Metabolism & hormones 2
1
,Table of Contents
Diabetes.............................................................................................................................4
1 Labo onderzoeken bij diabetes + cut-offs....................................................................................4
2 Behandeling type 2 diabetes.......................................................................................................6
3 Verschil type 1 en type 2.............................................................................................................9
4 Pathofysiologie, symptomen en behandeling bij diabetes type 1..............................................11
5 Chronische complicaties............................................................................................................13
6 Diabetische neuropathie...........................................................................................................15
7 Acute complicaties diabetes......................................................................................................17
8 Diabetische voet.......................................................................................................................20
9 Diabetes mellitus......................................................................................................................23
Extra over diabetes......................................................................................................................24
Obesitas............................................................................................................................27
1 Definitie, oorzaak, complicaties................................................................................................27
2 Evaluatie...................................................................................................................................30
3 Behandeling..............................................................................................................................32
Extra over obesitas......................................................................................................................34
Schildklier.........................................................................................................................35
1 Multinodulaire goiter................................................................................................................35
2 Toxisch schildklieradenoom/solitaire nodule............................................................................37
3 Thyroïditis.................................................................................................................................39
4 Hyperthyroïdie..........................................................................................................................41
5 Goiter........................................................................................................................................43
6 Graves-Basedow.......................................................................................................................45
7 Hypothyroïdie...........................................................................................................................47
8 Schildklieradenoom en carcinoom............................................................................................49
Extra over de schildklier...............................................................................................................51
Bijnier...............................................................................................................................52
1 Addison.....................................................................................................................................52
2 Cushing.....................................................................................................................................55
3 Feochromocytoom....................................................................................................................58
4 Hyperaldosteronisme................................................................................................................60
5 Congenitale bijnierhyperplasie..................................................................................................62
2
, 6 Bijnier incidentaloom................................................................................................................64
Extra over de bijnier.....................................................................................................................65
Andrologie........................................................................................................................67
1 Hirsutisme.................................................................................................................................67
2 Gynaecomastie.........................................................................................................................70
3 Mannelijk hypogonadisme........................................................................................................72
4 Vrouwelijk hypogonodatroof hypogonadisme..........................................................................75
Extra over andrologie...................................................................................................................76
Dislipidemie......................................................................................................................77
1 Familiale hypercholesterolemie................................................................................................77
2 Andere lipidenstoornissen........................................................................................................79
3 Normaalwaardes lipiden...........................................................................................................81
Extra over dislipidemie................................................................................................................82
Hypoglycemie...................................................................................................................83
1 Somatische oorzaken van hypoglycemie behalve diabetes.......................................................83
2 Insulinoom, DD hyperinsulinemisch hypoglycemie...................................................................85
Extra over hypoglycemie..............................................................................................................87
Hypofyse...........................................................................................................................88
1 Niet secretered hypofyseadenoom...........................................................................................88
2 Acromegalie..............................................................................................................................90
3 Hyperprolactinemie..................................................................................................................93
4 Diabetes insipidus.....................................................................................................................95
5 SIADH........................................................................................................................................97
6 Hypopituïtarisme......................................................................................................................98
Extra over de hypofyse..............................................................................................................100
Bijschildklieren................................................................................................................102
1 Hypocalciemie.........................................................................................................................102
2 Hypercalciemie.......................................................................................................................105
Extra over de bijschildklierenn...................................................................................................108
Overkoepelende onderwerpen........................................................................................109
3
, Diabetes
1 Labo onderzoeken bij diabetes + cut-offs
Diagnose
Glycemie (2x testen)
o At random >=200mg/dl (icm symptomen)
o Nuchter >=126mg/dl (100-125 IFG)
OGTT >=200mg/dl (140-199 IGT)
HbA1c >=6,5%
Typering
HLA D3,4 disbalans met DQ8/9
Genetisch onderzoek (genetische vormen zoals MODY)
Beta-cel antilichamen
o ICA: islet cell antibodies
o IAA: insuline auto-antibodies
C-peptide
Andere oorzaken van diabetes/hyperglycemie
Pancreas
o Bijv hemochromatose: ijzer
Endocriene pathologie
o Cushing: screening 24u vrije cortisolurie, dan dexa suppressietest, dan midnight
speeksel
o Acromegalie: IGF-1 (correlatie met GH), OGTT supressietest GH
o Feo: catecholamines 24u urine in zure container, plasma
o Glucagonoom
Comorbiditeiten T1: auto-immuunziektes (HLA-gelinkt)
Graves/Hashimoto: TSH, T4
Addison: ACTH en cortisol in serum in de ochtend, stimulatietest ACTH/ITT
Evt. screenen voor coeliakie, auto-immune gastritis, pernicieuze anemie
Opstart medicatie
Nierfunctie
Leverfunctie
Cardiovasculair risico
Lipidenprofiel
o LDL <77mg/dl of <55mg/dl als CVD
o HDL >40mg/dl M, >45mg/dl V
o TG <150mg/dl
o Lp(a)
Follow-up/chronische complicaties
HbA1c
Lipiden
Nefropathie
o Kalium
o Microalbuminurie 30-300mg/dl
