Suppress Hormone
Gland
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Diagnosis of Endocrine disorders.
PITUITARY GLAND
All anterior pituitary hormones are under stimulatory control of hypothalamus except Prolactin (under -ve influence of Dopamine)
[PROLACTIN Under -ve influence of DOPAMINE]
Hypothalamus.
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*Pituitary stalk damage
Vascular
mode of
control
Neurogenic
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ADH
Recovery
Initially (Scandixation)
SIADH (transient)
Finally
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due to desfraction
of vesicles in pitcit
Permanent lesion
SIADH
ADH
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ADH
receptors Aquaporinsessive reabsorption H2O
(Mostly in the medullary )
AMP Renin Aldosterone Nether
H2O plasma volume?
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MG
Patient of SIADH generally do not have edema
SIADH Euvolemlo Hypauricenia
True Hyponatremia (due to H2O)
Urine Na 20-40 Meg/l (Should be above 20)
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Urine asre > Plasma asm.
Single most imp parameter for plasma amolality Na
PLASMA OSM 2 (Na) + Glu + BUN
18 2.8
OY 2 (Na+k) + Glu + BUN
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18 2.8
Testing for SIADH :-
Jstater laading Sert sok remains high formally ADH)
Confirme diagnosis of SIADH.
True about GLADH are HEL
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1) pters are class of drugs appresed for
Urine Ma il N to t
3) The plasma Na con be as low as 125 mesi
4) Walin Loading test can be used for diagnosi
1) Headache Q:- Fluid restriction. moder
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3) Samnolence Mat Correction. off
3) Altered Sensorium... Vaatass
4) Lerzeirer CONIVARTAN Selective va receptors
TOLVAPIAN blockers
Rapid Correction of Sadrien asly caus Devrelacycline
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cover "Control Pantine Myclinesis
Payuria: >40-50. ad /lg/day
> 3 litres / day
Crine aereolabily
<300 masa/1 >300mm/L
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Free water loss Solute loss.
Bimary polydipsia Diabclis Insipidlit
1) Psychogeric polydipsia Central Nephrogerie
Plasma Nat conc.: ? Plasma Nat cone. ?
may be @ but never Nat or @ bat never Not
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War deprivation test
(1hr & 3hrs after crater deprivation)
Urine osm ? Urine Osm 11
(should Smprove by of least ox I by <50%.
[5020) te tay primary paydipsia). Central Nephrogenic
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Urine Osm 11 Urine Osm
R:- Dermopressin B Thiazider
Spray ?
Thiazides help by
causing Na loss in scie
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Reffer Nat abreratten in pa
Polyuria
urine <300mOsm/L
ADH
ADHT
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?
Nephrogenic Di
ADH
?
Brimary pelydipsia
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Mannitol infusion ezill
never case hypernatrenia.
although it I plasma asm.
Central DI
MRI of pituitary to cot
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(post: pituitary normally appears bright);
Bright spot Bright spat
Brimary palydipsia Central Di
Travosa +
Polyuria. (31/day)}
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Cerebral Salt Wasting Syod.
?
Urine Sadivern t
Unat > 20meg/L.
Diabetes Triipidur
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UNA
UNA <20 Meg/1
rent / M SNot 4/1
Both urine Not 1 x 8. Not ? Mic coure Sative in Gurion
PROLACTH:
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Mic functiesal lusor of pituitary: Belactiseesa
Prolactio Galactorrhea
GARH &
?
FSH
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?
Addteagent Extregon k
Prolactinemas (me)
Prolactin levels (sceogg/cal) Physiological state
Dopamine blocker dr dong history...
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Hypathyroidism Arst lurale) causes of
?ll th
Prolactina
PROLACTINOMA
Zorfertility Aorgiacchaa
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CF &
? Erectile dysfunction Galactorrhea
Galactorrhea (157) Prolactinerra deesn't cause Gynaecomastia
Prolactinema
(1/cm)
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Miemadenoma Macroadenoma
FM = 2011 FMEIL
Q: f.ac.il Dopeerior agoneta Cabergeline line (D.0.0 in non-monast
Macroadenoma
Visual Syedans
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Cabengaline
Casseer after few mantre)
Visual Symptoms persist Visual symptoms
Surgery Continue treatment
Trans-spheroidal resection.
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Pregnancy Prodacten kurale to paygaaney-dan't
Brolactinoma.- correlate & severity/progno
Micrcadepsana Maercaderama
Oxxocromptine free follow up..
