ENDOCRINOLOGIE
Uantwerpen, Prof. Dr. De Block
1
,Inhoudsopgave
1 HYPOFYSE ADENOOM ............................................................................................................. 5
2 HYPOPITUARISME ................................................................................................................... 7
2.1 ETIOLOGIE .................................................................................................................................8
2.2 KLINIEK .....................................................................................................................................9
2.3 GROEIHORMOON DEFICIËNTIE.....................................................................................................10
3 ACROMEGALIE ...................................................................................................................... 12
3.1 ETIOLOGIE ...............................................................................................................................12
3.2 KLINIEK ...................................................................................................................................12
3.3 BEHANDELING..........................................................................................................................13
4 PROLACTINOOM ................................................................................................................... 15
4.1 ETIOLOGIE ...............................................................................................................................15
4.2 KLINIEK ...................................................................................................................................15
4.3 BEHANDELING..........................................................................................................................16
5 NEUROHYPOFYSE .................................................................................................................. 17
5.1 DIABETES INSIPIDUS ..................................................................................................................17
5.2 SIADH ...................................................................................................................................18
6 SYNDROOM VAN CUSHING ................................................................................................... 20
6.1 KLINIEK ...................................................................................................................................21
6.2 DIAGNOSE ...............................................................................................................................22
6.3 BEHANDELING..........................................................................................................................23
7 ZIEKTE VAN ADDISON............................................................................................................ 25
7.1 ETIOLOGIE ...............................................................................................................................25
7.2 KLINIEK ...................................................................................................................................25
7.3 BEHANDELING..........................................................................................................................27
8 PRIMAIRE ALDOSTEROSIME + ZELDZAME BIJNIERZIEKTE ....................................................... 28
8.1 PRIMAIR ALDOSTERONISME ........................................................................................................28
8.2 FEOCHROMOCYTOOM ...............................................................................................................30
8.3 SURRENALE HYPERANDROGENEMIE..............................................................................................31
9 HYPERTHYROÏDIE .................................................................................................................. 33
9.1 ZIEKTE VAN GRAVES-BASEDOW ..................................................................................................33
9.2 TOXISCH SCHILDKLIER ................................................................................................................35
9.3 T HYROÏDITIS............................................................................................................................36
10 HYPOTHRYOÏDIE.................................................................................................................... 38
10.1 HASHIMOTO: AUTOIMMUNE THYROÏDITIS .....................................................................................39
11 SCHILDKLIER GOITER EN NODULE .......................................................................................... 41
2
, 11.1 EUTHYROÏDISCHE GOITER ...........................................................................................................41
11.2 KLINIEK ...................................................................................................................................42
11.3 SOLITAIRE NODULE ...................................................................................................................43
12 SCHILDKLIER CARCINOOM ..................................................................................................... 45
13 HYPERCALCIËMIE .................................................................................................................. 48
13.1 CALCIUM HOMEOSTASE .............................................................................................................48
13.2 OORZAKEN ..............................................................................................................................48
13.3 KLINIEK ...................................................................................................................................50
13.4 BEHANDELING..........................................................................................................................51
14 MULTIPLE ENDOCRIENE NEOPLASIE (MEN) SYNDROOM ........................................................ 53
15 HYPOCALCIËMIE .................................................................................................................... 54
15.1 ETIOLOGIE ...............................................................................................................................54
15.2 KLINIEK ...................................................................................................................................55
16 HIRSUTISME .......................................................................................................................... 57
16.1 ETIOLOGIE ...............................................................................................................................58
16.2 POLYCYSTISCH OVARIEEL SYNDROOM ...........................................................................................58
16.3 ANDERE OORZAKEN ..................................................................................................................59
16.4 KLINIEK ...................................................................................................................................60
17 GYNECOMASTIE .................................................................................................................... 62
17.1 PATHOFYSIOLOGIE ....................................................................................................................62
17.2 OORZAKEN .......................................................................... FOUT! BLADWIJZER NIET GEDEFINIEERD.
