Endocrine

Endocrine Dr.
Abo El - Asrar
endocrine
clinical cretinism written endocrine 100 % Nearly endocrine diabetes stature thyroid gonadal organs growth and development gonadal disorder endocrine thyroid stature disorder diabetes puberty diabetes
Diabetes
diabetes is a common disease all over the world diabetes family family
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Endocrine Dr. Abo El - Asrar
Medical consultant
diabetes diabetes
: diabetes
Primary Secondary primary
Primary diabetes Type one Type two type two type one
type one diabetes
deficiency of insulin deficiency of insulin Partial complete type one
Metabolism
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insulin dependent diabetes mellitus
Oral hypoglycemic
Most common type juvenile diabetes
Type one diabetes insulin dependent diabetes mellitus Juvenile diabetes
Most common type stress type two Insulin resistance
receptors
Insulin resistance
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Insulin
Insulin resistance receptors
Insulin resistance insulin
compensation
type two receptors Oral hypoglycemic
normal capacity
50 %
manifestations
compensation compensation
50 %
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Endocrine Dr. Abo El - Asrar compensation 50 % Insulin resistance Manifestations of type two diabetes type two diabetes islets cells 50 %
langerhans
already
50 %
restrict control of blood glucose
type two diabetes type two
Non insulin dependent
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Control of hyperglycemia
non insulin dependent diabetes mellitus Non insulin dependent diabetes mellitus Non insulin dependent diabetes mellitus
receptors of insulin
insulin
Resistant resistant
normal level of insulin
threshold receptors
stimulation
Non insulin dependent diabetes the most common Maturity onset diabetes Most common non insulin dependent diabetes mellitus two risk factors
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Endocrine Dr. Abo El - Asrar two risk factors genetic disease autosomal dominant Mode of inheritance autosomal dominant autosomal dominant
gene an autosomal dominant pattern
positive family history Positive family history positive family history type one type two
Obesity risk factors Is one of the major risk factors of type two diabetes Obesity truncal obesity type two diabetes
positive family history
type two diabetes autosomal dominant Genetic inheritance Obesity risk factor
diabetes type two diabetes 100 % obese diabetes
type two diabetes body built
control
risk factor
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obesity
Endocrine Dr. Abo El - Asrar type two diabetes
type one diabetes
common
Type two diabetes It is not common common
type two type one common maturity onset diabetes of young age or youth MODY diabetes MODY diabetes type two in pediatric age group auto immunity Positive family history of type two Obese type two positive family history type two type two diabetes type two diabetes Type two
common Primary diabetes diabetes Non curable diabetic
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secondary diabetes curable
secondary diabetes
secondary diabetes secondary diabetes pancreas Pancreatic disease acute pancreatitis what ever viral pancreatitis acute pancreatitis acute attack islets cells Inflammation
cystic fibrosis acute pancreatitis islets cells diabetes secondary to pancreatic disease counter regulatory hormones cystic fibrosis pancreatitis
hyperglycemia
cushing
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primary diabetes secondary
counter regulatory hormone acromegaly
growth hormone
gigantism growth hormone growth hormone stress Pulse rate epinephrine transient
counter regulatory hormone transient diabetes
associated with certain syndromes diabetes Down syndrome associated anomaly gene factor diabetes
syndrome
syndrome
mentally retarded
mental retardation short stature

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short stature
10
female
male
hypogonadism
hypogonadism Hypogonadism
floppy baby
generalized severe hypotonia severe generalized hypotonia Obesity side to diabetes marked obesity diabetes
diabetes type one
diabetes
diabetes
gestational diabetes gestational diabetes diabetes risk factors
diabetes onset of diabetes
very soon
diabetes gestational diabetes one of the risk factors for diabetes
diabetes type one diabetes
Type one Diabetes

complete deficiency of insulin Partial type one diabetes
Insulin dependent diabetes mellitus

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11
Endocrine Dr. Abo El - Asrar most common Juvenile diabetes
curable curable
diabetes curable diabetes Once curable
hormonal disturbance Mode of inheritance of type two diabetes mode of inheritance of type two diabetes
autosomal dominant inheritance
type two
type one diabetes Most common type one diabetes type one diabetes Type one diabetes is multi factorial disease
gene factor
type two
genetic susceptibility type one diabetes HLA human leucocytic antigen B 15 B8 DR 4 DR 3 HLA
B 15 B 8 Nowadays
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DR 4
DR3 HLA
12
type one diabetes Highly susceptible
Markers factors
environmental factors environmental factors type one diabetes
environmental factors viral infection viruses virus Mumps measles viruses
type one diabetes
viruses
Nowadays
environmental factors
cow milk
early cow milk feeding cow milk buffalo milk cow
100 %
diabetes
cow milk protein allergy
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13
Endocrine Dr. Abo El - Asrar 300 % 200
safe
cow milk feeding one of the risk factors of type one diabetes genetic susceptibility
auto immune type one auto immune disease auto immune environmental factors markers environmental factors viruses cow milk cross similarity islets cells cross similarity rheumatic fever immune system cow milk virus islets cells antibody
antibody
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14
Endocrine Dr. Abo El - Asrar cross similarity
antigenecity
viruses islets cells antigenecity antibody
islets cells
type one diabetes main cause
auto immune process
markers environmental factors environmental factors cross similarity viral infection antigenecity
type one diabetes type one diabetes type one diabetes
prevention Prevention
type one diabetes type two diabetes type two diabetes
prevention prevention
type one diabetes type one diabetes
prevention etiology
Etiology
epidemiology
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15
adolescent
10
type one diabetes neonatal period manifestations of diabetes Neonatal diabetes
5 pre adolescent classic type
neonatal period
diabetes
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16
spreading of infection
spreading of infection Infection One of the precipitating factor of type one diabetes clinical manifestations
Clinical manifestations
clinical manifestations of type one diabetes clinical manifestations of type one diabetes
cells not in need for insulin
cells Not in need for insulin to take glucose cells hypothalamus brain cells satiety center brain cell satiety center cells
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all brain cells satiety center RBCs RBCs
liver cells liver cell Kidney tubular cells renal tubules tubules cells tubular function diabetes
tubular cells
exercising muscles exercise Muscle not in need for insulin
resting muscle exercising muscle exercise Muscle during rest
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satiety center
brain cells
brain cells RBCs liver cells tubular cells of the kidney islets cells exercising muscle
clinical manifestations
diabetes type one
uptake of glucose
extra cellular glucose blood glucose
renal threshold
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blood glucose blood glucose
19
Endocrine Dr. Abo El - Asrar renal threshold Once urine glucosuria
urine
complete reabsorption
Polyuria renal threshold complete reabsorption
kidney
renal threshold urine urine
Polyuria
bladder
bladder bladder bladder comatosed comatosed
micturation secondary nocturnal enuresis
stress
common
secondary nocturnal enuresis stress
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20
bladder
bladder
enuresis
stress Is the main cause of secondary nocturnal enuresis stress
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21
cretin diabetic secondary enuresis polyuria
diabetes
Polyuria
excessive sweating water loss volume receptor ADH anti diuretic hormone Hypothalamus
thirst center
technology
Polydepsia polydepsia polydepsia polyuria this is a true answer

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22
Endocrine Dr. Abo El - Asrar common answer
osmolality osmo receptors osmolality Osmo receptors thirst center
positive family history of diabetes diabetes
dietic habits
blood glucose
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23
Polydepsia
polyuria polydepsia excess water loss blood osmolality
extra cellular hyperglycemia polyuria urine polydepsia
cellular hypoglycemia cellular hypoglycemia
cellular hypoglycemia satiety center brain satiety center satiety center satiety center gluco-state satiety center satiety center feeding center feeding center suppression satiety center feeding center feeding center
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satiety center
24
higher centers lower centers higher
full mouth full esophagus full mouth
feeding center
feeding center
satiety center satiety center feeding center poly-phagia satiety center Hypoglycemia Poly-phagia feeding center
hypoglycemia
Hypoglycemia feeding center