Visual fields
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Trare sebencidal resection
ACROMEGALY
Growth Hormone
Liver IGET
Epiphyseal growth seal growth Bene size/ lepath I
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I protein synthesis
Growth honosone
Na & insulin lipalysis
sutintion serectivity
Fasulla Argintere
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Like activity
Antilipolytic C/E-
TGH Muscle mass 1
Fat
Skull size ? Mandirlagroutthi gape
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Finger" + gape Wo Seeth
Feet Squaring of Mandible.
Enlarged Wall size Laget's discare Selle lurcice 1
Reconegsity Entanged sella turcice
Heet pad Thicknces 20m.
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Flezsky patere
I guicase. + Inralin resistance Dlabctée Mellitus
Na 1 + Systranc mecihr resistance Hypertension.
Cardiomyopathy Zechanic heart disease
Colonic polypr I sites of Ca Colon
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Motst daugby handsbake
Investigations.
8. Growth hormone levels axe not useful. In asecerment.
Screening test IGF 1 levels.
N
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Rule out disease Confirmatary test
Nil ovat overnight fasting
75 Togin glucose
GH & suppressed after thr
compared to bareline
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Seromegaly
OGII may be also used to describe the cenfiornatory list).
is Surgery
Drugs:- Sarmatastation anteques. (Octreotide, lanticstide)
MAT
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Resectable Men Resectable
Trass Sphenoidal Resection. Garima korife Surgery
(ne bongfit)
GH receptor blocken Legrisamarts).
GUSHINGS
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disease: Corticosteroid excers due to pitcilary ademama
Cushing syndrome: Entire spectrum of Corticosteroid exces disorders.
M.c. cause of Cueling syndrome: Patregenic
ACTH ? ACTH
Pituitary aderersa Adrenal
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Ectopic ACTH Syndrome No pigmentation
Pigmentation
Pitulary adenoma Ectopic. ACIM.
ACTH 1
Iasichiour Rapid anset Cortisol ? Mineralocorticor
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? bydroxylase
Cortisone Ne oriceralb
Hypokalemic Hypalsalemic
metabolic alkalosis metabolic alkalesie
40% 90%
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Insidious course hade Rapid course Ne indiction of UB-OH lase
-ta induction of B-bydraglase
which doesn't lead to rise in mineralocorticoids I mineralocorticoid activity.
F:M = 4:1 FM = 1:1 AF: M = A:1.
Obesity obesity ± obesity +
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(if obesity is absent it
is due to malignant cachexia)
Eartist manifestation of Culing's lah Jass of diurnal variation
cortisol levels.
west manifestation / cartiest /F atgaiy (glur constitutional features)
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[48 Centrál obezily Praedo Casting
Thin skin Easy bruisabilily alcoholics.
Moon facies
Strali abdamen
Thin extremeties
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Buffale hump
Ostiopecoris farthralgiai
Cushing Superted.
Overnight / low dare Dexa Suppresion Lect.
Img Dexamethaerine 11pm.
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8 am Cortisol
Coctisol Rule out Cruel
Cushing Cushing
ACTH ACTH
Pituitary adenoma Adrenal cause..
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Ectopic ACTH
High dase Dexa Supp. lest NCCT-abdomen...
<6cm >60m
Lituitary Benign Malignant
Ectopic 17 Ketasteroid II
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(ambiguous)
Petrous vein ACTH
Pexipheral vein ACIN
Petrous: Peripheral > 2:1 Pikuilery
44: Ectopic
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Pasiccatide alte through Sematistatin receptoce
Ketoconazole
Metyropane 19 hydroxylase inhibitors.
R.A.C Surgery
DISORDERS DE SEXUAL DEFERENTIATION (DSD)
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XX DSD XY DAD.
XY DSD: BRY gene on Y- ohromasome development of tatis
Jeevie Mullerian Inhibiting Factor.
Jestosterone.
5 a lestosterone reductare.
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Dihydroxy textosterone.
Astrogen receptors (x-chr-codes for androgen recepti
genitalia
Wolffour duct female structures
Wolffour duct Male structures
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External Genitalia develops from commen Embryonia Structurce
Of there is no Y-chromosome the Internal and external)
will lomate structures.
MIE bloks the Mutterian development
Testosterone pronadir development of Wolffion duct..
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DHT required for the external gerilitia to become mate
5° reductare deficiency.
caternal genitalia
MIE No mullerian development & internal,
Testosterone + Wolffian development A
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No DHI Denbiguous est genitalia (since the arklian
Androgen Receptor In Sensitivity
to dev inf
Testosterone
develop extigeritalia is creak) ()
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Testosterone + Na action on receptors 0 Wolffias Duct tabecot
MIF + Mullerian dict No mullerian systém
DHT + No action is receptors i cotermal genitalia
Testis are present in the abdomen / undiscended.
