METABOLISM & HORMONES 2
Diabetes mellitus ......................................................................................................................... 4
Definitie/diagnose ............................................................................................................................ 4
Acute complicaties ........................................................................................................................ 12
Chronische complicaties: microvasculair ........................................................................................ 21
Chronsiche complicaties: macrovasculair....................................................................................... 35
Behandeling van T2DM: orale antidiabetica ..................................................................................... 39
Behandeling van T2DM: injectables ................................................................................................. 46
Behandeling van T1DM ................................................................................................................... 52
Workshop: insulinetherapie ............................................................................................................ 57
Workshop: orale antidiabetica en GLP1RA ....................................................................................... 60
Schildklier................................................................................................................................... 62
Hyperthyroïdie ............................................................................................................................... 62
Hypothyroïdie ................................................................................................................................ 73
Euthyroïde goiter ............................................................................................................................ 78
Solitaire nodule .............................................................................................................................. 83
Schildkliercarcinoom ..................................................................................................................... 86
Hypofyse ..................................................................................................................................... 92
Hypofyse adenomen ...................................................................................................................... 92
Hypopituïtarisme............................................................................................................................ 94
Acromegalie................................................................................................................................... 99
Hyperprolactinemie.......................................................................................................................105
Neurohypofyse – diabetes insipidus en SiADH ................................................................................109
Radiologie hypofyse ......................................................................................................................114
Bijnieren ................................................................................................................................... 115
Cushing ........................................................................................................................................115
Primair aldosteronisme .................................................................................................................121
Feochromocytoom ........................................................................................................................125
Congenitale adrenale hyperplasie (CAH) ........................................................................................128
Bijnierincidentaloom .....................................................................................................................130
Addison ........................................................................................................................................131
Beeldvorming bijnieren ..................................................................................................................137
Lipiden – dyslipidemie ............................................................................................................... 142
Classificatie van lipide aandoeningen.............................................................................................142
Behandeling van hypercholesterolemie en dyslipidemie..................................................................145
Hypoglycemie bij niet diabeten .................................................................................................. 150
1
, Definitie hypoglycemie ..................................................................................................................150
Reactieve hypoglycemie ................................................................................................................151
Definitieve hypoglycemie ...............................................................................................................151
Besluit ..........................................................................................................................................155
Obesitas ................................................................................................................................... 156
Controle van gewichtshomeostase ................................................................................................156
Wat is obesitas? ............................................................................................................................156
Oorzaken van obesitas ..................................................................................................................158
Complicaties ................................................................................................................................160
Evaluatie van obesitas ...................................................................................................................161
Behandeling ..................................................................................................................................163
Hypogonadisme – man............................................................................................................... 167
Symptomen en tekens van hypogonadisme ....................................................................................167
Meten van testosteron ...................................................................................................................167
Oorzaken van hypogonadisme .......................................................................................................168
Hypogonadisme – vrouwen ........................................................................................................ 173
Hypogonadotroop hypogonadisme ................................................................................................173
Hypergonadotroop hypogonadisme ...............................................................................................174
Gynaecomastie ......................................................................................................................... 175
Differentieel diagnose....................................................................................................................175
Onderzoek ....................................................................................................................................175
Fysiologische gynaecomastie ........................................................................................................175