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25
Endocrine Dr. Abo El - Asrar feeding center feeding center
energy supply
counter regulatory hormones
Feeding center counter regulatory hormones counter regulatory hormones counter regulatory hormones
growth hormone
epinephrine counter regulatory hormones
fat fat Acetyl Co. A marasmus fat for ATP production counter regulatory hormones
counter regulatory hormones lipolysis of fat Acetyl Co. A for ATP production fat Acetyl Co. A
lipolysis of fat
classic manifestations of diabetes
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26
loss of weight
classic manifestations weight loss polyphagia polydepsia polyuria
weight loss
clinical manifestations asymptomatic polyuria secondary enuresis polyphagia polydepsia polyuria classic manifestations
Manifestations Of diabetes Extra cellular hyperglycemia Intra cellular hypoglycemia polydepsia polyuria weight loss polyphagia
extra cellular hyperglycemia Intra cellular hypoglycemia
complications of diabetes clinical manifestations of diabetes secondary nocturnal enuresis classic manifestations complications accidently discovered is not common in type one asymptomatic type It is common in type two
accidently discovered
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27
Endocrine Dr. Abo El - Asrar is not common in type one common in type two
type one diabetic keto acidosis first presentation type one diabetic keto acidosis 30 %
first presentation DKA diabetic keto acidosis
diabetic keto acidosis complications
50 %
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28
diabetes
complications
Complications
complications of diabetes repeated infection immunity immunity Hyperglycemia diabetes
hyperglycemia micro organism Is a good media Immune function Macrophages defect Immune cells B cells T cells
immune cells adolescent female
defect
first presentation repeated infection peak of type one diabetes adolescence adolescnece female DKA presentation vaginitis adolescent female vaginitis diabetes You must exclude
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29
diabetes
well known diabetic infection
well known diabetic
Infection
poly neuropathy diabetic foot diabetic foot
gangrene peripheral neurpathy diabetic
severe infection extremities
abrasion organism Infection Peripheral neuritis repeated infection complications coma coma DKA
coma
diabetic keto acidosis
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30
hyperglycemic hyperosmlar non ketotic coma It is not common in type one type two common
DKA non ketotic coma
well known diabetic
hypoglycemia
hypoglycemia
hypoglycemic coma diabetic Over exercise
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31
exercising muscle
Hypoglycemic coma lactic acidosis Is not common in pediatric age common in type two diabetes
lactic acidosis Hyperosmlar non ketotic Hypoglycemic diabetic keto acidosis late complications vasculitis late complications vasculitis Peripheral neuritis
diabetic retinopathy diabetic retinopathy diabetes So common Mandatory complications

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32
nephropathy nephritic nephrotic nephritic nephrotic What ever renal failure renal impairment
follow up renal function macrovascular complications cronary heart disease Macrovascular ischemic heart disease heart cardiomyopathy ischemic heart Myocardial infarction Heart failure cerebral stroke macro vascular complications limb gangrene vascular occulsion What ever diabetes macrovascular complications micro chronic complications chronic complications well controlled well controlled complications Un controlled hypoglycemic coma hyperosmalr non ketotic DKA
complications complications of diabetes

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33
Endocrine Dr. Abo El - Asrar type one and type two iatrogenic complications complications Type one iatrogenic complications
fat Loss of weight
A one C diameter
liver
fat hepatomeglay fat deposit
growing child
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34
Endocrine Dr. Abo El - Asrar Liver Insulin growth factor somatomedines somatomedines fat liver
growth hromone somatomedines
diet control
type one diabetes oral dose of insulin hepatomeglay syndrome
obesity
hepatomegaly over dose of insulin
polyphagia polyphagia cellular dehydration
diabetes
clinical manifestations secondary enuresis classic manifestations complications so rare in type one diabetes asymptomatic presentation
diagnosis
Diagnosis
diabetes
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35
type two
type one type one auto antibodies antibody
islets cells of langerhans
,,
urine analysis urine analysis diabetic Urine renal glucosuria Fanconi Urine glucose diabetic
abuse
abuse
Urine analysis
diabetes
Urine analysis
diabetes diabetic recommened

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36
Endocrine Dr. Abo El - Asrar diabetic
diabetes random blood glucose random blood glucose random blood glucose blood glucose follow up
random blood glucose 200 mg/dl random blood glucose Random blood glucose diabetic
500
400 300 220 200 sure diabetic 200 mg / dl random One step diabetic
sure diabetic
200 mg / dl
Random blood glucose random blood glucose
200
180
170
random 160 140
say
random
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37
110
70
110
60
fasting blood glucose 110 mg / dl
70
126 mg / dl 125 125 126
fasting 125
125 125
125 mg / dl
126
125 mg / dl 125 fasting 125 126 fasting
sure diabetic
sure diabetic 126 mg / dl
120
fasting
170
random
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38
Endocrine Dr. Abo El - Asrar 120 fasting Post prandial Post prandial
technician
stool
Urine
mentally retarded post prandial
oral
stool
Urine
1.75
say 35 1.75 x 20
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39
1.75
75 75
post prandial
140 mg / dl
125 140 diabetic 200 mg /dl 125
200 mg / dl
random
random blood glucose 200 mg / dl
random diabetic
border line fasting diabetic 126 post prandial fasting
fasting
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40
250
fasting 500 post prandial
250
fasting post prandial post prandial
business
250 fasting Post prandial
fasting
DKA
Post prandial
fasting DKA fasting
clinical pathology clinical pathology 126 Oral stool
post prandial
fasting urine
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41
diabetes type two type one type two type one
diabetic type two type one
oral hypoglycemic drugs type one type two type one
oral hypoglycemic drugs Oral hypoglycemic
Post prandial
fasting
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42
type two type one C peptide Insulin level C peptide Level type two type one C peptide endogenous insulin endogenous insulin exogenous endogenous type one C peptide C peptide
type two
Insulin
C peptide C peptide C peptide
Insulin
type two
high type one
Normal Low
type two type one type two type one
type one anti islets cells antibodies anti insulin antibodies anti islets cells antibodies anti insulin antibodies
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90 % 80 40 %
30
43
Endocrine Dr. Abo El - Asrar anti insulin antibodies anti islets cells antibodies anti islets cells anti insulin
type one type one frequent hypoglycemia hypoglycemia Hypoglycemia
low dose of insulin
honey moon diabetes Honey moon Honey moon diabetes
Isolated anti insulin antibodies
anti insulin antibodies
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44
Endocrine Dr. Abo El - Asrar antibodies antibody Islets cells compensation transient type one diabetes islets cells
antibody
immune system
anti islets cells antibodies
isolated anti insulin antibodies diabetes
hypo thyroid transient auto immune
Hashimoto's thyroiditis auto immune thyroditis
thyrotoxicosis hypo function of the thyroid gland l-thyroxine
isolated anti insulin
transient
diabetes
anti insulin antibodies antibodies
Permenant
anti islets antibodies
benefits
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45
diabetic type one anti body at diagnosis
for follow up
investigations
Investigations
follow up Investigations
type two facilities
type one text book
exercise multifactorial
exercise
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46
Hemoglobin A one C
Beta chain chemical bond
A one C terminal C
Hemoglobin A one C RBCs Half life hemoglobin A one C 120
hemoglobin A one C Hemoglobin A one C
I dont know I dont know
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47
roughly hemoglobin A one C risk factors American diabetes association ADA 6.5 hemoglobin A one C 5.5 complications 7.5 7 item 6.5 Normal
14
hemoglobin A one C
thalassemia hemosiderosis Fetal thalassemia major diabetes Islets cells secondary diabetes
thalassemia complications of thalassemia bronze diabetes diabetes diabetes follow up thalassemia
A
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hemoglobin A one C
48
Endocrine Dr. Abo El - Asrar diabetes thalassemia hemoglobin A one C follow up amino acids hemoglobin A one C follow up Beta thalassemia hemoglobin A one C hemoglobin A
lipid profile Hyper lipidemia liver function renal function fundus examination nephropathy albumin
endocrine
treatment of diabetes
Treatment
treatment of diabetes
management of diabetes type one diabetes type two Oral hypoglycemic
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49
diabetes diet sedentary life exercise exercise Is very essential to every one diabetic Is more essential psychology
general health nearly normal good quality of life diet diabetes dietic management
over feeding
diet
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50
healthy diet dietic control diet control
defect
psychological insult
strict diet control
effect diet control
type two diabetes
insulin surgery
Major stress This is true type two is a good control of diabetes What ever , type one or type two
oral
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type one Oral hypoglycemic type two Oral
51
Endocrine Dr. Abo El - Asrar stress say
type two
severe infection diabetic foot
surgery type two
stress type one
What ever
diet dietic management
dietic management total calories total calories team work dietic management
total calories
female male 1000 Male
100 125
female female
1000
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100
age
52
Endocrine Dr. Abo El - Asrar caloric supply Male
female
age in years x 100 male 125 1000
age in year x 100 + 1000 total calories
total calories 100 1800 8 x 100 + 1000 = 1800 calories total calories 8 125 Say
composition main component of food
total calories diet calories calories fat
50 %
total calories nutritional disorder 55 %
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53
Endocrine Dr. Abo El - Asrar hypoglycemia 5% 50 % 55 %
starch
fibers
total carbohydrates
say 90 gram
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54
Highly . Sugars
starch high fiber content starch
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55
Endocrine Dr. Abo El - Asrar absorption fat fat 35 % 35 % 30 % fat
hyperlipidemia low density lipoprotein of planet source
diabetes
animal source
Planet sources protein 15 % 15 % high biological value protein
High biological value protein
1000 starch poly scharrides
100 mono scharrides
diet control total calories 55 % carbohydrates fibers starch
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56
Endocrine Dr. Abo El - Asrar fat Planet sources 30 % 15 % protein high biological value
animal sources
vitamin B complex daily
vitamins vitmain B vitamin B complex
Onset of neuropathy protective Neuropathy
vitmain B
Infection
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57
vitmain B complex
vitamins
fat
total calories
20 %
total calories 30 %
Say
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58
main meal
Main diet main diet
main diet Hypoglycemia Hypoglycemia
Hypoglycemia Hypoglycemia
20 % 20 % 30 % 30 %
Say
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59
Hypoglycemia
fat
20 % 30 % 30 % 80 %
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60
180 180 180 180 180
180 180
30 %
30 %
dietic management
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61
exercise
diet
Prevention disease preventive measure
Parking
parking
energy
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62
Not in need for insulin exercising muscle
exercising muscle
diet control body built Over weight
obesity built control
coronary heart disease
exercise micro vascular complications
Hyper lipidemia micro vascular complications cerebral stroke coronary heart

