临床助理专业综合部分内分泌系统Clinical Assistant General Section.docx

临床助理专业综合部分内分泌系统Clinical Assistant General Section.docx

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临床助理专业综合部分内分泌系统ClinicalAssistantGeneralSection

（临床助理专业综合部分）——内分泌系统（（ClinicalAssistantGeneralSection）

（临床助理专业综合部分）内分泌系统（（ClinicalAssistantGeneralSection）-endocrinesystem）（临床助理专业综合部分）内分泌系统（（ClinicalAssistantGeneralSection）-endocrinesystem）endocrinesystemEndocrineandmetabolicdiseasesThediagnosisofendocrinopathyincludesthreeaspects:

（1）qualitativediagnosis;pathologicallocationdiagnosis;etiologicaldiagnosis.Amongthem,functionalqualitativediagnosis（2006）includes:

（1）clinical:

medicalhistory,symptomsandsigns.

（2）laboratoryexamination:

metabolicdisorder,bloodsugar,bloodelectrolyte,bloodlipid,etc..Hormonesecretionstate（2003）:

T3,T4,cortisolandsoon.Endocrinedynamicfunctiontest:

TRHstimulationtestandDXMsuppressiontest.Hypopituitarism1.:

theprimarycauseisthemostcommoncauseofpituitarytumorinfiltrationandnearcompression（2019/2004）;themostcommonetiologyofpituitarystalkissecondarytovariouscausesdamage,suchassurgery,radiotherapyandtraumaofthesellarregion（2003）.2.clinicalmanifestation:

（1）gonadotropinandprolactinweretheearliestmanifestationsofsexuality,hypoplasiaordegeneration（2019）,postpartumnomilk,amenorrhea（2019）,infertility,maleimpotence,etc..

（2）ACTHdeficiency:

secondaryadrenalcorticalhypofunction.（3）TSHdeficiencyleadstosecondaryhypothyroidism.（4）hypopituitarismcrisis:

themostimportantmanifestationishypoglycemia（2007）.1.Sheehansyndrome（Shee-han）（2004/2006）:

pituitaryhyperplasiaandhypertrophyofpregnancy,abundantbloodsupply,iftheperinatalperiodforplacentaprevia,placentalabruption,retainedplacenta,uterineatonycausedbybleeding,shock,thrombosis.Makethemostofpituitarynecrosisandfibrosis,clinicalcalledSheehansyndrome（Shee-han）.HyperthyroidismHyperthyroidism,referredtoashyperthyroidism,isagroupofcommonendocrinediseasescausedbyavarietyofcausesofexcessivethyroidhormonesecretion.1.clinicalmanifestation:

Typicalsignsarediffuseandsymmetricalenlargementofthethyroidgland,whichmayhavetremororvascularmurmur,whichisofdiagnosticvalue（2019）.2.laboratoryexamination:

thethyroidhormoneexaminationisthemostreliableexaminationforthediagnosisofhyperthyroidism（2019/2003/2004/2005/2006）.3.treatment:

hyperthyroidismtreatmentisacomprehensivetreatment.Http:

//

（1）calm,rest,andreplenishenoughcaloriesandnutrients.

（2）usingantithyroiddrugs,thetreatmentmechanismistoinhibitthesynthesisofthyroidhormone（2004）.Commonlyuseddrugs6-methyl-2-thiouracil（MTU）andpropylthiouracil（PTU）andmethimazole（MM,methimazole）andcarbimazole（CMZ,JiaKangping）.Indications:

milddisease,thyroidglandissmall;theagebelow20yearsold,pregnantwomen（2007）withseverelesionsordifficultsurgery;thesubtotalthyroidectomypreoperativepreparation;adjuvanttherapybeforeandafterthe131oftheradiationtreatment.Adversereactions:

mainlythedecreaseorlackofgranulocytes（2003）,WBCbelow3x109/L,orneutrophilbelow1.5x109/L,shouldbediscontinuedtreatment;drugeruptionismorecommon,antihistaminescontrol,donothavetostopthedrug.（3）iodine:

itisonlyusedintwocases:

preparationbeforethyroidsurgery（2007）andrescueofhyperthyroidismcrisis.Simplegoiter1.causes:

soilwaterfoodiodineinlowendemicgoiteriscausedbythemostcommoncause（2019）.2.clinicalmanifestations:

exceptforgoiter,thereareusuallynoothersymptoms（2019）.Mildormoderatediffusegoiter,softtexture,notenderness.3.diagnosis:

themainbasisisgoiter,anditsfunctionisbasicallynormal（2006）.ThebloodT4andT3werenormalorhigh;therateof131Iuptakebythyroidincreasedmostly,butthepeakwasnotinhibitedbyT3.Theradionuclidescanofnodulargoitercouldbeawarmnoduleorcoldnodule.Theprevalenceofendemicgoiterintheregionishelpfulforthediagnosisofthisdisease（2019）.DiabetesDiabetesmellitusisacommonendocrinemetabolicdisease.Isduetoabsoluteorrelativedeficiencyofinsulin（2019）causedbysugar,fat,proteinandwaterandelectrolytemetabolismfollowing.1.typingTable5-39classificationofdiabetesmellitusprojectType1diabetesmellitusType2diabetesmellitus（2019/2003/2004）PathogenyPancreaticisletBcellsdamageandcauseanabsolutelackofinsulinMainlywithinsulinresistanceaccompaniedbyinsufficientinsulinsecretionCrowdMorecommonamongadolescentsMorecommoninadultsClinicalfeaturesAcuteonset,metabolicdisorder,obvioussymptoms,patientsneedtoinjectinsulintomaintainlife,tendtohaveketoacidosisMostofthepatientsareoverweightorobese,andtheydonotneedinsulintreatmentattheearlystageofthediseaseorevenforlife,andtendtohavenotendencytoketoacidosis4.laboratoryexaminationanditsdiagnosticsignificance:

（1）:

positiveurineurineisanimportantcluetothediagnosisofdiabetes,butnotdiagnosis.