17.3 DIAGNOSE ...............................................................................................................................64
17.4 BEHANDELING..........................................................................................................................64
18 DIABETES .............................................................................................................................. 66
18.1 DIABETES MELLITUS TYPE 1 ........................................................................................................67
18.2 DIABETES MELLITUS TYPE 2 ........................................................................................................68
18.3 HYPERGLYCEMIE .......................................................................................................................69
18.3.1 Acute hyperglycemische keto-acidotische coma .........................................................69
18.3.2 Hyperosmolair non-ketotische hyperglycemische coma .............................................71
18.3.3 Medicatie gerelateerde acidose ..................................................................................71
18.4 HYPOGLYCEMIE ........................................................................................................................72
19 DIABETES CHRONISCHE COMPLICATIES ................................................................................. 75
19.1 HET BELANG VAN METABOLE CONTROLE .......................................................................................75
19.2 RETINOPATHIE .........................................................................................................................76
19.3 NEFROPATHIE ..........................................................................................................................76
19.4 NEUROPATHIE..........................................................................................................................77
19.4.1 Senso-somatische neuropathie ...................................................................................78
19.4.2 Autonome neuropathie ...............................................................................................79
19.5 MACROVASCULAIRE COMPLICATIES..............................................................................................80
19.6 DE DIABETEISCHE VOET ..............................................................................................................81
3
, 19.7 ANDERE COMPLICATIES..............................................................................................................82
20 DIABETES: BEHANDELING ...................................................................................................... 83
20.1 DIABTES MELLITUS TYPE 1 ..........................................................................................................83
20.2 DIABETES MELLITUS TYPE 2: ORALE ANTIDIABETICA + GLP-1 (INJECTIE)..............................................84
20.3 RICHTLIJNEN ............................................................................................................................89
21 HYPOGLYCEMIE BIJ NIET DIABETEN ....................................................................................... 93
21.1 ETIOLOGIE ...............................................................................................................................93
21.1.1 Ziekte pt of medicatie ..................................................................................................93
21.1.2 Gezonde pt ..................................................................................................................94
21.2 DIAGNOSE ...............................................................................................................................95
21.3 DUMPING SYNDROOM...............................................................................................................96
22 HYPERLIPIDEMIE ................................................................................................................... 98
22.1 PATHOFYSIOLOGIE ....................................................................................................................98
22.2 CLASSIFICATIE ..........................................................................................................................98
22.3 BEHANDELING........................................................................................................................100
23 OBESITAS ............................................................................................................................ 103
23.1 PATHOFYSIOLOGIE ..................................................................................................................103
23.2 OORZAKEN ............................................................................................................................103
23.3 COMPLICATIES .......................................................................................................................105
23.4 BEHANDELING........................................................................................................................105
4
Uantwerpen, Prof. Dr. De Block
1
,Inhoudsopgave
1 HYPOFYSE ADENOOM ............................................................................................................. 5
2 HYPOPITUARISME ................................................................................................................... 7
2.1 ETIOLOGIE .................................................................................................................................8
2.2 KLINIEK .....................................................................................................................................9
2.3 GROEIHORMOON DEFICIËNTIE.....................................................................................................10
3 ACROMEGALIE ...................................................................................................................... 12
3.1 ETIOLOGIE ...............................................................................................................................12
3.2 KLINIEK ...................................................................................................................................12
3.3 BEHANDELING..........................................................................................................................13
4 PROLACTINOOM ................................................................................................................... 15
4.1 ETIOLOGIE ...............................................................................................................................15
4.2 KLINIEK ...................................................................................................................................15
4.3 BEHANDELING..........................................................................................................................16
5 NEUROHYPOFYSE .................................................................................................................. 17
5.1 DIABETES INSIPIDUS ..................................................................................................................17
5.2 SIADH ...................................................................................................................................18
6 SYNDROOM VAN CUSHING ................................................................................................... 20
6.1 KLINIEK ...................................................................................................................................21
6.2 DIAGNOSE ...............................................................................................................................22
6.3 BEHANDELING..........................................................................................................................23
7 ZIEKTE VAN ADDISON............................................................................................................ 25
7.1 ETIOLOGIE ...............................................................................................................................25
7.2 KLINIEK ...................................................................................................................................25
7.3 BEHANDELING..........................................................................................................................27
8 PRIMAIRE ALDOSTEROSIME + ZELDZAME BIJNIERZIEKTE ....................................................... 28
8.1 PRIMAIR ALDOSTERONISME ........................................................................................................28
8.2 FEOCHROMOCYTOOM ...............................................................................................................30
8.3 SURRENALE HYPERANDROGENEMIE..............................................................................................31