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63
Endocrine Dr. Abo El - Asrar DVT What ever
Micro vascular complications
Myocardial
cardio vascular
micro vascular complications infarction
good psychological sastisfaction exercising muscle
addiction
Infection
Mode psychological satisfaction
psychological satisfaction
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64
non complicated exercise
competitive exercise
fatigue
stress
hypoglycemia
20
10 10 - 20 %
Muscle muscle Hypoglycemia 20 10
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65
200 cm
Say 1000 cc 15 200 cm 200 cm
Hypoglycemia
200 cc
delayed gastric emptying despepsia
delayed gastric emptying Hypoglycemia
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66
Endocrine Dr. Abo El - Asrar 600 500 40 20 delayed absorption delayed hyperglycemia
exercise Obesity coronary heart good psychological support exercise exercise exercise
competitive exercise 10 - 15 % Hypoglycemia
exercise
psychotherapy
Psychological therapy
third line of treatment
psychotherapy chronic disease chronic disease
psychological support
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67
family
diabetic random blood glucose diabetic type two type one 250 diabetic
post prandial
fasting
MR
random
type two
type one
C peptide
insulin level
deny
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68
disturbance
Psychological disorders
depression
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69
Endocrine Dr. Abo El - Asrar team work oral hypoglycemic diet exercise
12 12
diagnosis
psychological effect
bypass
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70
diet staff
check management diabetes reflection diabetes camp
Management
recommended
recommended carcinogenic effect carcinogenic effect
hypoglycemia rapidly absorbed comatosed

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71
amino acids human type
beta chain
alpha chain
bovine type
Pork type Nowadays human insulin by genetic engineering Human insulin
Long acting
generations
subcutaneous Inhaler method Lung fibrosis intra nasal insulin
rapid withdrwal
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72
Endocrine Dr. Abo El - Asrar sublingual insulin tablets Ischemia nitrate Oral insulin
Parentral route
dose
regular insulin
Onset Peak
Intermediate Onset peak duration peak peak 12 Long acting long acting insulin 12
basal insulin release basal insulin
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73
Endocrine Dr. Abo El - Asrar basal insulin Normal peak level
peak level
Peaks
In between
Is the main cause of obesity
peak levels peaks
Hypoglycemia
hyper
normal peak
Peak ( cloudy intermediate acting

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Endocrine Dr. Abo El - Asrar 12 analogue analogue analogue 12 peak level hypoglycemia Peak
50
90 400
300
Insulin dose dose

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75
Endocrine Dr. Abo El - Asrar 1 unit per Kilogram per day unit 2 unit per kilogram 2 unit per kilo 2 unit Parameters You must check 0.5
Maximum
unit 10 unit per kilo Ctrl + F Over dose of insulin
fatty liver
dose
conventional therapy 2010 conventional therapy
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76
Endocrine Dr. Abo El - Asrar early diagnosed
conventional
Pregnant female Hypoglycemia Pregnant female conventional therapy conventional therapy
12
p.m. a.m. p.m. a.m.
p.m. 12 12
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total dose
2/3 1/3
hypoglycemia
Hypoglycemia 100
Hypoglycemia
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78
Intermediate
one unit 24 36 24 12 8 16 16 8 4 8 12 8 4
36 36
24
base line Base line
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79
Endocrine Dr. Abo El - Asrar conventional therapy
Indicated
therapy
uncontrolled diabetes during stressful conditions
therapy Normal Normal caloric supply
Long acting insulin perfect
Long acting
Intermediate
long acting analogue American Diabetes Association ADA Nowadays International society of pediatric diabetes
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80
Endocrine Dr. Abo El - Asrar recommendation
Hypoglycemia Hypoglycemia
complications of insulin complications of insulin hypoglycemia
lipogenic effect Lipodystrophy Lipodystrophy lipodystrophy
Lipodystrophy Lipodystrophy
hematoma Hematoma Lipodystrophy
hematoma
Lipodystrophy
stressful Very sterssful

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81
stressful
insulin pump Insulin pump
container basal basal Infusion basal timing
crystaline insulin
basal insulin rapidly absorbed bolus bolus Pump pump
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82
bolus
pump
Hypoglycemia
bolus
Pump
bolus Pump bolus Pump
bolus
manual
pump Hypoglycemia Pump Pump
pump DKA diabetic keto acidosis pump pump DkA pump

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83
Endocrine Dr. Abo El - Asrar Pump accessory
Pump Accessory continuous glucose monitoring system (CGMS )
15 140 100 alarm Pump 15
alarm
140
Pump Pump
Normal pancreas artificial pancreas islets cells stem cell transplantation stem cells islets cells research work
transplantation islets cells stem cells
stem cell transplantation stem cell transplantation 30,000
stem cell
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84
stem cell transplantation is a reasearch work
auto immune auto immune disease IV Ig Plasma pharesis cyclo sporins immune suppressant drugs
diabetic keto acidosis
Diabetic Keto Acidosis ( DKA )