Will present at puberty with Minnany amenorrhea and blad ingreal pers
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Proast development will be sorasal. (esteggen dependent).
Axillary pubic hair will be absent (aadrages dependent)
Testicular feminization syndrome Karyotype xx
The testie axe either widescended Laser à Indirect in Sagedaal trovia
and have a 30 fold Afghar xists of maltenary (Sorsicana)
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Testicular Feminization Syndrome MRKH Syndrome
Xx Mullerian agenesis XX
IG Assort Int genitalia Absent
Ext genitalia Absent Ext: genitalia
Breast Breast
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Axillary/Pubic hair Asical Axillax Pubic.bair (N
inguinal hernias int (androger xcopter @)
Gonadal Dysgenesis Pure gonadal dragoncesi dysgences's
Mired ixed gonadal gonadal dysgencies.
Pure genadel dysgenesi Streals testis
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No testosterone, No MIF
Bath Int. cxt geritatia are fecrality default
Breast development - absent
Ari: / Aible hair growth - 1 (due to ansingens frens adrenal)
Mixed Gonadal Dozgenesis
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Qve Lielli (genad) & streak, one gonad i normal
General masculine picture, not proper masculinization because
Just ane ganad se present (virilization Hon i not completar)
Hypespadias As clamor
Range Normal nale to Male
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any phenotype in betrecer
XX D.SD.
Maternal couc Androgen producing tumor
Androgenic drugs
Eetal cave Congenital Adrenal Hyperplasia
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210 OR deficiency
14. 2014 Eyftinny Andenges
3. Bere deficiency
Cytochrome P450 oxidereductase
Aromatase defect Glucocorticoid receptor gene mutation.
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GEAWARSA CELL
FSH. Aromatase ESTROGEN
DHEA
H
Theca cells. TESTOSTERONE
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CAH
Cholestiral 17 lydroxy ketosteroids.
Pregnenelone 17-OH pregnene H pregnenolone D?
3BOH deryd Progeilesane 17-OH pengertirone Androstenedione
21 a hydroxylase 410ydrocoylase
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Deoxy corticosterone Deoxy Cortisol Testosterone
Portisone 804 delydrogenate
Medulla Reticularis Fasciculata. Glomerulosa.
Ses Merside. / Glucocorticoids / Mineralocorticity)
Most cancer enz defect. 210 bydroxylase deficiency.
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Autosomal recessive
Any defect of hacizantal enz will & formation of Corted
ACTH will constantly stimulate adrenal cortés
CAH
21004/11 Bar deficiency 17 K Katasteroid levels will ?
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Can be used for evaluation in care of
ambiguous genitalia
(17:04 progesterone crore proferred than 17:08 pxegreachzu
Deary corticosterone (Doc) hae mineralororticoid action
21204 11204
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Androgens 1 Padringens 1
Xx Ambigueur genitalia xx- ambiguous genitalie.....
XY precociou puberty. -de-
Metabolic acidars Metabdic alkalesi
Hyperkalemia Hypokalemla
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HTN
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PHAEOCHROMOCYTOMA / PARAGANGLIOMA
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Phacchromocytema is for timers of adrenal & extra-adrenal reglass
Paragangliona is for head and neck Linoy
95%
Asdomical Extra abdominal
90% 5%
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Adveral Extra-adresal
Urinary bladder
Rule of 10: 10% Extraadrenal
10% Bilateral
105 Children
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10 tegast malignast at the time of diggnosis
Tyrosine
DOPA
?
Dopamine
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?
Mor Adrenaline.
PrNMT not present in extra-adrenal
tissue, 80 in such tumors adrenalin)
is notpresent
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? Para ethetidamine methyl aferase (PNMT)
Adrenaline
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Extra-adrenal Adrenal Phaco
Nor adrenaline aug size 4 tass
<3cm >3cm
Epinephrine Noradrenaline
Tor MEN Syndrome, Phaes are adrenal? So adrenalin is produerd
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Malignant Phaco :- 4/cratie
Milotic Spindler Do not heth to differentiale
Capsular invasion
Metastore's only way to differentiati
Ipmauction of combrajante /primitive metabolilée Mitsi z
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HF: Headache Emic gyoyatorn).
Triad. Palpitation
Surcating
Wt. loss (differential for at Jers) fors
Phacochromocytama Thyrotoxicosis
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Catetiols 1 Catichale
Hyperadrenergic features Hyperadrenergic features.
? BMR ? IBMR.
