
Brain
Earliest change Earliest change
Most specific change Most specific change
So retinal examination in type 1 DM.........................
and type 2 DM .............
Managment of DM
1- BIGUANIDES
MOA
Effect on Hb1aC
S/E -
C/I
2 - sulfonylurea - 1st generation
2nd generation
MOA
S/E
MOST POTENT
3- SGLT -2 inhibitors
SGLT2
Eg-
S/E
Preferred in
4 thiazolidinediones
MOA
S/E
5.Incretins
GLP(glucagon like peptide -1 ) analogue -
MOA
S/E-
DPP-4 INHIBITOR-
Most renal safe DPP-4 #-
6. Alpha- glucosidase inhibitor
Complex carbohydrate
Glucose
Other
Carbohydrate
Glucosidase
7. Amylin analogue
Gastric emptying
8.insulin
Basal insulin
Prandial insulin
Complication of insulin therapy
DAWN phenomenon
Gloucose
Level
Somogyi phenomenon
So in
Type 1 DM
Type 1.5 DM
Type 2 -
MODY
Summary
*Hb1ac shows average of - ........................weeks
2. Anemia leads to fasle ............ HB1ac
3. FALSE + OGTT --
4. FALSE - ve OGTT -
5. Fasting hyperglycemia in DM is due to ........
6.anti - diabetic to avoid
If -- DM + HF
-- DM + medullary ca of thyroid
-- DM + uti
-- DM +MI
7. Maximum Hb1AC reduction -
8. Longest acting insulin -
9. Dawn phenomenon - fasting .................................. Rx-
10. Somogyi phenomenon - fasting ........................... Rx-
Chapter 3
Diabetic keto acidosis (DKA) &
Hyperglycemic Hyperosmolar State (HHS)
DIABETIC KETO ACIDOSIS
Pathogensis
B- cell
Fatty acid
Blood
glucose
Tissue
C/f-
Investigation - blood glucose level-
- urine keton
- ABG - pH-
- S. Na+
Rx-
Complication
Initially Later
Hyperglycemic hyperosmolor state
Commonly seen with -
Age -
Pathogenesis
Blood osmolarity
Blood
C/f
Treatment
Summary
1. DKA commonly seen with type ...... DM and trigger is ......................../,..........,.....
2. M/C keton body synthesized in liver is -
3. Keton body having fruity smell-
4. Keton body can be detected by -
5. Main stay of rx in DKA-
6. ............................... insulin used in DKA managment .
7. MCC of death in DKA is .............
8. HHS seen with type .... DM in ..................... age group .
9. C/f of HHS - commonly - ...................................t manifestation .
10 . prognosis of HHS
Chapter 4
Thyroid Physiology
Thyroid gland
Cancer of parafollicular c cell is called
Pituitary
T4 v/s T3
Production
Activity
Half life
Convertion of T4 To T3
Brain
Effect of thyroxine
On α recpetor
On B- receptor
Metabolism
Bone
Testosteron
Thyroid FeedbBack system
Hypothalamus
Pituitary
Chapter 5
Interpretation of thyroid profile test
Hypothalamus
Pituitary
Hypothalamus
Pituitary
Hypothalamus
Pituitary
Hypothalamus
Pituitary
Hypothalamus
Pituitary
Lets practice
T4 TSH Diagnosis
Primary hyperthyroidism
Sick euthyroid syn
Chapter 6
Hypothyroidism & Hyperthyroidism
Hypothyroidism
Etiology
C/f. - Metabolism
Lipid level
Hair
Eyebrow
Skin-
Deep tendon reflex
Heart (ECG)-
GIT -
body temprature-
Menstrual bleed-
Rx-
Hyperthyroidism
Etiology
C/f. - Metabolism-
Skin-
Deep tendon reflex -
Heart - HR ........./ SBP ......../ ......CMP/.......... .............. murmur
Hands-
GIT -
body temprature-
Menstrual bleed-
Upper eye lid sign of hyperthyroidism
Managment of hyperthyroidism
Follicular cell Colloid
So
1. Thyroid peroxidase inhibitor -
2. Harmone release inhibitor -
3. Peripheral convertion inhibitor-
Chapter 7
RAIU & Thyroid disorders
Radioactive iodine uptake test (RAIU)
For RAIU - ................... ...... is used.
Mechanism of RAIU -
Thyroid Pathology
Hashimoto thyroiditis
Pathogenesis
Thyroglobin (TG)
Thyroid peroxidase (TPO)
Associated with -
C/f - initially -
- later. Stage (main) -
Increased risk of -
Biopsy -
Rx-
Subacute thyroiditis or dequervein thyroiditis
Pathogenesis
C/F - initially
- later
Rx-
Reidel thyroiditis
Pathogenesis
C/f-
Associated with -
Rx - for hypothyroidism
- to decrease fibrosis-
Grave disease
Pathogenesis
Immune
Pituitary system
TSH receptor
Associated with-
Rx
Toxic multinodular goiter
Pathogenesis
C/f
Rx
Thyroid storm
Pathogensis
C/f - HR -
BP -
Body temp. - Sensorium -
Rx-
Myxedema coma
Pathogenesis
Poe
C/f - HR -
BP-
Body temp.-
Sensorium - S.glucose............. S.Na +..............