(Patho)fysiologie ...........................................................................................................................176
Diagnose gynaecomastie ...............................................................................................................177
Behandeling van gynaecomastie ....................................................................................................178
Hirsutisme ................................................................................................................................ 179
Differentiaal diagnoses ..................................................................................................................179
Pathogenese .................................................................................................................................179
Etiologie........................................................................................................................................180
Evaluatie hirustisme ......................................................................................................................182
Behandeling ..................................................................................................................................183
Transgender zorg ....................................................................................................................... 185
Genderkoek ..................................................................................................................................185
Problemen bij genderincongruentie ................................................................................................185
Medische zorg ...............................................................................................................................185
Medische interventies ...................................................................................................................185
Bijschildklieren – hypercalciëmie ............................................................................................... 189
2
, Calcium homeostase ....................................................................................................................189
Definitie hypercalcemie .................................................................................................................189
Fysiopathologie .............................................................................................................................189
Etiologie........................................................................................................................................189
Symptomen ..................................................................................................................................191
Diagnose ......................................................................................................................................192
Therapie .......................................................................................................................................192
Conclusies ...................................................................................................................................193
Bijschildklieren – multipele endocriene neoplasie (MEN) ............................................................ 194
Multipele endocriene neoplasie I....................................................................................................194
Multipele endocriene neoplasie II ...................................................................................................194
Bijschildklieren – hypocalcemie ................................................................................................. 196
Definitie ........................................................................................................................................196
Fysiopathologie .............................................................................................................................196
Etiologie........................................................................................................................................196
Symptomen ..................................................................................................................................198
Diagnose ......................................................................................................................................199
Therapie .......................................................................................................................................200
Conclusies ...................................................................................................................................200
Diabetische voet ....................................................................................................................... 201
Epidemiologie ...............................................................................................................................201
Pathofysiologie .............................................................................................................................201
Classificatie ..................................................................................................................................204
Behandeling ..................................................................................................................................205
Preventie! .....................................................................................................................................206
3
,Diabetes mellitus
Definitie/diagnose
- Metabole ziekte primair gekenmerkt door hyperglycemie
- Veroorzaakt door
o Absoluut insulinetekort (type 1 diabetes)
o Relatief gebrek (type 2 diabetes) aan insuline met/zonder insulineresistentie
- Stoornissen in het koolhydraatmetabolisme, eiwit- en vetstofwisseling
o Want insuline heeft hier ook allemaal effect op
- Chronische hyperglycemie → langetermijnscomplicaties
o Microvasculaire (oa retinopathie, nefropathie, neuropathie)
o Macrovasculaire verwikkelingen (hart- en vaatziekten)
- Prevalentie
o Toenemende prevalentie van diabetes in België
o 7-10% heeft T2DM, maar waarschijnlijk onderschat, want niet iedereen gediagnosticeerd
o 65j en ouder: bijna 20% heeft diabetes (vnl T2DM)
o Ook veel GGT (verstoorde glucosetolerantie), indicator van pre-diabetes
Risico-inschatting T2DM: FINDRISC vragenlijst
- Interpretatie:
o 1-6 punten
§ Kans op DM binnen 10 jaar: 1 op 100
o 7-11 punten
§ 1 op 25 – blijf dus gezond eten en goed
bewegen
o 12-14 punten
§ 1 op 6 – gezonde voeding en beweging. Ga
naar huisarts voor een nuchtere
bloedsuikerbepaling
o 15-20 punten
§ 1 op 3 – ga naar huisarts voor een nuchtere
glucosebepaling. Maak dringend werk van
gezonde levensstijl: beweging, groenten en
fruit
o 21-26 punten
§ 1 op 2 – misschien hebt u al diabetes zonder het te weten? Het is noodzakelijk
uw levensstijl aan te passen. Ga naar uw huisarts voor een nuchtere bloedname
4
, Prediabetes en risico op DM
- IFG (impaired fasting glucose) OF IGT (impaired glucose tolerance): ~5-7% per jaar ontwikkelt DM
- IFG + IGT: ~10-13% per jaar ontwikkelt DM
- HbA1c 5.7-6.4%: ~5% per jaar ontwikkelt DM
- Risico verlagen:
o Dieetadvies en 30min fysieke activiteit per dag: -58% kans
o LEVENSSTIJL is dus zeer belangrijk
Diagnose ‼‼
Criteria voor de diagnose van diabetes (1 is voldoende voor diagnose)
- A1C (geeft idee over chronische glucoseregulatie) ≥ 6.5%
- FPG ≥ 126 mg/dl (vasten: geen calorische intake voor minstens 8u)
- 2u plasma glucose ≥ 200 mg/dl tijdens een OGTT
- Pt met klassieke symptomen van hyperglycemie of hyperglycemische crisis (polydypsie, polyurie,
herhaaldelijke bacteriële UWI’s…), random plasma glucose ≥ 200mg/dl
Orale glucosetolerantietest (OGTT)!
