Endocrine Disorders and Diabetes Mellitus Quiz

Diabetes Mellitus Overview

• In the US, 1.4 million new cases of diabetes are diagnosed annually, with a prevalence of 3% in adults.
• Adult onset diabetes typically occurs in individuals older than 40 and is more prevalent in Hispanic, Native American, Asian American, and African American populations.
• Normal blood glucose levels range from 70 to 120 mg/dL, and clinicians aim to achieve an HbA1c level between 7% and 8% in diabetics.
• Type 1 diabetes is an autoimmune disease with genetic susceptibility and environmental triggers leading to the destruction of beta cells, resulting in absolute insulin deficiency and hyperglycemia.
• Type 1 diabetes is associated with other autoimmune conditions such as Hashimoto thyroiditis and celiac disease, necessitating regular screening for thyroid disease in affected children.
• Type 2 diabetes is characterized by decreased peripheral tissue response to insulin, beta cell dysfunction, and a decrease in the number of insulin receptors, with a strong genetic association and a higher occurrence in adults, elderly, and certain ethnic groups.
• The primary pathological mechanism underlying type 1 diabetes is autoimmune destruction of pancreatic beta cells, while type 2 diabetes is primarily characterized by insulin resistance.
• Type 1 diabetes is characterized by autoimmune "insulitis" and amyloid deposition in the islets, while type 2 diabetes is associated with insulin resistance and failure of compensation by beta cells.
• Type 1 diabetes primarily affects children and teens, while type 2 diabetes primarily affects adults and the elderly, with different physical attributes and onset timelines.
• Treatment for type 1 diabetes involves insulin injections, dietary plans, regular blood sugar level checks, and daily exercise, while type 2 diabetes is managed with diet, exercise, weight loss, and medication to release insulin from the pancreas.
• Diabetic retinopathy (DR) is the most common cause of visual impairment and blindness in patients aged 25–74 years in the US, necessitating frequent eye exams for both type 1 and type 2 diabetes patients.
• The pathogenesis of diabetic retinopathy involves pericyte loss, weakened blood vessels, retinal ischemia, VEGF upregulation, neovascularization, and subsequent complications such as hemorrhage, fibrosis, and retinal detachment, leading to non-proliferative and proliferative DR.

Endocrine Disorders Summary

• Thyroid disorders include chronic lymphocytic thyroiditis (Hashimoto's) and Graves' disease, affecting different age groups and genders.
• Graves' disease is characterized by autoimmune stimulation of the thyroid gland, leading to hyperthyroidism and specific symptoms such as exophthalmos and thyroid dermopathy.
• Parathyroid hormone (PTH) functions to regulate calcium and phosphate levels in the body, with hyperparathyroidism leading to hypercalcemia and related symptoms such as kidney stones and abdominal discomfort.
• Hypoparathyroidism, less common than hyperparathyroidism, can result from various causes including surgical ablation and autoimmune hypoparathyroidism, leading to decreased plasma calcium and phosphate levels.
• Hypercalcemia can manifest with symptoms such as painful bones, renal stones, abdominal discomfort, and psychiatric effects, along with specific ocular manifestations like calcific band keratopathy.
• A patient with hypoparathyroidism may present with decreased plasma calcium, phosphate levels, and symptoms such as neuromuscular irritability, Chvostek and Trousseau signs, and cardiac arrhythmias.
• The pituitary gland plays a crucial role in the regulation of various hormones, including thyroid-stimulating hormone (TSH), prolactin, growth hormone (GH), and adrenocorticotropic hormone (ACTH).
• Diabetes mellitus, both type 1 and type 2, is associated with dysregulation of hormones and the hypothalamic-pituitary axis, leading to various symptoms and complications.
• Anti-diuretic hormone (ADH) and its role in diabetes insipidus are related to the pituitary gland and its functions.
• Prolactinoma is a pituitary tumor leading to excessive prolactin production, while growth hormone disorders can result in conditions such as acromegaly.
• Thyroid disorders, including chronic lymphocytic thyroiditis (Hashimoto's) and Graves' disease, are characterized by specific pathologic findings, thyroid status, and symptoms.
• Age, gender, and autoimmune factors play crucial roles in the development and presentation of thyroid and parathyroid disorders.