Rx-
Extra point - Wolf- chaikoff effect
Jod basedow effect
Summary
1. More active .......... form .
2.more production of .............. form.
3. Calcitonin is secreted by ..................................................cell.
4.MCC of hypothyroidism .........
5. DTR - In hypothyroidism ..........
- in hyperthyroidism..........
6.upper rim of sclera is visible is called as .................................. sign.
7.thyroid peroxidase inhibitor drugs ........
8.most safe anti thyroid medication in pregnancy ................
9.RAIU in a) thyroiditis..............................
b) Grave disease ........./
10.hashimoto thyroiditis - HLA .................. // Anti ........... Ab
-Bx
11.viral illness f/b pain in neck (tender thyroid) - .......................
12.fibrosis of thyroid gland ............................. thyroiditis .
13. Excess Iodine leading to hypothyroidism -c/a- .............. ............. effect
14. Delibrate ingestion of thyroxine to loose wait c/a ............. ................
RA
RA
Chapter 8
Basics of Adrenal Gland
Medulla
Increase in Aldosteron -
Increase in Cortisol -
Increase in NE/E -
Slow (Gradual) decrease in all adrenal haromones -
Rapid (acute) decrease in all adrenal harmones -
RASS system (Renin - Angiotensin - Aldosteron-System)
Angiotensinogen
ENaC
Gain of ............ & .........
Blood
So loss of ........... & ...........
in urine
ALDOSTERON - leads to S.Na+ .........
S.K+........
S.H+........
Chapter 9
Hyperaldosteronism
Definition Aldosteron so - S.Na + ......... / S.K+............./ S.H+................
From zona ..................................... of adrenal gland.
Etiology
Definition -
1 hyperaldosteronism
2 hyperaldosteronism
Summary
1 hyperaldosteronism 2 hyperaldosteronism
Aldosterone
S.Na+
S.K+
Metabolic
HTN
Renin
Pedel edema
Rx
Chapter 10
Cushing Syndrome
DEFINITION - increase in ........
Pituitary
Cortisol
Level
Cortisol
Time
Etiopathogenesis
Pituitary
Iatrogenic Pituitary tumor Lung cancer
Cortisol
ACTH
Pigmentation
Headache
Hemoptysis
C/f
Blood sugar -
BP -
Work up Cushing suspected
1.Screening test of choice
2. IOC
To differentiate between iatrogenic v/s pitutory tumor / lung cancer
Managment-
1. Cortisol receptor antagonist-
2. Cortisol synthesis inhibitor -
3 .In Cushing Disease to decrease release of ACTH from pituitary
tumor -
Summary of cushing syndrome
1. M/C/C of cushing syndrom -
2. 2nd MCC of Cushing syndrome ............................. ..............c/a .......... ...............
3. earliest pathological change of cushing syndrome -
4. MC C/F -
5. Blood sugar ........................and BP.........................
6. pigmentation of skin is seen if cause of cushing syn is .........................
........................
7. Screening test of choice
8 IOC
9 To differentiate between pituitary adenoma v/s lung cancer -
Chapter 11
Pheochromocytoma
Definition- Tumor of .........................................found in ............
Etiopathogenesis
AORTA
........... % Pheochromocytoma are extra adrenal.
........... % Pheochromocytoma are Malignant .
........... % Pheochromocytoma are bilateral.
C/f - .............. activity of sympathetic system
...rec
....rec
....... metabolism so wt ......
Investigation -
screening test of choice
IOC-
For localization -
Rx
RxOC-
Summary of PCC
A/C/A -
RULE of 10
Rule of 5o -
Rule of 9-
M/C extra-adrenal site
M/C- c/f -
Screening test -
IOC -
RX - ......... blocker f/b .......... blocker .
Chapter 12
Adrenal Insufficiency
1 adrenal insufficiency
Etiopathogenesis
Z.glomerulosa
Z.fasiculata
Z.reticularis
M/C/C- worldwide-
- India
- HIV patients -
C/f - due to decrease in aldosterone - S.Na+......./ S.K+......../S.H+....
-due to decrease in cortisol -
-due to decrease in sex harmone -
-due to increase in ACTH -
IOC -
Rx. -DOC -
- For salt craving-
ACUTE ADRENAL INSUFFICIENCY
Pathogenesis
DOC
Glucagunoma - tumor of ......cell so ...................
C/f - blood sugar
- skin -
Gastrinoma/ zollinger elison syndome
Tumor or ...... cell. M/c site-
C/f-
Doc-
Multiple endocrine neoplasia (MEN)
MEN 1 MEN 4
overall mc enteropancreatic tumor
M/C pancreatic tumor
MEN 2A MEN 2B (MEN 3)