（2）bloodsugar:

fastingandpostprandialbloodsugarelevation（2019/2019）isthefirstchoiceforthediagnosisofthisdisease,whichcanmonitorthediseasecontrol.Http:

//（3）oralglucosetolerancetest（2019）:

forsuspecteddiabetesmellitus,fastingorpostprandialbloodglucoselevelsarehigherthannormal,butthediagnosticcriteriafordiabetesshouldnotbecarriedout.OGTTshouldbedoneearlyinthemorningandfastedforatleast8hours.WHOrecommendadultoralglucose75g（2005）,dissolvein250~300mlwater,drinkin5minutes,andthentesttheplasmaglucoseafter2hours.Childrenaccordingto1.75gperkilogrambodyweight,thetotalamountdoesnotexceed75g.（4）glycosylatedhemoglobinreflectsthecomprehensivelevelofbloodglucoseinthelast2~3weeks（2019）,whichcanmakeupfortheshortageofbloodglucosemeasurementwhichreflectsonlytheinstantaneousbloodsugarvalue,andisanimportantindicatortomonitortheconditionofdiabetes.（5）insulinreleasetest:

itishelpfultoclassifydiabetesmellitus（2019）.5.acutediabeticcomplicationsInsulintherapy:

asmalldoseofinsulinshouldbefollowedbyintravenousinfusionofthedrug（2007）

（2）hyperosmolarnonketoticdiabeticcoma:

Clinicalmanifestations:

mostofthepatientswereinthemiddleandoldagegroupof50~70yearsold.Mostpatientshadnohistoryofdiabetesoronlymilddiabetessymptoms.Thelaboratoryexaminationshowedamarkedincreaseinbloodglucose,usually33.3mmol/L（600mg/dl）,theincreaseofserumsodiumreached155mmol/L,andtheosmoticpressureofplasmaincreasedsignificantly,generally350mmol/L.Strongpositiveurine,butwithoutketosisorlighter.（2019）7.chronicdiabeticcomplications

（1）:

largearteryatherosclerosismainlyaortacoronaryarteryandcerebralartery,renalartery;limbperipheralarteryfollowinglimbarterymainlymanifestedaslowerextremitypain,paresthesiaandintermittentclaudication.

（2）microvasculardisease:

diabeticnephropathy（2019/2019/2007）syndrome,proteinuria,edema,hypertension,nephroticsyndrome;diabeticretinopathy,whichcancauseproliferativeretinaldetachmentisamajorcauseofblindnessindiabetesmellitus.（3）:

peripheralnerveneuropathy（2019/2004）,seemoreperformanceforsymmetry,lowerthanthatoftheupperlimb,firstacroparesthesia,gloves,sockslikedistribution,maybeassociatedwithhyperalgesia.Thenthereispain.Finally,themotornervewasinvolvedandthemuscletensiondecreased.8.treatment

（1）diettherapy（2019）:

diettreatmentisthebasicmeasureofdiabetestreatment,andneedslong-termstrictimplementation.

（2）oralhypoglycemicagents:

oralantidiabeticdrugsshouldbeusedinpatientswithtype2diabeteswhocannotbecontrolledbydietarytherapy.Sulfonylurea（2003）:

thiskindofmedicinedirectlystimulatesinsulinBcellstoreleaseinsulin,whichissuitablefornonobesetype2diabetesmellitus.Withthiskindofmedicine,specialattentionshouldbepaidtoseverehypoglycemiaadversereactions（2005/2006）.Thebiguanidedrugs:

promoteperipheraltissueglucoseuptakeandinhibitionofgluconeogenesis,inhibitordelayinglucoseabsorptioninthegastrointestinaltract,mainlysuitableforobeseoroverweightpatientswithtype2diabetes,commonlyuseddrugsformetformin（2003/2007）.Lacticacidosisiseasilyinducedbyhepaticorrenaldysfunctionandhypoxia（2005）.Insulinsensitizer:

usedmainlyfortype2diabetesmellituswithpoorefficacyofotherantidiabeticagents,especiallythosewithinsulinresistance（2007）.Themaindrugsarerosiglitazone,pioglitazoneandsoon.Http:

//Theabovehypoglycemicdrugsinthesingleapplicationcannotachievethepurposeoftreatment,orclinicalcannotuseinsulintreatment（2006）,mayconsiderthecombinationofmedication.Thecombineduseofsmalldosescouldalsoreducethesideeffectsofthedrugs（2019）.（4）indicationsforinsulintherapy（2019/2019/2004）:

Type1diabetesmellitus（2019/2019）.Type2diabetesmellitushasnotbeenwellcontrolledbystrictdietcontrolandoralhypoglycemicagents.Ketoacidosisorhyperosmolarnonketoticcomaoccurredinanytypeofdiabetes.Gestationaldiabetesmellitusanddiabetesmellituscombinedwithpregnancyanddelivery.Severeinfection,consumptivediseases,retinopathy,kidneydisease,acutemyocardialinfarction,cerebrovascularaccident,etc..Theperioperativeperiod（2005）.Thewholepancreasresectioncausedbysecondarydiabetes.Surgicaltreatmentofhyperthyroidism1.categories:

accordingtothecausesofhyperthyroidismcanbedividedintoprimary,secondaryandhighfunctionaladenomathreecategories.

（1）primaryhyperthyroidism:

themostcommon（2004）,morecommoninwomenaged20~4