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Endocrino para el ENARM || Dr Garcia

Dr Garcia・71 minutes read

Endocrinology covers topics such as diabetes, obesity, metabolic syndrome, and thyroid disorders, with treatment options ranging from non-pharmacological methods to pharmacological interventions and surgical procedures. Diagnosis and management of endocrine disorders involve a variety of tests, criteria, and treatment protocols tailored to each condition, highlighting the importance of regular monitoring and individualized care.

Insights

Metabolic syndrome diagnosis requires three positive criteria: abdominal obesity, high blood pressure, elevated triglycerides, low HDL, and altered fasting glucose.
Treatment for hypothyroidism involves levothyroxine, monitoring ts h levels until normalization, and considering treatment in subclinical cases with symptoms or specific risk factors.
Diagnosis of hyperprolactinemia involves prolactin level measurement, MRI of the pituitary gland, and treatment based on adenoma size, with surgery for macroadenomas and dopamine agonists for microadenomas.

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Recent questions

What are the treatment goals for diabetes?
Maintaining glycosylated hemoglobin below 7%, specific lipid levels, normal weight, and avoiding smoking and nephrotoxic substances.
What is the initial treatment for ketoacidosis?
Intravenous saline solutions before insulin administration.
What is the primary treatment for hypothyroidism?
Levothyroxine, taken in fasting 30 minutes to an hour before eating.
What are the common symptoms of hyperprolactinemia?
Headache, rhinorrhea, visual alterations, forced amenorrhea or galactorrhea.
How is hyperaldosteronism diagnosed?
Renin aldosterone ratio (PAC: PRA) test and adrenal tomography.

Related videos

Summary

00:00

Managing Diabetes: Diagnosis, Treatment, and Goals

Endocrinology is a highly requested topic on the channel due to the prevalence of diabetes and obesity in Mexico.
A clinical case is presented of a 60-year-old patient with specific vital signs and lab results indicating metabolic syndrome.
Metabolic syndrome diagnosis requires three positive criteria, including abdominal obesity, high blood pressure, elevated triglycerides, low HDL, and altered fasting glucose.
Type 1 diabetes is associated with specific leukocyte histocompatibility antigens, while type 2 diabetes diagnosis requires two positive criteria from fasting glucose, glucose tolerance curve, glycosylated hemoglobin, or random glucose levels.
Non-pharmacological treatment for diabetes includes weight loss, exercise, and a diet rich in polysaccharides and proteins unless kidney damage is present.
Metformin is the first-line pharmacological treatment for diabetes, with regular patient evaluations every three to six months.
Treatment goals for diabetes include maintaining glycosylated hemoglobin below 7%, specific lipid levels, normal weight, and avoiding smoking and nephrotoxic substances.
Antibodies found in type 1 diabetes include anti-GAD, anti-ICA, and anti-IA2.
DPP-4 inhibitors can be given at any stage of chronic kidney disease, while metformin is contraindicated below a glomerular filtration rate of 30 ml/min.
Insulin therapy is indicated for patients with high plasma glucose or glycosylated hemoglobin levels, pregnant patients, or those hospitalized, with different types of insulins available for treatment.

14:55

Managing Diabetes and Hypercholesterolemia with Statins

Statins are preferred over fibrates for mixed hypercholesterolemia, depending on triglyceride levels.
Statins are categorized as low, intermediate, or high potency, with pravastatin recommended for dyslipidemia in diabetes.
Atorvastatin at high doses is advised for acute events like heart attacks.
Ketoacidosis is more common in type 1 diabetes due to insulin deficiency.
Criteria for diagnosing ketoacidosis include glucose levels over 250 mg/dL, pH below 7.3, and low bicarbonate.
Initial treatment for ketoacidosis involves intravenous saline solutions before insulin administration.
Hyperosmolar state is more prevalent in type 2 diabetes, with glucose levels exceeding 600 mg/dL.
Initial treatment for hyperosmolar state includes intravenous solutions and insulin if necessary.
Ophthalmological follow-up for type 2 diabetes is recommended annually, while for type 1 diabetes, it's 3 to 5 years post-diagnosis.
IECAs are recommended for diabetic patients with proteinuria.