Wt. loss Wt. Joss.
Tacky-CoVTI
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HTNS Sustained
Episodic Sustained
Tremor occassional Fromor
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Orthostatic hypotension abrent
(due to udume contrition)
Law 24 hoc urine catecholamine & Metanephrine seray ? T.O.C.
(fradtonalid)
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Plasma extechatamine & free asetrosphilae assay
Chromogranin A levelet in plasma.
Optional Inv for pharachiramaytona ? abderainal MRT (
lacatization it true if-ve.
MIBG (to look for ameti)
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Best suvestigation:- DOPA PET
X Bladers
Cirectvity
MIBG. (soultivity 8176)
Phexaxybenzamine (Rarter to achieve full offert)
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Prazasin
Phentolamine
Q-Blockade.
B. blockers Surgery
CONN'S - PRIMARY HYPERALDOSTERONISM
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Aldosterone 1
Not + TO ANP ? Natho
? kt? ?H++ (metabolic alkalosis)
HIN Renin
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As Conn's pimary hyperaldastèrantem (cana) do not have sedema.
Spironolactone, Eplerenone (Aldo xcceptor blocker)
Primary byperaldasteranian (Alde seula)
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Abdominal inagprag
8/1 - adrenal evitaregensert (7016)
caser ? Should only be wed for Adrenal adenome (3070)8
not for adornal hyperplasia
Auto Prusune Polyglandular Ayndrome
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APS 1 APS 2.
Early Childhood, infant Aldo Adolescent
Hype parathyroidism Cocliar Sprave, Dermatitie Herpaty
Asplenism Graves disease.
Mueacutaneous candidia's Hyperparathyroid.
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Hypogenadien -do-
Autoimmune Hyraidite -do -
Alopecia -do
Hypogonadisis. -do
type I diabetie - do
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Adcliran's disease - de
Vitiligo
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MEN-1 MEN-2A MEN 20. MEN-4
Werner Syndrome Sipple Syndr
Parathyroid adenona (c) MTC MTC PTH-adenaosa
Multicentric Phacochromeytarma Phaeachromocytoma Pituitary alien
Enteropancreatic problem. PTHadenoma Jicken - Amyloid Marfanoid
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Gottrinama eutascous lesion Mucoset/GT
Inscelinoma * Hirskpring's. neuroma Cax
Rituitary adename, * Hirskpring's. 2 Adrenal Her
Carcinoide
Mc. entire estère pancreatic tumor In MEN 1 Gastrinama
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M-e-parercatie Aunor In MENI Insulinoma.
M-C- tumor in MENT Parathyroid adenoma
Gastrinoma Gattrin
?
1. Baral acid output
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?
Peptic ulcer discare.
I. Serum Gartrin on cair be due to 2-1. PPT
2) Pernicious araemia...
3) Atrophic gastritie
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If Stomach PM <2.0 Serum Gastrin in 21000pg/ml.
M. c. site for Gasteinara Gartrinoma
A Pavercas PPI -Pet, Surgery.
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Jasulinema: Episodes of Hypoglycaemia.
Insulin: 72 wr fasting (1.0.0)
?
: Glucose 30.3. (Checks insulin: glucose ratio eve
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possibility of inrutinana.
Tasulinoma Factitious Hypoglycaemia
B-cells. ? Sulphonyl urea
pro-insulin Insulin
insulin Opeptide B-cell Opeptide &
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? ?
20.9ugjat 20.Ing/ml
2200pmol/L 5200 ?/L
[2]: Diazonide + Carbohydrate dict
Surgery (insuliname accrire equally in all parts of paverear)
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occurs
Metastatic - Streptozocin. + 5E0
Surgery Localisation of Surror in paccocess
EUS
CI (Contrant CT) ?1.0.C.
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?Tatra-operative Ultrasound.
Gold Standard Adeniagmoky
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CARCINOID.
location 2/3 GIT ileus 2
rectum 3
colon (4)
13 Jung appendix
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ovary (5)
(Carcinoid syndrome il vero in rectal carcinoide.
M-c. complaiat of Carcinoid timer: Abdominal pain
M.c. complaint of Carcinoid Syadmme: Flushing & diarrhea
Carciavid Syndrome
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F: Diazrihea
Hushing
Asthara like wheezing episodes..
Dada Mya
rdial fibrosis - RV
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Myocardial
TR > TS > PR > PS Serotonin
In: Bert: PET Seas.
1.O.C: Scintigraphy.
4:- Surgery
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?(Aum)
Tryptophan
Niacin
Pellagra
Diarrhea
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Dermatitis
Dementia.
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