diabetic keto acidosis DKA DKA first presentation 30 % diabetes type one DKA Is the first presentation of type one diabetes
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85
Endocrine Dr. Abo El - Asrar DKA
Stress hormones
stress hormones DKA DKA counter regulatory hormones
DKA
Precipitating factors of DKA
well known diabetic
Hypoglycemia Hyperglycemia counter regulatory hormones hypoglycemia counter regulatory hormones DKA
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86
Low dose of insulin 36
Hypoglycemia counter regulatory hormones stress stress stress stress
consumption
hypoglycemia counter regulatory hormones DKA Infection DKA Infection consumption Infection counter regulatory hormones Precipitating factors of DKA diabetic keto acidosis
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87
Endocrine Dr. Abo El - Asrar Metabolism Liver liver Liver metabolism
extra cellular glucose
Liver cell glucose glycogen glucose Liver Liver cells liver
glycogen
glucose
glycogen synthesis glycogen synthetase glycogen Liver
liver Acetyl Co. A glycgogen Liver Acetyl Co. A Acetyl Co. A DKA Hyperglycemia counter regulatory hormones hypoglycemia counter regulatory hormones counter regulatory hormones fat
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88
Endocrine Dr. Abo El - Asrar Acetyl Co. A fat
counter regulatory hormones Lipolysis Lipolysis Acetyl Co. A Acetyl Co. A Liver Liver Acetyl Co. A Acetyl Co. A Liver Acetyl Co. A rule liver
fat
Acetyl Co. A glycogen Liver glycogen fat Acetyl Co. A
Acetyl Co. A
Liver
Liver fat fat fat Acetyl Co. A fat Liver is a lipogenic hormone Acetyl Co. A
kreb's cycle kreb's cycle Acetyl Co. A
Acetyl Co. A Liver
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89
Liver keton bodies ATP Acetyl Co. A keton bodies Liver
keton bodies
keton bodies
Acetyl Co. A keton bodies
Liver Keton bodies
keton bodies Muscle liver brain Keton bodies 60 % brain
keton bodies
ketolysis keton bodies Ketolysis
keton bodies ketolysis
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90
Endocrine Dr. Abo El - Asrar keton bodies keton bodies Keton bodies Keton bodies
Keton bodies
Pathophsiology
glucose keton bodies
glucose + keton bodies
blood vessel blood vessel
Urine
kidney keton bodies Kidney Polyuria
Keton bodies
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91
Endocrine Dr. Abo El - Asrar Keton bodies
Glucosuria Ketonuria
Kidney keton bodies
gut secretion
gut gut Motility of the gut
Motility of the gut DKA diabetic DKA
motility Motility
Vomiting Diarrhea Abdominal colic respiratory secretions keton bodies respiratory secretion
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92
Endocrine Dr. Abo El - Asrar keton bodies Keton bodies keton bodies
volatile volatile
metabolic acidosis
PH
Keton bodies acidosis
respiratory center
stimulation stimulation
respiratory center rapid deep respiration Pneumonia
air hunger air hunger pneumonia differential dignosis respiratory distress
Keton bodies
60 % brain
chemoreceptor trigger zone stimulation vomiting center
keton bodies brain chemoreceptor trigger zone Central vomiting
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93
Endocrine Dr. Abo El - Asrar vomiting Peripheral central reticular formation complete loss of consciousness clinical manifestations
clinical manifestations
severe dehydration
Polyuria
dehydration DKA dehydration Polyuria
diarrhea
vomiting vomiting
diarrhea air hunger
water loss
excessive sweating
Infection
precipitating factor dehydration
Oliguria
dehydrated GIT differentiating point Oliguria dehydrated dehydrated DKA
polyuria
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94
DKA dehydrated Polyuria dehydrated Oliguria GIT manifestations Vomiting Diarrhea Abdominal colic breathing air hunger respiration
disturbed level of consciousness
laboratory
Investigations
DKA
200
above 200 mg
Hyperglycemia 300 Level Nowadays
200 mg / dl 200 diabetic keto acidosis hyperglycemia diabetic keto acidosis ketonemia keton bodies 3 keton bodies
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95
Endocrine Dr. Abo El - Asrar Keton bodies
keton bodies keton bodies ketonemia acidosis Blood gases 7.3 15 degree severe Mild Moderate PH
200 mg / dl 3 15 7.3
Hyperglycemia Ketonemia PH Acidosis
elctrolyte renal function for diagnosis assessment
endocrine treatment of DKA Treatment of diabetic ketoacidosis
Treatment
DKA type one diabetes 30 % Diabetic Keto Acidosis first presentation
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96
Endocrine Dr. Abo El - Asrar DKA si so simple died
center
mis management
treatment of DKA DKA electrolyte disturbance dehydration dehydrated disturbance
heart
arrhythemia DKA Heart arrhythemia second commonest of death
Keton bodies
ketonemia
hyperglycemia keton bodies blood glucose hyperglycemia
keton bodies Metabolic acidosis acidosis Infection third generation cephalosporin Infection DKA broad spectrum antibiotics infection is the commonest precipitating factor
DKA Is more liable to infection
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97
dehydration dehydration dehydration dehydration GIT rehydration therapy
parentral
Oral
dehydration dehydration GIT dehydration oral
parentral route Diabetic Keto Acidosis parentral route IV
is absolutely contraindiacted Oral
36 DKA
Oral intake
Oral 36 oral ketosis motility of the gut gut irritation Oral aspiration drowsy Oral
ketosis
still irritated
gut
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98
Endocrine Dr. Abo El - Asrar gut hormones oral gut hormones anti insulin effect gut hormones hyperglycemia hyperglycemia 36 oral fluids
hyperglyceima
irritated gut gut hormones gut hormones
parentral
GIT amount type of fluid duration
duration GIT
amount type of fluid duration
500 cm 500 cm
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99
Endocrine Dr. Abo El - Asrar 500 cm 500 cm
500 cm rate of effusion effusion diffusion cell 500 cm
effusion
initial therapy shocked initial therapy shock Initital shock Intra vascular dehydration tissue perfusion Intra vascular volume blood Intra vascular volume Intra vascular volume initial therapy Initial therapy Intra vascular volume Intra vascular volume
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100
Endocrine Dr. Abo El - Asrar pulse volume tissue perfusion
shock
initial therapy Initial therapy Initial therapy amount
10 - 20 ml / kg
amount
Hyperglycemia glucose
saline saline Initial
shock One hour
20 ml / kg
10 Saline
Monitor Pulse volume tissue perfusion You can repeat assessment shock
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101
You can repeat
50 ml / kg
total amount 50 ml / kg
diabetic keto acidosis first cause of death cerebral edema cerebral edema brain cells Uptake keton bodies keton bodies 60 % 60 % brain cells ATP
keton bodies
keton bodies
brain cells
brain cells
osmotic pressure
keton bodies keton bodies
brain cells brain cells osmolality of the cells
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102
brain edema
brain
brain edema brain edema shocked saline
50 ml / kg initial therapy shock maintenance GIT deficit deficit maintenance
limit Limit
shock
deficit deficit
100
say
100 deficit
maintenance
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103
Endocrine Dr. Abo El - Asrar maintenance
oral intake
absolutely contraindiacted
Oral intake
maintenance deficit polyuria
tachypnea infection excessive sweating deficit deficit maintenance
deficit deficit
moderate degree of dehydration 80 ml / kg dehydration keto acidosis moderate degree of dehydration 80 ml / kg dehydration 100 ml / kg Moderate 80 ml / kg gastroentritis dehydration
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104
Endocrine Dr. Abo El - Asrar 100 ml / kg GIT dehydration 80 ml / kg
cerebral edema 100 ml / kg Moderate dehydration 80 ml / kg cerebral edema
severe dehydration 100 ml / kg severe dehydration GIT 150 ml / kg 100 ml / kg dehydration severe
severe
cerebral edema
deficit 80 ml / kg moderate 100 ml / kg severe
maintenance maintenance
Nephrology
surface area surface area
caloric requirements
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105
Endocrine Dr. Abo El - Asrar 100 ml / kg dehydration 50 ml / kg 20 ml / kg calori / kg maintenance 100 ml / kg 50 ml / kg 20 ml / kg ml / kg
maintenance
deficit
Maintenance
deficit
saline blood glucose
normal
blood glucose severe hypertension
700 mg / dl 100 mg / dl You are mental retarded, your patient will die
70 mg / dl
50
700 mg / dl 650 mg / dl
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106
Endocrine Dr. Abo El - Asrar 590 mg / dl 70 mg percent 50
rate of drop 300 mg / dl 300 mg / dl 90 mg per cent rate of drop
saline glucose 5 % 5% saline
5%
saline
5%
shift 300 mg / dl
rate of drop of glucose 90 mg per cent
drop glucose 5 % glucose 10 %
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107
Endocrine Dr. Abo El - Asrar 10 %
saline glucose 10 %
90 mg percent / hour 12.5 % IV fluids
12.5 %
keton bodies keton bodies
Keto acidosis
12.5 % 90 mg percent
12.5 %
90 mg percent per hour
rate of drop glucose
300 mg percent
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108
90 mg percent per hour saline glucose 10 %
90 mg percent per hour saline glucose 12.5 %
90 mg per cent per hour glucose 12.5
90 mg percent per hour
maintenance blood osmolality
deficit
Management
blood osmolality 24
Page |
109
Endocrine Dr. Abo El - Asrar 36 blood osmolality
dehydration dehydration ketonemia hyperglycemia management of DKA
ketonemia
hyperglycemia
rapidly acting regular insulin subcutaneous Intra venous drips IV drip
DKA dehydration Initial saline
blood volume glomerular filtration glucose glomerular filtration urine
Page |
110
urine
glucose
250 mg percent
180 250 mg percent cerebral cortex Kidney 180
kidney
filtration Kidney glucose filtration kidney
nephrology
Hypokalemia hypokalemia Is the second commonest cause of death
cerebral edema Hypokalemia
serum
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111
Endocrine Dr. Abo El - Asrar serum K
2.5 ml Eq/ L
serum K
2.5
Dont give insulin serum K
0.1 unit per kg intra venous insulin shock Incidence of cerebral edema
quality intra venous insulin shock cerebral edema IV insulin shock drip
0.1 unit per kg per hour effusion set 500 effusion set 0.1 unit per kg per hour 500 effusion IV drip
0.05 unit per kg per hour
0.1 unit per kg per hour 0.05 unit per kg per hour
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112
0.1 unit per kg per hour 0.05 unit per kg per hour
rate effusion drop of blood glucose 90 mg percent 1: 1 saline 90 mg percent saline
saline
12.5 %
12.5 %
rate of drop of blood glucose Keton bodies Hyperglycemia
rate of effusion
acidosis metabolic acidosis
endocrine Nephrology
Page |
speciality endocrine nephrology
113
system speciality
system system
metabolic acidosis Na bicarb acidosis Na HCO3
incidence of cereberal edema
DKA
incidence of cerebral edema Incidence of cerebral edema incidence of cerebral edema
bicarb
Na HCO3 acidosis keton bodies PH keton bodies
Na HCO3 Na HCO3 Na bicarb 6.9 PH severe acidosis Na bicarb
severe acidosis
brain edema
Page |
brain edema
114
Life threatening hyperkalemia
cerebral edema Hypokalemia Hyper bicarb Hyper kalemia Hyperkalemia Hyperkalemia third commonest cause of death
hypoglycemia
Na bicarb ions
electrolyte disorders Na pump
Na pump
Hyperkalemia
Hyperkalemia life threatening hyperkalemia
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115
Indications of Na HCO3 7 PH severe acidosis hyperkalemia
dose
2 ml/ Eq / kg 1 80 ml / Eq / liter Liter square
dehydration Ketonemia Hyperglycemia acidosis electrolyte disorder electorlyte disorder Hypokalemia Hypokalemia insulin hypokalemia Insulin Level
Kidney kidney Hyperkalemia
Hypokalemia
renal failure Hyper renal failure Hyperkalemia
kidney
Page |
Kidney 1.5 ml / kg / hour deficit
116
Endocrine Dr. Abo El - Asrar dose
Infection infection precipitating factor Infection highly predispose
Infection broad spectrum antiboitics DKA
DKA
deficit Initial
causes of death
complications
Complications ( causes of death )