9 HYPERTHYROÏDIE .................................................................................................................. 33
9.1 ZIEKTE VAN GRAVES-BASEDOW ..................................................................................................33
9.2 TOXISCH SCHILDKLIER ................................................................................................................35
9.3 T HYROÏDITIS............................................................................................................................36
10 HYPOTHRYOÏDIE.................................................................................................................... 38
10.1 HASHIMOTO: AUTOIMMUNE THYROÏDITIS .....................................................................................39
11 SCHILDKLIER GOITER EN NODULE .......................................................................................... 41
2
, 11.1 EUTHYROÏDISCHE GOITER ...........................................................................................................41
11.2 KLINIEK ...................................................................................................................................42
11.3 SOLITAIRE NODULE ...................................................................................................................43
12 SCHILDKLIER CARCINOOM ..................................................................................................... 45
13 HYPERCALCIËMIE .................................................................................................................. 48
13.1 CALCIUM HOMEOSTASE .............................................................................................................48
13.2 OORZAKEN ..............................................................................................................................48
13.3 KLINIEK ...................................................................................................................................50
13.4 BEHANDELING..........................................................................................................................51
14 MULTIPLE ENDOCRIENE NEOPLASIE (MEN) SYNDROOM ........................................................ 53
15 HYPOCALCIËMIE .................................................................................................................... 54
15.1 ETIOLOGIE ...............................................................................................................................54
15.2 KLINIEK ...................................................................................................................................55
16 HIRSUTISME .......................................................................................................................... 57
16.1 ETIOLOGIE ...............................................................................................................................58
16.2 POLYCYSTISCH OVARIEEL SYNDROOM ...........................................................................................58
16.3 ANDERE OORZAKEN ..................................................................................................................59
16.4 KLINIEK ...................................................................................................................................60
17 GYNECOMASTIE .................................................................................................................... 62
17.1 PATHOFYSIOLOGIE ....................................................................................................................62
17.2 OORZAKEN .......................................................................... FOUT! BLADWIJZER NIET GEDEFINIEERD.
17.3 DIAGNOSE ...............................................................................................................................64
17.4 BEHANDELING..........................................................................................................................64
18 DIABETES .............................................................................................................................. 66
18.1 DIABETES MELLITUS TYPE 1 ........................................................................................................67
18.2 DIABETES MELLITUS TYPE 2 ........................................................................................................68
18.3 HYPERGLYCEMIE .......................................................................................................................69
18.3.1 Acute hyperglycemische keto-acidotische coma .........................................................69
18.3.2 Hyperosmolair non-ketotische hyperglycemische coma .............................................71
18.3.3 Medicatie gerelateerde acidose ..................................................................................71
18.4 HYPOGLYCEMIE ........................................................................................................................72
19 DIABETES CHRONISCHE COMPLICATIES ................................................................................. 75
19.1 HET BELANG VAN METABOLE CONTROLE .......................................................................................75
19.2 RETINOPATHIE .........................................................................................................................76
19.3 NEFROPATHIE ..........................................................................................................................76
19.4 NEUROPATHIE..........................................................................................................................77
19.4.1 Senso-somatische neuropathie ...................................................................................78
19.4.2 Autonome neuropathie ...............................................................................................79
19.5 MACROVASCULAIRE COMPLICATIES..............................................................................................80
19.6 DE DIABETEISCHE VOET ..............................................................................................................81
3
, 19.7 ANDERE COMPLICATIES..............................................................................................................82
20 DIABETES: BEHANDELING ...................................................................................................... 83
20.1 DIABTES MELLITUS TYPE 1 ..........................................................................................................83
20.2 DIABETES MELLITUS TYPE 2: ORALE ANTIDIABETICA + GLP-1 (INJECTIE)..............................................84
20.3 RICHTLIJNEN ............................................................................................................................89
21 HYPOGLYCEMIE BIJ NIET DIABETEN ....................................................................................... 93
21.1 ETIOLOGIE ...............................................................................................................................93
21.1.1 Ziekte pt of medicatie ..................................................................................................93
21.1.2 Gezonde pt ..................................................................................................................94
21.2 DIAGNOSE ...............................................................................................................................95
21.3 DUMPING SYNDROOM...............................................................................................................96
22 HYPERLIPIDEMIE ................................................................................................................... 98
22.1 PATHOFYSIOLOGIE ....................................................................................................................98
22.2 CLASSIFICATIE ..........................................................................................................................98
22.3 BEHANDELING........................................................................................................................100
23 OBESITAS ............................................................................................................................ 103
23.1 PATHOFYSIOLOGIE ..................................................................................................................103
23.2 OORZAKEN ............................................................................................................................103
23.3 COMPLICATIES .......................................................................................................................105
23.4 BEHANDELING........................................................................................................................105
4
