METABOLISME EN
HORMONEN 2
Universiteit Antwerpen
MASTER 1
,INHOUDSOPGAVE
Diabetes mellitus........................................................................................................................................ 6
Diagnose ............................................................................................................................................................... 6
Verschillende typen............................................................................................................................................... 7
Diabetes type I (10%) ........................................................................................................................................ 7
Diabetes type II (85%) ..................................................................................................................................... 10
Andere specifieke types (5%) ......................................................................................................................... 12
Zwangerschapsdiabetes ................................................................................................................................. 13
Acute complicaties .............................................................................................................................................. 13
Acute hypoglycemie ....................................................................................................................................... 13
Acute hyperglycemie ...................................................................................................................................... 16
Hyperglycemische diabetische ketoacidose ............................................................................................... 16
Euglycemische ketoacidose bij SGLT2-inhibitoren ..................................................................................... 19
Hyperosmolair coma (door dehydratatie) .................................................................................................. 19
Chronische complicaties ..................................................................................................................................... 20
Chronische microvasculaire complicaties ...................................................................................................... 20
Retinopathie ............................................................................................................................................... 22
Nefropathie................................................................................................................................................. 23
Neuropathie ................................................................................................................................................ 24
Chronische macrovasculaire complicaties ..................................................................................................... 27
Hartlijden .................................................................................................................................................... 27
Cerebrovasculair lijden ............................................................................................................................... 27
Perifeer vaatlijden ...................................................................................................................................... 27
Behandeling macrovasculaire complicaties ............................................................................................... 27
Overige complicaties ...................................................................................................................................... 28
Huidafwijkingen .......................................................................................................................................... 28
Tandafwijkingen ......................................................................................................................................... 29
Infecties ...................................................................................................................................................... 29
Diabetische voet ................................................................................................................................................. 29
Pathofysiologie ............................................................................................................................................... 29
Diagnose ......................................................................................................................................................... 33
Classificatie ..................................................................................................................................................... 34
Behandeling .................................................................................................................................................... 34
Preventie......................................................................................................................................................... 35
Behandeling ........................................................................................................................................................ 36
Behandeling diabetes type I ........................................................................................................................... 36
Insuline........................................................................................................................................................ 36
Monitoring .................................................................................................................................................. 38
Toediening .................................................................................................................................................. 39
Behandeling diabetes type II .......................................................................................................................... 40
Levensstijl aanpassingen ............................................................................................................................ 40
Orale antidiabetica ..................................................................................................................................... 40
injecties ....................................................................................................................................................... 45
Schildklierpathologie ................................................................................................................................ 48
Metabolisme en hormonen 2 1
, Hyperthyroïdie .................................................................................................................................................... 48
Symptomen..................................................................................................................................................... 48
Diagnose ......................................................................................................................................................... 49
Oorzaken......................................................................................................................................................... 50
Ziekte van Graves-Basedow........................................................................................................................ 50
Toxische multinodulaire goiter ................................................................................................................... 53
Toxisch adenoom ........................................................................................................................................ 54
Thyroïditis ................................................................................................................................................... 55
Medicatie/jodium-geïnduceerde hyperthyroïdie....................................................................................... 58
Hypothyroïdie ..................................................................................................................................................... 59
Symptomen..................................................................................................................................................... 59
Diagnose ......................................................................................................................................................... 60
Behandeling .................................................................................................................................................... 60
Oorzaken......................................................................................................................................................... 61
Ziekte van Hashimoto ................................................................................................................................. 61
Thyroïditis ................................................................................................................................................... 62
Overigen...................................................................................................................................................... 63
Euthyroïdie goiter (= struma).............................................................................................................................. 63
Pathofysiologie ............................................................................................................................................... 64
Differentiaal diagnose .................................................................................................................................... 64
Oorzaken......................................................................................................................................................... 64
Endemische goiter ...................................................................................................................................... 64
Familiale goiter ........................................................................................................................................... 65
Sporadische goiter ...................................................................................................................................... 65
Iatrogene goiter .......................................................................................................................................... 65
Diagnose ......................................................................................................................................................... 66
Behandeling .................................................................................................................................................... 67
Solitaire nodule ................................................................................................................................................... 68
Verschillende typen ........................................................................................................................................ 68
Benigne nodule ........................................................................................................................................... 68
MAligne nodule .......................................................................................................................................... 69
Andere nodules........................................................................................................................................... 69
Diagnose ......................................................................................................................................................... 69
Behandeling .................................................................................................................................................... 70
Schildkliercarcinoom ........................................................................................................................................... 70
Pathofysiologie ............................................................................................................................................... 70
Verschillende typen ........................................................................................................................................ 71
Symptomen..................................................................................................................................................... 72
Diagnose ......................................................................................................................................................... 72
Behandeling .................................................................................................................................................... 74
Prognose ......................................................................................................................................................... 75
Hypofyse pathologie ................................................................................................................................. 76
Adenohypofyse ................................................................................................................................................... 76
Hypofysetumor ............................................................................................................................................... 76
Symptomen................................................................................................................................................. 76
Diagnose ..................................................................................................................................................... 77
Behandeling ................................................................................................................................................ 78
Metabolisme en hormonen 2 2