DKA DKA cerebral edema cerebral edema DKA commonest cause commonest cause of death
second commonest cause of death disorder hypo kalemia Hyper

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117
Hypoglycemia hypoglycemia
is an anabolic hormone consumption of calcium anabolic hormone hypoglycemia hypokalemia hypocalcemia consumption tetany Hypocalcemia
fulminant infection
Infection fulminant infection antibiotics DKA
exercise
diet diabetes DKA
complications therapy
Preventive medicine complications exercise diet control DKA DKA
DKA
dietic management exercise

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118
How to manage the complications complications complicated
complications
DKA DKA
5%
saline saline 5% saline saline
5%
glucose
10 % 5% without saline saline 10 %
saline
risk of cerebral edema risk of cerebral edema
IV bolus of insulin IV bolus of insulin IV bolus of insulin tissue perfusion
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119
Incidence of cerebral edema dehydration rapid drop of blood glucose insulin infusion
hyperkalemia serum Hyperkalemia Hypokalemia
Metabolism 100 mg glucose 50 mg glucose
cerebral edema
Hyperkalemia pump
acidosis
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120
Hyperkalemia acidosis Na HCO3
Hyperkalemia
hyperkalemia endocrine
Short Stature
Standard deviation score Percentile curves skull circumference Length height Length hard table Height length
Length height stand bare footed
length
height
stand
Page |
121
complete rest
blood pressure
facial expression
Psychotherapy
standard deviation score
Length Length
height height Percentile
Page |
122
Endocrine Dr. Abo El - Asrar minus two standard deviation 3rd percentile dwarfism 3rd percentile - 2 standard deviation
disproportionate
proportionate dwarfism proportionate disproportionate
disproportionate
proportionate
span shoulder arm trunck span span
Height
symphsis pubis Upper segment
symphsis pubis Lower segment
- 2 standard deviation 3rd percentile Height lower segment
span upper segment disproportionate
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123
Endocrine Dr. Abo El - Asrar Height span Lower segment upper segment Normal short stature Proportionate short stature Proportionate Disproportionate normal Lower segment ratio Upper segment Normal Proportionate height span
lower segments Upper abnormal ratio span height abnormal ratio disproportionate short stature
genetic potential
Genetic height potential
genetic height potential
genetic height potential genetic height potential
height Height Length Height Height mid parental height
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124
Endocrine Dr. Abo El - Asrar female 6.5
normal
male 6.5
170 160 160 170
330 170 + 160 165 2 330
158.5 171.5
6.5 6.5
165 165
range range
genetic height potential adult expected height short stature
Causes of short stature

short stature short stature text short stature
Page |
125
Primary Secondary
tertiary secondary primary tertiary idiopathic primary
idiopathic idiopathic
short stature Primary Secondary Idiopathic idiopathic secondary Primary
Primary Primary
disproportionate short stature disproportionate span height Lower segment Upper segment skeletal disorders
autosomal dominant disease
achondroplasia hydrocephalus Hydrocephalic changes
shallow posterior fossa

Page |
126
Endocrine Dr. Abo El - Asrar Normal trunck humerus Upper segment femur span
Lower segment upper segment
Height span Upper segment Lower segment
Proportionate short stature disproportionate Disproportionate short stature Achondroplasia Osteogenesis imperfecta bone disease Osteogenesis imperfecta collagen support
humerus femur facial bone
Multiple fracture malunion Multiple fracture deopsits disproportionate short stature
Pott's disease pott's disease vertebrae trunck Upper segment Height Lower segment
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span upper segment
127
Endocrine Dr. Abo El - Asrar disproportionate short stature Metabolic disorder mucopolysacchardosis disproportionate short stature rickets
disproportionate short stature
genu varus
rickets deformity normal deformity rickets
short stature deformity
metabolic disorders rickets skeletal disorder skeletal disorders osteogenesis metabolic disorders rickets
brain edema Intra cranial hemorrhage
primary dysmorphic facies
chromosomal Dwon Down turner
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128
Non chromosomal genetic disorder Noonan Syndrome turner Silver Russel Syndrome Silver Russel secondary causes secondary cause secondary nutritional secondary to malnutrition Causes of short stature Nutritional disorder nutritional dwarfism Nutritional dwarfism caloric intake so deficient
Normal growth kwashiorkor Marasmus
slow rate of growth
accomodated
Proportionate chronic malnutrition nutritional dwarfism main presentation so early Loss of weight
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129
Endocrine Dr. Abo El - Asrar endocrinal cause
growth hormone releasing hormone
endocrinal cause endocrinal gland Hypothalamus Pituitary growth hormone Pituitary
Liver growth hormone growth factors liver somatomedines end organs growth hormones somatomedines receptors
growth hormones
growth hormone releasing hormone Hypothalamus Pituitary growth hormone releasing horomones growth hormone Pituitary Liver growth hormone somatomedines Liver receptors somatomedines receptors
thyroxine growth factor growth factors thyroxine
growth factors growth factor
female sex hormone
Male
sex hormones
Anti growth factor cortisone supra renal anti growth factore