4
1
,Table of Contents
Diabetes.............................................................................................................................4
1 Labo onderzoeken bij diabetes + cut-offs....................................................................................4
2 Behandeling type 2 diabetes.......................................................................................................6
3 Verschil type 1 en type 2.............................................................................................................9
4 Pathofysiologie, symptomen en behandeling bij diabetes type 1..............................................11
5 Chronische complicaties............................................................................................................13
6 Diabetische neuropathie...........................................................................................................15
7 Acute complicaties diabetes......................................................................................................17
8 Diabetische voet.......................................................................................................................20
9 Diabetes mellitus......................................................................................................................23
Extra over diabetes......................................................................................................................24
Obesitas............................................................................................................................27
1 Definitie, oorzaak, complicaties................................................................................................27
2 Evaluatie...................................................................................................................................30
3 Behandeling..............................................................................................................................32
Extra over obesitas......................................................................................................................34
Schildklier.........................................................................................................................35
1 Multinodulaire goiter................................................................................................................35
2 Toxisch schildklieradenoom/solitaire nodule............................................................................37
3 Thyroïditis.................................................................................................................................39
4 Hyperthyroïdie..........................................................................................................................41
5 Goiter........................................................................................................................................43
6 Graves-Basedow.......................................................................................................................45
7 Hypothyroïdie...........................................................................................................................47
8 Schildklieradenoom en carcinoom............................................................................................49
Extra over de schildklier...............................................................................................................51
Bijnier...............................................................................................................................52
1 Addison.....................................................................................................................................52
2 Cushing.....................................................................................................................................55
3 Feochromocytoom....................................................................................................................58
4 Hyperaldosteronisme................................................................................................................60
5 Congenitale bijnierhyperplasie..................................................................................................62
2
, 6 Bijnier incidentaloom................................................................................................................64
Extra over de bijnier.....................................................................................................................65
Andrologie........................................................................................................................67
1 Hirsutisme.................................................................................................................................67
2 Gynaecomastie.........................................................................................................................70
3 Mannelijk hypogonadisme........................................................................................................72
4 Vrouwelijk hypogonodatroof hypogonadisme..........................................................................75
Extra over andrologie...................................................................................................................76
Dislipidemie......................................................................................................................77
1 Familiale hypercholesterolemie................................................................................................77
2 Andere lipidenstoornissen........................................................................................................79
3 Normaalwaardes lipiden...........................................................................................................81
Extra over dislipidemie................................................................................................................82
Hypoglycemie...................................................................................................................83
1 Somatische oorzaken van hypoglycemie behalve diabetes.......................................................83
2 Insulinoom, DD hyperinsulinemisch hypoglycemie...................................................................85
Extra over hypoglycemie..............................................................................................................87
Hypofyse...........................................................................................................................88
1 Niet secretered hypofyseadenoom...........................................................................................88
2 Acromegalie..............................................................................................................................90
3 Hyperprolactinemie..................................................................................................................93
4 Diabetes insipidus.....................................................................................................................95
5 SIADH........................................................................................................................................97
6 Hypopituïtarisme......................................................................................................................98
Extra over de hypofyse..............................................................................................................100
Bijschildklieren................................................................................................................102
1 Hypocalciemie.........................................................................................................................102
2 Hypercalciemie.......................................................................................................................105
Extra over de bijschildklierenn...................................................................................................108
Overkoepelende onderwerpen........................................................................................109
3
, Diabetes
1 Labo onderzoeken bij diabetes + cut-offs
Diagnose
Glycemie (2x testen)
o At random >=200mg/dl (icm symptomen)
o Nuchter >=126mg/dl (100-125 IFG)
OGTT >=200mg/dl (140-199 IGT)
HbA1c >=6,5%
Typering
HLA D3,4 disbalans met DQ8/9
Genetisch onderzoek (genetische vormen zoals MODY)
Beta-cel antilichamen
o ICA: islet cell antibodies
o IAA: insuline auto-antibodies
C-peptide
Andere oorzaken van diabetes/hyperglycemie
Pancreas
o Bijv hemochromatose: ijzer
Endocriene pathologie
o Cushing: screening 24u vrije cortisolurie, dan dexa suppressietest, dan midnight
speeksel
o Acromegalie: IGF-1 (correlatie met GH), OGTT supressietest GH
o Feo: catecholamines 24u urine in zure container, plasma
o Glucagonoom
Comorbiditeiten T1: auto-immuunziektes (HLA-gelinkt)
Graves/Hashimoto: TSH, T4
Addison: ACTH en cortisol in serum in de ochtend, stimulatietest ACTH/ITT
Evt. screenen voor coeliakie, auto-immune gastritis, pernicieuze anemie
Opstart medicatie
Nierfunctie
Leverfunctie
Cardiovasculair risico
Lipidenprofiel
o LDL <77mg/dl of <55mg/dl als CVD
o HDL >40mg/dl M, >45mg/dl V
o TG <150mg/dl
o Lp(a)
Follow-up/chronische complicaties
HbA1c
Lipiden
Nefropathie
o Kalium
o Microalbuminurie 30-300mg/dl
4