, Samenvatting aanpak ................................................................................................................................. 79
Hypopituïtarisme ............................................................................................................................................ 79
Oorzaken..................................................................................................................................................... 80
GH deficiëntie ............................................................................................................................................. 81
LH/FSH deficiëntie ...................................................................................................................................... 82
TSH deficiëntie ............................................................................................................................................ 82
ACTH deficiëntie ......................................................................................................................................... 83
PRL deficiëntie ............................................................................................................................................ 83
ADH deficiëntie ........................................................................................................................................... 84
Hypersecretie.................................................................................................................................................. 84
Acromegalie ................................................................................................................................................ 84
Hyperprolactinemie .................................................................................................................................... 87
Neurohypofyse .................................................................................................................................................... 90
Diabetes insipidus ........................................................................................................................................... 90
SIADH (syndrome of inappropriate ADH secretion) ....................................................................................... 92
Beeldvorming ...................................................................................................................................................... 94
Bijnierpathologie ...................................................................................................................................... 95
Bijnierschorsinsufficiëntie ................................................................................................................................... 95
Verschillende vormen ..................................................................................................................................... 95
Oorzaken......................................................................................................................................................... 95
Symptomen..................................................................................................................................................... 97
Diagnose ......................................................................................................................................................... 98
Behandeling .................................................................................................................................................... 99
Prognose ....................................................................................................................................................... 100
Syndroom van Cushing ..................................................................................................................................... 100
Oorzaken....................................................................................................................................................... 101
Symptomen................................................................................................................................................... 102
Diagnose ....................................................................................................................................................... 103
Behandeling .................................................................................................................................................. 105
Prognose ....................................................................................................................................................... 106
Hyperaldosteronisme ........................................................................................................................................ 106
Oorzaken....................................................................................................................................................... 106
Symptomen................................................................................................................................................... 107
Screenen ....................................................................................................................................................... 107
Diagnose ....................................................................................................................................................... 108
Behandeling .................................................................................................................................................. 109
Feochromocytoom ............................................................................................................................................ 109
Regel van 10.................................................................................................................................................. 110
Oorzaken....................................................................................................................................................... 110
Kliniek............................................................................................................................................................ 110
Diagnose ....................................................................................................................................................... 111
Behandeling .................................................................................................................................................. 112
Hyperandrogenemie ......................................................................................................................................... 113
Congenitale bijnierhyperplasie ..................................................................................................................... 113
Bijnierincidentaloom ......................................................................................................................................... 115
Metabolisme en hormonen 2 3
HORMONEN 2
Universiteit Antwerpen
MASTER 1
,INHOUDSOPGAVE
Diabetes mellitus........................................................................................................................................ 6
Diagnose ............................................................................................................................................................... 6
Verschillende typen............................................................................................................................................... 7
Diabetes type I (10%) ........................................................................................................................................ 7
Diabetes type II (85%) ..................................................................................................................................... 10
Andere specifieke types (5%) ......................................................................................................................... 12
Zwangerschapsdiabetes ................................................................................................................................. 13
Acute complicaties .............................................................................................................................................. 13
Acute hypoglycemie ....................................................................................................................................... 13
Acute hyperglycemie ...................................................................................................................................... 16
Hyperglycemische diabetische ketoacidose ............................................................................................... 16
Euglycemische ketoacidose bij SGLT2-inhibitoren ..................................................................................... 19
Hyperosmolair coma (door dehydratatie) .................................................................................................. 19
Chronische complicaties ..................................................................................................................................... 20
Chronische microvasculaire complicaties ...................................................................................................... 20
Retinopathie ............................................................................................................................................... 22
Nefropathie................................................................................................................................................. 23
Neuropathie ................................................................................................................................................ 24
Chronische macrovasculaire complicaties ..................................................................................................... 27
Hartlijden .................................................................................................................................................... 27
Cerebrovasculair lijden ............................................................................................................................... 27
Perifeer vaatlijden ...................................................................................................................................... 27
Behandeling macrovasculaire complicaties ............................................................................................... 27
Overige complicaties ...................................................................................................................................... 28
Huidafwijkingen .......................................................................................................................................... 28
Tandafwijkingen ......................................................................................................................................... 29
Infecties ...................................................................................................................................................... 29
Diabetische voet ................................................................................................................................................. 29
Pathofysiologie ............................................................................................................................................... 29
Diagnose ......................................................................................................................................................... 33
Classificatie ..................................................................................................................................................... 34
Behandeling .................................................................................................................................................... 34
Preventie......................................................................................................................................................... 35
Behandeling ........................................................................................................................................................ 36
Behandeling diabetes type I ........................................................................................................................... 36
Insuline........................................................................................................................................................ 36
Monitoring .................................................................................................................................................. 38
Toediening .................................................................................................................................................. 39
Behandeling diabetes type II .......................................................................................................................... 40
Levensstijl aanpassingen ............................................................................................................................ 40
Orale antidiabetica ..................................................................................................................................... 40
injecties ....................................................................................................................................................... 45
Schildklierpathologie ................................................................................................................................ 48
Metabolisme en hormonen 2 1
, Hyperthyroïdie .................................................................................................................................................... 48
Symptomen..................................................................................................................................................... 48