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130
Endocrine Dr. Abo El - Asrar endocrinal causes Hypothalamus
growth hormone releasing hormone Frohlich's Syndrome
growth hormone releasing hormone
Hypothalamus
statiety center
Obesity truncal obesity
female
amenorrhea
Hypogonadism
Mental retardation
growth hormone growth hormone Pituitary growth hormone growth hormone growth hormone releasing cells Pituitary growth hormone
primary
congenital malformation growth hormone releasing cells Pituitary Inflammation neuritis exposure to irridation cranial irridation CNS infiltration Pituitary Leukemia cranial irridiation Irridiation
Pituitary
encephalitis
Pituitary Pituitary
Page |
Tumor tumor
131
Endocrine Dr. Abo El - Asrar craniopharyngeoma ENT ENT Histocytosis X pituitary
truama skull base fracture base of the skull fracture base of the skull sella turcica Pituitary gland truama
growth hormone somatomedines Liver somatomedines somatomedines liver cell somatomedines Liver cells somatomedines somatomedines end organ resistance Liver
end organ resistnant
somatomedines
Mediator somatomedines receptors growth hormone Laron Syndrome
somatomedines somatomedines complications of diabetes
somatomedines
Page |
fatty liver
Fatty liver
132
grwoth factor
thyroxine cretinsim cretinsim thyroxine growth factor thyroxine Insulin diabetes sex hormones sex hormones Precoicous puberty precocious puberty
tall child
say
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133
Endocrine Dr. Abo El - Asrar 120 cm 30 cm
Over growth 120 cm 110 tall child
180 cm
170 cm 150 cm
Primary school short stature
precocious puberty tall stature
cushing cushing osteoporosis endocrinal cause secodary renal failure renal failure renal failure
catabolic effect
osteomalacia
chronic disease
renal rickets growth hormone effect

Page |
chronic anemia renal osteodystrophy
resistance
134
Endocrine Dr. Abo El - Asrar renal failure short stature renal failure liver disease somatomedines chronic infection toxemia short stature chronic disease Iatrogenic short stature prolonged use of steroid therapy
psychogenic short stature Psychogenic adolescent female female anorexia nervosa anorexia nervosa
induction of vomiting short stature malnutrition
Page |
135
anorexia nervosa maternal deprivation Maternal deprivation Psychogenic short stature
depression
Main cause
maternal deprivation short stature
Idiopathic causes of short stature idiopathic hereditary familial short stature constitutional short stature constitutional
Page |
136
Endocrine Dr. Abo El - Asrar constitutional 6 6
platue
3rd percentile minus two standard deviation
rate of growth 6 range percentile minus two standard deviation third percentile
Normal rate
rate of growth Normal rate Normal rate
fusion of epiphysis
16
Page |
137
16
constitutional short stature by exclusion
delayed puberty constitutional short stature short stature Investigations
Investigations
Infection
WBCs
chronic anemia
CBC
Page |
138
Endocrine Dr. Abo El - Asrar chronic disease parasitic infection occult blood malabsorption pyelonephritis pus cells diabetes glucose tubular defect Low's Lignac Karyotyping renal function growth hormone ESR stool analysis chronic disease Undigested food
Urine analysis Urine Fanconi
chromosomal renal failure endocrinal thyroid function endocrinal cause
achondroplasia bone X - ray Osteogenesis imperfecta rickets search for underlying etiology
Treatment
cause familial reassurance constitutional
exclusion turner replacement therapy growth hormone

Page |
turner growth hormone
growth hormone
139
Endocrine Dr. Abo El - Asrar thyroxin cretin
endocrine 50
49
differential diagnosis of DKA post acidotic phase
short stature short stature Pseudo hypo parathyroidism rickets tetany rickets Hypo para thyroidism tetany true hypo para Psuedo hypo para pseudo pseudo hypo para thyroidism pseudo hypo hyper para thyroidism
Hypo para thyroidism Parathormone para thyroid
psudo hypo para thyroidism end organ resistance parathormone para thyroid parathormone target tissue target tissue Kidney bone rickets
Parathormone
Page |
140
Endocrine Dr. Abo El - Asrar Pseudo hypo parathyroidism associated short stature short stature growth horomone resistance growth hormone
pseudo hypo para thyroidism Parathormone receptors growth hormone receptors
short stature
pseudo hypo para type one A associated anomalies pseudo hypo para type one A associated anomalies growth hormones growth hormone
growth hormone receptors growth hormone
pseudo hypo para
short stature pseudo hypo para
pseudo hypo para Pseudo hypo para type one A
associated anomaly
Pseduo hypo para type two type one B short stature short stature type one A type one A associated anomaly
growth hormone receptors
growth hormone short stature growth hormone growth hormone deficiency growth hormone level Investigations
Page |
141
Endocrine Dr. Abo El - Asrar 10 nano gram growth hormone level growth hormone
Provocation test Provocation Provocation test 10 nano gram Level growth hormone deficiency
growth hormone
pituitary
stimulation basal level stimulation
growth hormone release
Hypoglycemia
blood glucose
stimulation hypoglycemia insulin provocation test growth hormone growth hormone Hypoglycemia counter regulatory hormones growth hormone
Hypoglycemia Hypoglycemia counter regulatory hormones growth hormones growth hormone 10 basal limit provocation growth hormone Provocation test test effect growth hormone stimulation 10 nano gram alpha receptors Very easy growth hormone deficiency growth hormone
growth hormone
growth hormone
10 nanogram
Page |
142
Endocrine Dr. Abo El - Asrar reseve provocation test Hypoglycemia alpha receptors
growth hormone provocation test growth hormone release activation Provocation test growth hormone growth hormone dose assessment growth hormone
growth hormone
tall stature
Tall Stature
tall
tall stature tall stature 97th percentile plus two standard deviation score
familial tall stature gene factor endocrinal causes endocrinal causes growth hormone
growth hormone acromegaly
gigantism
gigantism growth horomone
Page |
143
Puberty growth acceleration sex hormones fusion of the epiphysis tall child Precoicous puberty short stature
Primary school
tall stature secondary school
hypogonadism adolescence Puberty fusion of the epiphysis
delayed puberty
epiphysis constitutional
tall adult
closure of the epiphysis delayed puberty hypogonadism sex hormones closure of the epiphysis Hypogonadism
tall stature tall child familial Precoicious puberty hypo gonadism
Page |
144
Endocrine Dr. Abo El - Asrar sex chrmosomes anomaly genetics X chrmosomes Y X sex chrmosomes
super female
XXY sex chrmosomes XYY super male sex chrmosomal disorder sex chrmosomes super male super female Others simple obesity Obesity body mass index
obesity
Obese bondy mass index plus two standard deviation score 97th percentile obese pathological obesity secondary to other cause simple obesity simple obesity Obesity
Page |
145
is not simple obesity
obesity
simple obesity
normal dietic management hormonal assessment
Obesity
Investigations
delayed puberty
Hypogonadism hypogonadism delayed puberty still
delayed puberty Hypogonadism
Private
Page |
146
Hypogonadism
delayed puberty
Hypogonadism
Page |
147
Endocrine Dr. Abo El - Asrar Other causes simple obesity Homocystinuria homocystinuria amino acids methionine homocystine homocystine biochemistry
biochemistry
homocystine skeletal system tall stature
Homocystinuria homocystine
cerebral gigantism cerebral gigantism growth hormone releasing hormone growth hormone growth hormone releasing hormone Hypothalamus SOTO Syndrome cerebral gigantism collagen disorders Marfan Marafan syndrome tall stature
thyroid dysfunction cretinism gonadal disorder thyroid dysfunction
Thyroid dysfunction
thyroid Hypothalamus
Page |
148
Endocrine Dr. Abo El - Asrar thyrotropin releasing hormone Hypothalamus anterior pituitary thyrotropin releasing hormone thyroid stimulating hormone anterior pituitary thyroid gland anterior pituitary TSH TSH receptors vascularity of the gland receptors thyroid gland vascular flow thyroid
specific receptors
TSH thyroid gland
trapping
In organic thyroid follicle Uptake Uptake thyroid follicle
amino acid
tyrosine
thyroid thyroxine thyroid Organic tyrosine In organic
Organic Organification Organification
In organic
Organic tyrosine tyrosine
Mono iodo tyrosine di iodo tyrosine duplication T4 T3 T4 T3
thyroid follicle
Page |
149
Endocrine Dr. Abo El - Asrar carrier protein thyroid thyroglobulin
active form
thyroid T3 thyroid In active form T4 T4
deiodinase enzyme T4 deiodinase enzyme T3 active form T3
Hypothalamus receptors T3 pituitary receptors
negative feed back inhibtion controlling system thyroxin Hypothalamus Long arm suppression short arm suppression Pituitary within normal level T3 TSH
cretinism
Cretinism
congenital hypothyroidism cretinism Hypothyroid function so early after birth Even intra uterine
I dont know
Page |
150
Endocrine Dr. Abo El - Asrar I dont know I dont know SOTO Syndrome
hypothyroidism Hypothyroidism transient causes Permenant causes Permenant causes transient Permenant causes
Hypothalamus Hypothalamus Tertiary hypothyroidism
hypogthalamus TSH TRH thyroxine tertiary hypothyroidism
TRH
Pituitary pituitary Secondary hypothyroidism teritary hypothyroidism Hypothalamus secondary hypothyroidism Pituitary
vascularity of the gland

