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Endocrinology and Metabolism

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  • Adrenal disorders
  • Diabetes
  • Diet
  • Thyroiditis
  • Thyrotoxicosis & Thyroid Storm
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    Adrenal disorders



    Unclear when asymptomatic persons should be screened. ADA wants to test at age 45 and q3y thereafter -- seems a bit excessive. Screen if risk factors including: non-Euro (Euros seem relatively resistant - possibly due to selection pressure), FH or hx GDM or macrosomia, obesity.

    Diagnosis and Classification.

    See Diagnosis and Classification of Diabetes Mellitus New Criteria - Oct 15, 1998 - AFP.

    Any one of the following on two different days makes diagnosis. Screening criteria for GDM is very controversial -- esp. what cutoff value to use.

    test normal diabetes impaired glucose tolerance gestational (GDM)
    post-prandial (50 gm glu load) >= 140 indicates need for OGTT, some advocate a lower threshhold of 130. Less than 130 rules out GDM -- consider using risk adjusted criteria.
    random glucose (with symptoms?) > 200
    fasting glucose < 110 >= 126 mg/dl 110-125
    post-prandial (75 gm glu load) < 140 >= 200 140-199
    post-prandial (50 gm glu load) >= 140 indicates need for OGTT, some advocate a lower threshhold of 130. Less than 130 may r/o GDM -- consider using risk adjusted criteria. Currently skip this and do OGTT if PMH GDM.
    OGTT 100 gm (US) Exceed any two of four
    • baseline: 105
    • 1 hr: 190
    • 2 hr: 165
    • 3 hr: 145
    OGTT 75 gm (WHO) Exceed 165 2 hours after load.

    Oral Agents

    Oral Agents in the Management of Type 2 Diabetes Mellitus - May 2001 - AFP

    Type II DM is in part a disorder of excessive insulin, but most treatments act to increase insulin levels or activity. Only metformin (biguanide) lacks the side effect of weight gain; arguably only it treats the real disorder.

    biguanide - insulin sensitizer



    alpha-glucosidase inhibitors


    Combined Oral/Insulin

    Insulin Notes

    Insulin Resistant Patients

    Exercise Evaluation



    type synonyms comments
    chronic lymphocytic Hashimoto's
    • most common cause goiter in US, 95% women, typical age 40,  high level antithyroid microsomal or peroxidase antibodies.
    • not acute
    subacute lymphocytic postpartum, sporadic painless
    • postpartum: thyrotoxic phase at 6w to 6m postpartum, then hypothyroid 1 y pp. About 25% remain hyopthyroid. High anti-mitochondrial antibody.
    subacute granulomatous de Quervain's
    • most common cause of diffusely swollen painful thyroid
    • viral: EB, coxsackie, adeno -- usually preceded by URI, esp. women age 40-50 in summer/fall
    • T4>T3, initially hyperthyroid with low TSH
    • RAIU is low vs Graves disease where RAIU is high
    • thyroglobulin elevated
    • pain for 3-6 weeks, then hypothyroid, 95% recover thyroid function
    • can treat with prednisone if no improvement in 1 week (40-60 mg/day over 4-6 wks)
    microbial inflammatory (suppurative) suppurative, acute
    • rare, usually pt has pre-existing nodular goiter
    • fine needle aspiration, Gram stain and culture
    invasive fibrous Riedel's struma

    Thyrotoxicosis & Thyroid Storm


    Author: John G. Faughnan.  The views and opinions expressed in this page are strictly those of the page author. Pages are updated on an irregular schedule; suggestions/fixes are welcome but they may take weeks to years to be incorporated. Anyone may freely link to anything on this site and print any page; no permission is needed for citing, linking,  printing, or distributing printed copies.