Diagnose ......................................................................................................................................................... 49
Oorzaken......................................................................................................................................................... 50
Ziekte van Graves-Basedow........................................................................................................................ 50
Toxische multinodulaire goiter ................................................................................................................... 53
Toxisch adenoom ........................................................................................................................................ 54
Thyroïditis ................................................................................................................................................... 55
Medicatie/jodium-geïnduceerde hyperthyroïdie....................................................................................... 58
Hypothyroïdie ..................................................................................................................................................... 59
Symptomen..................................................................................................................................................... 59
Diagnose ......................................................................................................................................................... 60
Behandeling .................................................................................................................................................... 60
Oorzaken......................................................................................................................................................... 61
Ziekte van Hashimoto ................................................................................................................................. 61
Thyroïditis ................................................................................................................................................... 62
Overigen...................................................................................................................................................... 63
Euthyroïdie goiter (= struma).............................................................................................................................. 63
Pathofysiologie ............................................................................................................................................... 64
Differentiaal diagnose .................................................................................................................................... 64
Oorzaken......................................................................................................................................................... 64
Endemische goiter ...................................................................................................................................... 64
Familiale goiter ........................................................................................................................................... 65
Sporadische goiter ...................................................................................................................................... 65
Iatrogene goiter .......................................................................................................................................... 65
Diagnose ......................................................................................................................................................... 66
Behandeling .................................................................................................................................................... 67
Solitaire nodule ................................................................................................................................................... 68
Verschillende typen ........................................................................................................................................ 68
Benigne nodule ........................................................................................................................................... 68
MAligne nodule .......................................................................................................................................... 69
Andere nodules........................................................................................................................................... 69
Diagnose ......................................................................................................................................................... 69
Behandeling .................................................................................................................................................... 70
Schildkliercarcinoom ........................................................................................................................................... 70
Pathofysiologie ............................................................................................................................................... 70
Verschillende typen ........................................................................................................................................ 71
Symptomen..................................................................................................................................................... 72
Diagnose ......................................................................................................................................................... 72
Behandeling .................................................................................................................................................... 74
Prognose ......................................................................................................................................................... 75
Hypofyse pathologie ................................................................................................................................. 76
Adenohypofyse ................................................................................................................................................... 76
Hypofysetumor ............................................................................................................................................... 76
Symptomen................................................................................................................................................. 76
Diagnose ..................................................................................................................................................... 77
Behandeling ................................................................................................................................................ 78
Metabolisme en hormonen 2 2
, Samenvatting aanpak ................................................................................................................................. 79
Hypopituïtarisme ............................................................................................................................................ 79
Oorzaken..................................................................................................................................................... 80
GH deficiëntie ............................................................................................................................................. 81
LH/FSH deficiëntie ...................................................................................................................................... 82
TSH deficiëntie ............................................................................................................................................ 82
ACTH deficiëntie ......................................................................................................................................... 83
PRL deficiëntie ............................................................................................................................................ 83
ADH deficiëntie ........................................................................................................................................... 84
Hypersecretie.................................................................................................................................................. 84
Acromegalie ................................................................................................................................................ 84
Hyperprolactinemie .................................................................................................................................... 87
Neurohypofyse .................................................................................................................................................... 90
Diabetes insipidus ........................................................................................................................................... 90
SIADH (syndrome of inappropriate ADH secretion) ....................................................................................... 92
Beeldvorming ...................................................................................................................................................... 94
Bijnierpathologie ...................................................................................................................................... 95
Bijnierschorsinsufficiëntie ................................................................................................................................... 95
Verschillende vormen ..................................................................................................................................... 95
Oorzaken......................................................................................................................................................... 95
Symptomen..................................................................................................................................................... 97
Diagnose ......................................................................................................................................................... 98
Behandeling .................................................................................................................................................... 99
Prognose ....................................................................................................................................................... 100
Syndroom van Cushing ..................................................................................................................................... 100
Oorzaken....................................................................................................................................................... 101
Symptomen................................................................................................................................................... 102
Diagnose ....................................................................................................................................................... 103
Behandeling .................................................................................................................................................. 105
Prognose ....................................................................................................................................................... 106
Hyperaldosteronisme ........................................................................................................................................ 106
Oorzaken....................................................................................................................................................... 106
Symptomen................................................................................................................................................... 107
Screenen ....................................................................................................................................................... 107
Diagnose ....................................................................................................................................................... 108
Behandeling .................................................................................................................................................. 109
Feochromocytoom ............................................................................................................................................ 109
Regel van 10.................................................................................................................................................. 110
Oorzaken....................................................................................................................................................... 110
Kliniek............................................................................................................................................................ 110
Diagnose ....................................................................................................................................................... 111
Behandeling .................................................................................................................................................. 112
Hyperandrogenemie ......................................................................................................................................... 113
Congenitale bijnierhyperplasie ..................................................................................................................... 113
Bijnierincidentaloom ......................................................................................................................................... 115
Metabolisme en hormonen 2 3