Page |
TSH TSH
151
Endocrine Dr. Abo El - Asrar goiter goiter swelling TSH thyroid
Goiter
gland
Primary hypothyroidism Primary causes thyroxine Primary TSH thyroxine TSH
goiter
goiter
goiter
TSH TSH
congenitally TSH receptors TSH receptors TSH receptors
thyroid thyroxin TSH gland
goiter
goiter
hypoplasia
aplasia
thyroid gland gland gland thyroxin goiter MCQ
TSH
TSH gland
except
Page |
goiter
TSH
152
except
goiter
TSH
TSH receptors aplasia of the thyroid gland Hypoplasia
goiter endemic iodine deficiency
TSH
hypothyroidism 2012 2010
304
anethesia
400 400
Page |
153
endemic iodine deficiency
Iodine deficiency
endemic
endemic iodine deficiency
thyroxine synthesis
trapping thyroid follicle Organic form Organification defect
duplication monon iodo tyrosine di T4 T3
Page |
154
Endocrine Dr. Abo El - Asrar thyroxine thyroglobulin Thyroglobulin thyroxine thyroxine
T4 T3 T4 deiodinase enzyme Permnant causes anti thyroid drugs anti thyroid drugs thyrotoxic radio active iodine Neomercazole
thyroid thyroid anti thyroid
Hypothyroidism Permenant causes of hypothyroidism
transient causes transient causes endemic iodine deficiency
anti thyroid drugs transient causes permenant causes
Clinical manifestations
clinical manifestations of hypothyroidism
Prognosis
Hypothyroidism hypothyroidism L- thyroxin
cretin
Page |
155
Mental affection
mental retardation Mentality
early diagnosis of cretinism diagnosis of cretinism cretin full clinical pictures
cretinism Preventive medicine
complications diseases Obligatory
Page |
156
thyroid function
placenta
thyroxin 48 thyroxin so early Hypothyroidism cretinism
cretinism cretin cretin prevention cretinism
cretin Down cretin
cretin
Lab
cretin Clinically how suspect cretinism cretinism suspection
early manifestations of cretinism Over weight cretin
Page |
157
neonatology constitutional constitutional constitutional
constitutional
diabetes Over weight baby
diabetic cretin exclusion over weight baby
Posterior fontanell closed at the time of delivery
Posterior fontanell full term Posterior fontanell Posterior fontanell Posterior fontanell preterm Hydrocephalus
delayed closure of the posterior fontanell cretin You must exclude psoterior fontanell heart 140 per min
120 100
heart rate Heart rate bradycardia
Page |
158
90 sinus tachycadia 140 per min
heart rate
120 90 per min bradycardia
resuscitation resuscitation resuscitation anaus delayed passage of stool stool delayed passage of mechonium
sleepy
Page |
159
Endocrine Dr. Abo El - Asrar markedly exhusted
cretin sleepy
weak suckling weak suckling
weak suckling
sleepy
gut
Motility of the gut thyroxin thyroxin
Motility
gut gut
thyroxin
cretin
Page |
160
15 1930 15 jaundice
delayed physiological jaundice delayed phsyiological jaundice hypothyroidism jaundice Indirect billrubin Liver glucouronide transferase enzyme neonatology Maturation Immature direct billrubin Liver
glucouronide transferase enzyme thyroxin thyroxin
Hypotonia
Umblical hernia
Low anterior hair line
Page |
161
Endocrine Dr. Abo El - Asrar diagnostic cretin
cretin so early closure posterior fontanell bradycardia
abdominal distention Umblical hernia Delayed physiological jaundice weak harsh cry vocal cords myxemtous tissue deposit vocal cords coarse cry hash cry cretin
myxomatoustissue deposit
cretin standard
cretion
manifestions of cretinism
hypokinesia Hypokinesia
Page |
162
dull apathy waddling gait waddling gait weakness Myopathy thyroxin
proximal muscles ATP ATP
Muscle weakness ATP waddling gait
Mentally retarded
dull apathy
Mental apathy History spincteric control signs of mental retardation dull apathetic Mental retarded
ATP production
Hypothermia thyroxin
Hypothermia ATP production
Page |
163
cold weather
bradycardia tachycardia S. A. node stimulation
pulse bradycardia thyroxin thyroxin bradycardia
cardic output
systole thyrotoxicosis diastole systole systole bradycardia heart rate x stroke volume heart rate cardic output systolic blood pressure diastole Hyperlipidemia hypercholestrolemia thyroxin thyroxin Hyperlipidemia Premature atherosclerosis peripheral resistance
diastole
Peripheral resistance diastolic pressure
Pulse temperature blood pressure
Page |
164
thyroxin brittle hair thyroxin anterior hair line posterior hair line posterior hair line turner anterior hair line
Low anterior hair line
Outer third of the eye brow Outer third of the eye brow
buffy eye lids myxomatoustissue deposits thyroxin myxemtous tissue thyroxin Lower eye lid upper puffy eye lids Upper eye lid depressed nasal bridge depressed nasal bridge
epicanthus fold snoring Nose Mucosa
myxomatoustissue nasal obstruction
Page |
165
big and thick lips
Myxomatoustissue deposits
denitation growth factors thyroxin
delayed delayed dentitation dentitation
congenital absence of the thyroid
secondary
Neck thyroid swelling Neck tertiary thyroid swelling defect TSH receptors goiter goiter Heart chest bradycardia goiter
Heart chest
pot belly abdomen myopathy weak muscle
Hypotonia Hypotonia
Hypotonia inguinal hernia umblical spleen liver ptosis extremities
short tappering fingers
distal part
Proximal part
Over weight
dorsal pad of fat thyroxin thyroxin
fat
Page |
166
Endocrine Dr. Abo El - Asrar zinc thyroxin vitamin A caroteen vitamin A thyroxin vitamin A rough scaly thyroxin
skin
hematology one of the essential hormones for erythropioesis thyroxin erythropioesis pallor
Normal sclera
yellow skin
normal sclera vitamin A hyper caroteenemia
sclera normal yellow skin
Mental retardation cretin short stature
Mental retardation clinical manifestation cretin disproportionate short stature investigations
Investigations
Hypothyroid Investigations hormonal TSH T4 T3
Pituitary
hypothalamus
thyroglobin releasing hormone
TRH
Page |
167
Endocrine Dr. Abo El - Asrar TSH TRH TSH TRH Pituitary TRH Pituitary hypothalamus TRH brain brain TSH
TSH
T4
T3 Primary hypothyroidism
TSH
T4
T3 deiodinase
negative feed back
deiodinase T4 TSH
Hypothyroidism
clinically
TSH
T4
T3
end organ resistance
waves
bradycardia tachycardia ECG Low voltage
ECG bradycardia Low voltage ECG
thyroid scan thyroid biopsy