OGTT Nuchter 2u na 75g glucosedrank
Normaal <100 mg/dl (5.6 mmol/L) <140 mg/dl (7.8 mmol/L)
Gestuurde nuchtere glycemie (IFG) 100-125 mg/dl
(prediabetes)
Gestoorde glucosetolerantie (IGT) 140-199 mg/dl
(prediabetes)
Diabetes mellitus ≥126 mg/dl (7.0 mmol/L) ≥200 mg/dl (11.1 mmol/L)
Classificatie
- Type 1 diabetes
- Type 2 diabetes
- Andere specifieke types: MODY (monogenetische diabetes), endocrinopathie,
medicatiegeïnduceerd, pancreaspathologie…
- Zwangerschapsdiabetes
Zwangerschapsdiabetes:
5
Diabetes mellitus ......................................................................................................................... 4
Definitie/diagnose ............................................................................................................................ 4
Acute complicaties ........................................................................................................................ 12
Chronische complicaties: microvasculair ........................................................................................ 21
Chronsiche complicaties: macrovasculair....................................................................................... 35
Behandeling van T2DM: orale antidiabetica ..................................................................................... 39
Behandeling van T2DM: injectables ................................................................................................. 46
Behandeling van T1DM ................................................................................................................... 52
Workshop: insulinetherapie ............................................................................................................ 57
Workshop: orale antidiabetica en GLP1RA ....................................................................................... 60
Schildklier................................................................................................................................... 62
Hyperthyroïdie ............................................................................................................................... 62
Hypothyroïdie ................................................................................................................................ 73
Euthyroïde goiter ............................................................................................................................ 78
Solitaire nodule .............................................................................................................................. 83
Schildkliercarcinoom ..................................................................................................................... 86
Hypofyse ..................................................................................................................................... 92
Hypofyse adenomen ...................................................................................................................... 92
Hypopituïtarisme............................................................................................................................ 94
Acromegalie................................................................................................................................... 99
Hyperprolactinemie.......................................................................................................................105
Neurohypofyse – diabetes insipidus en SiADH ................................................................................109
Radiologie hypofyse ......................................................................................................................114
Bijnieren ................................................................................................................................... 115
Cushing ........................................................................................................................................115
Primair aldosteronisme .................................................................................................................121
Feochromocytoom ........................................................................................................................125
Congenitale adrenale hyperplasie (CAH) ........................................................................................128
Bijnierincidentaloom .....................................................................................................................130
Addison ........................................................................................................................................131
Beeldvorming bijnieren ..................................................................................................................137
Lipiden – dyslipidemie ............................................................................................................... 142
Classificatie van lipide aandoeningen.............................................................................................142
Behandeling van hypercholesterolemie en dyslipidemie..................................................................145
Hypoglycemie bij niet diabeten .................................................................................................. 150
1
, Definitie hypoglycemie ..................................................................................................................150
Reactieve hypoglycemie ................................................................................................................151
Definitieve hypoglycemie ...............................................................................................................151
Besluit ..........................................................................................................................................155
Obesitas ................................................................................................................................... 156
Controle van gewichtshomeostase ................................................................................................156
Wat is obesitas? ............................................................................................................................156
Oorzaken van obesitas ..................................................................................................................158
Complicaties ................................................................................................................................160
Evaluatie van obesitas ...................................................................................................................161
Behandeling ..................................................................................................................................163
Hypogonadisme – man............................................................................................................... 167
Symptomen en tekens van hypogonadisme ....................................................................................167
Meten van testosteron ...................................................................................................................167
Oorzaken van hypogonadisme .......................................................................................................168
Hypogonadisme – vrouwen ........................................................................................................ 173
Hypogonadotroop hypogonadisme ................................................................................................173
Hypergonadotroop hypogonadisme ...............................................................................................174
Gynaecomastie ......................................................................................................................... 175
Differentieel diagnose....................................................................................................................175
Onderzoek ....................................................................................................................................175
Fysiologische gynaecomastie ........................................................................................................175