28:59

Hypothyroidism: Symptoms, Diagnosis, and Treatment Options

Clinical picture of a hypothyroidism patient includes goiter, weight gain, constipation, carpal tunnel wrist pain, bradycardia, and cold intolerance.
Most common symptoms in hypothyroidism are cold intolerance and alterations in memory.
Diagnosis involves requesting a thyroid profile, antibodies like anti pp or iu for Hashimoto's thyroiditis, a thyroid gammagram, and an ultrasound if a nodule is present.
Primary hypothyroidism shows increased ts h levels and decreased thyroid hormones, with free t4 being crucial for monitoring.
Secondary hypothyroidism involves decreased ts h and thyroid hormones, with subclinical hypothyroidism showing normal ts h levels and high ts h.
Sick thyroid syndrome in polytraumatized patients presents normal ts h and thyroid hormones but elevated reverse t3.
Treatment for hypothyroidism includes levothyroxine, taken in fasting 30 minutes to an hour before eating, with doses ranging from 1.6 to 1.8 thousand micrograms per kilogram per day.
Monitoring treatment effectiveness involves checking ts h levels until they normalize, with treatment recommended in subclinical hypothyroidism when symptoms appear or in specific conditions like cardiovascular risk factors or infertility.
Grave's disease, a common cause of hyperthyroidism, presents with a classic triad of goiter, ophthalmia, and mick edema, with treatment options including antithyroids, radioiodine, and thyroidectomy.
Diagnosis of Grave's disease involves a thyroid profile showing suppressed ts h and increased free t4, with anti tc antibodies and a thyroid gammagram aiding in differentiation.
Complications of Grave's disease can include severe manifestations like thyroid storm, and treatment involves antithyroids, symptomatic relief with propranolol, and long-term management leading to potential hypothyroidism.

43:23

Thyroid Disorders: Diagnosis, Treatment, and Risk Factors

Hypothyroidism leads to hyperthyroidism when follicles rupture, diagnosed clinically with ultrasound as a supportive tool.
Treatment for hyperthyroidism involves Haines + beta blockers during toxic episodes.
Riedel thyroiditis results in fibrosis of the gland, leading to hypothyroidism and necessitating gland removal.
Thyroid nodules are diagnosed through an algorithm, with size determining further evaluation.
A thyroid profile is crucial in diagnosing nodules, with specific criteria for benign versus malignant nodules.
Gammagram results guide the need for needle aspiration to determine malignancy.
Thyroid cancer classification includes papillary, follicular, medullary, and anaplastic types, each with distinct characteristics.
Papillary thyroid cancer commonly metastasizes to lymph nodes, while other types have different metastatic patterns.
Risk factors for thyroid cancer include radiation exposure and iodine deficiency.
Treatment for thyroid cancer involves surgical removal, radioiodine ablation, and hormone replacement therapy to prevent recurrence.

57:35

Hyperprolactinemia and Gigantism: Etiology, Diagnosis, Treatment

Hyperprolactinemia can be classified as microadenoma (less than 1 cm) or macroadenoma (more than 1 cm).
The main etiology of hyperprolactinemia depends on the physiological state, such as pregnancy, or a pathological state, like drug consumption.
Prolactin levels can help determine the possible etiology, with levels exceeding 100 nanograms in microadenomas.
Common symptoms of hyperprolactinemia include headache, rhinorrhea, visual alterations, and forced amenorrhea or galactorrhea.
Diagnosis of hyperprolactinemia involves measuring prolactin levels and conducting an MRI of the pituitary gland with contrast.
Treatment for hyperprolactinemia varies based on the adenoma size, with surgical intervention for macroadenomas and medical treatment with dopamine agonists for microadenomas.
Gigantism or acromegaly is primarily caused by macro pituitary adenomas, leading to compressive symptoms like visual disturbances and hyperhidrosis.
Patients with polyposis in the large intestine may be at risk for colon cancer and require a colonoscopy for diagnosis.
Diagnosis of gigantism involves screening with oral growth hormone suppression and a glucose tolerance curve to confirm the condition.
Treatment for gigantism includes surgical intervention for adenomas or medical treatment with somatostatin analogues.

01:12:21

Diagnosis and Treatment of Adrenal Disorders

Diagnosis of ectopic adrenal surgical adenoma, treated surgically or with ketoconazole if surgery is not an option.
Diagnosis of Cushing's disease through high-dose dexamethasone inhibition test, indicating pituitary origin.
Etiological diagnosis of hyperaldosteronism involves distinguishing between adenoma, bilateral hyperplasia, or neoplasia in adrenal glands.
Clinical presentation of resistant arterial hypertension in young patients with hypokalemia indicates hyperaldosteronism.
Diagnosis of hyperaldosteronism involves renin aldosterone ratio (PAC: PRA) test and adrenal tomography.
Treatment for hyperaldosteronism includes spironolactone and surgical intervention based on etiology.
Addison's disease diagnosis involves ACTH stimulation test to assess cortisol levels.
Treatment for Addison's disease includes hormone replacement therapy with hydrocortisone or cortisone.
Pheochromocytoma diagnosis based on symptoms of paroxysmal hypertension, headache, and palpitations, confirmed through catecholamines in urine test.
Treatment for pheochromocytoma involves alpha and beta blockade followed by surgery if necessary.

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