Page |
168
Endocrine Dr. Abo El - Asrar thyroid sonar
X - ray
dysgenesis
bone peaking of the vertebrae Head of the femur delayed ossification femur ossification center radiological finding skull X - ray
cretin
Treatment
causes
thyroxin thyroxin 50
100 unit
dilution clinical assessment 4 unit per kg 4 unit per kg Insomnia sleeping pulse dose dose
Page |
169
Endocrine Dr. Abo El - Asrar sleeping pulse response trials and errors clinical response prognosis dose
Mental retardation
Unknown
prognosis
thyroxin
Myxomatoustissue deposit myxomatoustissue deposits disproportionate short stature cretin growth Long bones cretin achondroplasia achondroplasia Humerus femur lower segment Upper segment Height span
Humerus
femur
Myxedema
10 autoimmune 12 female Hashimoto thyroiditis females Hashimoto's thyroiditis Myxedema Hypothyroidism brain
thyroid
inflammation
auto antibodies
auto immune thyrotoxicosis
thyroid Hypothyroidism
Page |
170
endemic iodine hypothyroid function anti thyroid drugs Over dose deficiency
thyrotoxicosis Irridation irridation
Neck irridiation Hypothalamus pituitary
Hodgkin's lymphoma Neck Lymph node brain Irridiation leukemia TSH TRH trauma tumor brain
pituitary
Hypothalamus
Symptoms
thyroid function
sleepy
Page |
171
female Intolerance to cold weather rate of growth short stature
Signs
delayed eruption Miss Permenant teeth
brady cardia pulse cretin
Treatment
thyroxin cretin Mental retardation
mental apathy
endocrine genetic
Gondal Organs
illustration XY
Page |
172
Endocrine Dr. Abo El - Asrar male Male XY XY
gene Y
short arm gene sex related Y gene sex related Y gene
sex related Y gene Sex related Y gene Y chromosomes short arm gene
hormones HY antigen I dont know HY antigen testis determining factor gene HY antigen testis determining factors
Y chromosomes
gene
embryo Undifferentiated gonads Undifferentiated gonadal cells Undifferentiated cells gene hormone Undifferentiated gonads
testicular cells
Ovum
receptors
Page |
173
Endocrine Dr. Abo El - Asrar Undifferentiated gonads receptors
testis
undifferentiated gonads testis
testis HY antigen undifferentiated gonads testis determining factors testis determining hormone testis testis Sertoli cell anti substance
sertoli cells factors inhibitory hormone
inhibitory duct system suppression duct system upper 2/3 of the vagina Uterus tube
duct
regression
Lydig cells
testis testosterone testosterone
duct
stimulation duct epididymis
Page |
174
Endocrine Dr. Abo El - Asrar testis testis seminal vesicles
epididmyis vas defrens
Male genital tract Organs seminal vesicle 5 alpha reductase vas epididymis testosterone 5 alpha reductase external genitalia testosterone external genitalia genital fold embryology Penis scrotum Genital tubercle genital tubercle fusion genital fold external genital Penis scrotum scrotum testis male genital system
duct system
female XX gene sex related Y antigen
12 testis determining hormone
Undifferentiated gonads HY antigen Ovary Passively Ovary Passively
stimulation
Page |
175
Endocrine Dr. Abo El - Asrar passively Ovary Ovary Ovary
suppression
inhibitory hormones duct system
upper 2/3 of the vagina
uterus
tube female genital tract
testosterone regression duct seminal vesicles
epididymis
vas
clitoris Lower 1/3 of the Labia minora labia majora testerone
testosterone external genitalia genital tubercle genital fold vagina
Upper 2/3 of the vagina duct genital fold lower 1/3 Hymen duct genital fold
genitalia
genital tract
disorders of sex differentiation
abnormalities genetic
Disorders of sex differentiation
Page |
176
Endocrine Dr. Abo El - Asrar Male XY female turner X female XXY Male genetic sex disorder
XX
gonadal sex gonadal sex differentiation Undifferentiated gonads gonadal sex
Male sex related Y antigen HY antigen testis determining hormone
Undifferentiated gonads
receptors
Ovary
XY Male Undifferentiated gonads testis Ovary XY
female genital tract sonar
female
genital tract
female XY female Ovary genital tract female extranal genitalia Female atrophic ovary
germinal cells
aptosis
two X
Ovary turner X karyotyping turner infertile
male primary amenorrhea

Page |
177
Ovary atrophic
two X chromosomes
gonads
ovary XY X
Infertile
turner
turner Infertile XY female
duct XY inhibitory factors Sertoli cells testosterone
seminal vesicles
vas
XY Male external genitalia epididymis testis Internal genitalia tubes Uterus sonar hernia abdominal exploration female genital tract false male and female genital tract inhibitory hormones fertile Uterus
cells inhibitory Sertoli cells testis
Page |
178
Endocrine Dr. Abo El - Asrar testosterone cells male genital tract female genital tract testosterone Labia minora Labia majora female external genitalia clitoris
Lower third of the vagina
external genitalia sonar XY Female
female
external genitalia female genital system Male
external genitalia female female Intra uterine androgens Penis clitrois verilization Labia minora labia majora fusion
scrotum
bilateral undescending testis
external genitalia penis scrotum testis
estrogen
ovary
female secondary sex character Male external genitalia female behaviour
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179
Endocrine Dr. Abo El - Asrar female
verilization actually female
testosterone Inhibitory substance female genital tract testis duct testosterone 5 alpha reducatase genitalia
labia minora
Labia majora
clitrois genital fold female
penis fusion Male
ambiguous genitalia 5 alpha reductase
lower 1/3 of the vagina
complete female external genitalia labia minora labia majora clitrois Male
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www.facebook.com/dr.tafreegh
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Endocrine

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Endocrine

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Endocrine Dr.

Endocrine Dr. Abo El - Asrar

type one diabetes

deficiency of insulin deficiency of insulin Partial complete type one

Endocrine Dr. Abo El - Asrar

insulin dependent diabetes mellitus

Most common type juvenile diabetes

Type one diabetes insulin dependent diabetes mellitus Juvenile diabetes

Most common type stress type two Insulin resistance

Endocrine Dr. Abo El - Asrar

Insulin resistance receptors

Insulin resistance insulin

type two receptors Oral hypoglycemic

restrict control of blood glucose

type two diabetes type two

Non insulin dependent

Endocrine Dr. Abo El - Asrar

normal level of insulin

gene an autosomal dominant pattern

positive family history

diabetes type two diabetes 100 % obese diabetes

type two diabetes body built

Endocrine Dr. Abo El - Asrar type two diabetes

type one diabetes

Type two diabetes It is not common common

common Primary diabetes diabetes Non curable diabetic

Endocrine Dr. Abo El - Asrar

secondary diabetes curable

Endocrine Dr. Abo El - Asrar

primary diabetes secondary

counter regulatory hormone acromegaly

counter regulatory hormone transient diabetes

mental retardation short stature

Endocrine Dr. Abo El - Asrar

diabetes type one

gestational diabetes gestational diabetes diabetes risk factors

diabetes onset of diabetes

diabetes gestational diabetes one of the risk factors for diabetes

diabetes type one diabetes

Type one Diabetes

Insulin dependent diabetes mellitus

Endocrine Dr. Abo El - Asrar most common Juvenile diabetes

diabetes curable diabetes Once curable

autosomal dominant inheritance

Endocrine Dr. Abo El - Asrar

type one diabetes Highly susceptible

environmental factors environmental factors type one diabetes

environmental factors viral infection viruses virus Mumps measles viruses

type one diabetes

early cow milk feeding cow milk buffalo milk cow

cow milk protein allergy

Endocrine Dr. Abo El - Asrar 300 % 200

Endocrine Dr. Abo El - Asrar cross similarity

viruses islets cells antigenecity antibody

type one diabetes main cause

auto immune process

type one diabetes type one diabetes type one diabetes

type one diabetes type two diabetes type two diabetes

type one diabetes type one diabetes

Endocrine Dr. Abo El - Asrar

type one diabetes neonatal period manifestations of diabetes Neonatal diabetes

5 pre adolescent classic type

Endocrine Dr. Abo El - Asrar

cells not in need for insulin