(Patho)fysiologie ...........................................................................................................................176
Diagnose gynaecomastie ...............................................................................................................177
Behandeling van gynaecomastie ....................................................................................................178
Hirsutisme ................................................................................................................................ 179
Differentiaal diagnoses ..................................................................................................................179
Pathogenese .................................................................................................................................179
Etiologie........................................................................................................................................180
Evaluatie hirustisme ......................................................................................................................182
Behandeling ..................................................................................................................................183
Transgender zorg ....................................................................................................................... 185
Genderkoek ..................................................................................................................................185
Problemen bij genderincongruentie ................................................................................................185
Medische zorg ...............................................................................................................................185
Medische interventies ...................................................................................................................185
Bijschildklieren – hypercalciëmie ............................................................................................... 189
2
, Calcium homeostase ....................................................................................................................189
Definitie hypercalcemie .................................................................................................................189
Fysiopathologie .............................................................................................................................189
Etiologie........................................................................................................................................189
Symptomen ..................................................................................................................................191
Diagnose ......................................................................................................................................192
Therapie .......................................................................................................................................192
Conclusies ...................................................................................................................................193
Bijschildklieren – multipele endocriene neoplasie (MEN) ............................................................ 194
Multipele endocriene neoplasie I....................................................................................................194
Multipele endocriene neoplasie II ...................................................................................................194
Bijschildklieren – hypocalcemie ................................................................................................. 196
Definitie ........................................................................................................................................196
Fysiopathologie .............................................................................................................................196
Etiologie........................................................................................................................................196
Symptomen ..................................................................................................................................198
Diagnose ......................................................................................................................................199
Therapie .......................................................................................................................................200
Conclusies ...................................................................................................................................200
Diabetische voet ....................................................................................................................... 201
Epidemiologie ...............................................................................................................................201
Pathofysiologie .............................................................................................................................201
Classificatie ..................................................................................................................................204
Behandeling ..................................................................................................................................205
Preventie! .....................................................................................................................................206
3
,Diabetes mellitus
Definitie/diagnose
- Metabole ziekte primair gekenmerkt door hyperglycemie
- Veroorzaakt door
o Absoluut insulinetekort (type 1 diabetes)
o Relatief gebrek (type 2 diabetes) aan insuline met/zonder insulineresistentie
- Stoornissen in het koolhydraatmetabolisme, eiwit- en vetstofwisseling
o Want insuline heeft hier ook allemaal effect op
- Chronische hyperglycemie → langetermijnscomplicaties
o Microvasculaire (oa retinopathie, nefropathie, neuropathie)
o Macrovasculaire verwikkelingen (hart- en vaatziekten)
- Prevalentie
o Toenemende prevalentie van diabetes in België
o 7-10% heeft T2DM, maar waarschijnlijk onderschat, want niet iedereen gediagnosticeerd
o 65j en ouder: bijna 20% heeft diabetes (vnl T2DM)
o Ook veel GGT (verstoorde glucosetolerantie), indicator van pre-diabetes
Risico-inschatting T2DM: FINDRISC vragenlijst
- Interpretatie:
o 1-6 punten
§ Kans op DM binnen 10 jaar: 1 op 100
o 7-11 punten
§ 1 op 25 – blijf dus gezond eten en goed
bewegen
o 12-14 punten
§ 1 op 6 – gezonde voeding en beweging. Ga
naar huisarts voor een nuchtere
bloedsuikerbepaling
o 15-20 punten
§ 1 op 3 – ga naar huisarts voor een nuchtere
glucosebepaling. Maak dringend werk van
gezonde levensstijl: beweging, groenten en
fruit
o 21-26 punten
§ 1 op 2 – misschien hebt u al diabetes zonder het te weten? Het is noodzakelijk
uw levensstijl aan te passen. Ga naar uw huisarts voor een nuchtere bloedname
4
, Prediabetes en risico op DM
- IFG (impaired fasting glucose) OF IGT (impaired glucose tolerance): ~5-7% per jaar ontwikkelt DM
- IFG + IGT: ~10-13% per jaar ontwikkelt DM
- HbA1c 5.7-6.4%: ~5% per jaar ontwikkelt DM
- Risico verlagen:
o Dieetadvies en 30min fysieke activiteit per dag: -58% kans
o LEVENSSTIJL is dus zeer belangrijk
Diagnose ‼‼
Criteria voor de diagnose van diabetes (1 is voldoende voor diagnose)
- A1C (geeft idee over chronische glucoseregulatie) ≥ 6.5%
- FPG ≥ 126 mg/dl (vasten: geen calorische intake voor minstens 8u)
- 2u plasma glucose ≥ 200 mg/dl tijdens een OGTT
- Pt met klassieke symptomen van hyperglycemie of hyperglycemische crisis (polydypsie, polyurie,
herhaaldelijke bacteriële UWI’s…), random plasma glucose ≥ 200mg/dl
Orale glucosetolerantietest (OGTT)!
OGTT Nuchter 2u na 75g glucosedrank
Normaal <100 mg/dl (5.6 mmol/L) <140 mg/dl (7.8 mmol/L)
Gestuurde nuchtere glycemie (IFG) 100-125 mg/dl
(prediabetes)
Gestoorde glucosetolerantie (IGT) 140-199 mg/dl
(prediabetes)
Diabetes mellitus ≥126 mg/dl (7.0 mmol/L) ≥200 mg/dl (11.1 mmol/L)
Classificatie
- Type 1 diabetes
- Type 2 diabetes
- Andere specifieke types: MODY (monogenetische diabetes), endocrinopathie,
medicatiegeïnduceerd, pancreaspathologie…
- Zwangerschapsdiabetes
Zwangerschapsdiabetes:
5
