ALU 201: Intermediate Medical Life Insurance Writing PDF

AN OVERVIEW OF ENDOCRINOLOGY Introduction Pituitary Gland Prolactinoma and the excess prolactin causes menstrual irregularities and galactorrhea. In males, the tumors are usually large (macroadenoma – greater than 10 mm), and the excess prolactin causes impotence Page 279 ALU 201: Intermediate Medic...

AN OVERVIEW OF ENDOCRINOLOGY Introduction Pituitary Gland Prolactinoma and the excess prolactin causes menstrual irregularities and galactorrhea. In males, the tumors are usually large (macroadenoma – greater than 10 mm), and the excess prolactin causes impotence Page 279 ALU 201: Intermediate Medical Life Insurance Writing compressing the optic chiasm. For small tumors, treatment is aimed at restoring normal menstrual agonist drugs such as bromocriptine (Parlodel®), pergolide (Permax®), and cabergoline (Dostinex®) Diabetes Insipidus hypernatremia (high serum sodium). Antidiuretic hormone can be replaced by using intranasal, intravenous, or oral desmopressin (DDAVP®), which thus restores normal water balance. Page 280 Acromegaly Acromegaly is a rare pituitary disorder that one can see in underwriting. The most common ® population. Thyroid Gland T4 and T3 1. increased oxygen consumption 2. 3. enhanced lipolysis 4. enhanced response to epinephrine and norepinephrine Page 281 ALU 201: Intermediate Medical Life Insurance Writing 5. increased heart rate and contractility 6. increased growth and development. help the physician diagnose autoimmune thyroid disease. In addition, there are several radiologic evaluating a thyroid nodule or glandular enlargement. For underwriting, the two major etiologies activity. Symptoms include heat intolerance, weakness, diarrhea, palpitations, nervousness, anxiety, pulse pressure, moist skin, thin hair, hair loss, brittle nails, muscle weakness, muscle atrophy, eyelid untreated hyperthyroidism in the older ages is most likely associated with extra risk. include hyperthermia, cardiac arrhythmias, malignant hypertension, coma, seizures, and hepatic presents no extra risk. Page 282 becomes noticed. and is associated with an autoimmune attack on the thyroid gland. In this case, however, the hormone. Antimicrosomal and antithyroglobulin antibodies are usually present. Total T4 levels are [Synthroid® ® ® ® Page 283 ALU 201: Intermediate Medical Life Insurance Writing and underlying disease. Adrenal Gland 1. the glomerulosa that produces aldosterone 2. 3. the reticularis that produces androgens. low to low normal potassium levels because aldosterone acts on the kidney to increase sodium blood pressure. Page 284 hypertension, striae, hyperglycemia, proximal muscle weakness, amenorrhea, hirsuitism, acne, easy bruising, osteoporosis, depression, and/or psychosis. When the excess cortisol production surgical treatment, bilateral adrenalectomy, medication to stop steroid production, or external beam radiation can be necessary. pathology is not carcinoma. Adrenal carcinoma requires adjuvant chemotherapy. For small cell 1. autoimmune attack 2. 3. 4. hemorrhage. Page 285 ALU 201: Intermediate Medical Life Insurance Writing Pheochromocytoma paragangliomas, 10% occur in children, and 10% are recurrent. palpitations. In addition, they have accelerated hypertension, cardiac arrhythmias, or high output usually the best test), surgery to remove the pheochromocytoma is essential. Surgery must be The Parathyroid Glands Parathyroid hormone act on multiple tissues but predominately on kidney, bone, and intestine to increase serum calcium concentrations when levels are low. All cause hypercalcemia which may result in polyuria, thirst, abdominal pain, constipation, Page 286 surgery to remove either the adenoma or the hyperplastic glands (usually only 3.5 glands are 1. 2. 3. both 1 and 2. and/or coma. Acute treatment is aimed at reducing serum calcium levels with saline hydration, ® , used to promote increased calcium excretion by the kidneys), and bone antiresorptive therapy with medications such as pamidronate (Aredia® 1. a. primary hyperparathyroidism (present in 90%) b. pituitary adenomas (present in 30%) c. pancreatic tumors (present in 60%) a. b. pheochromocytoma (present in 50%) c. primary hyperparathyroidism (present in 30%) a. b. pheochromocytoma (present in 50%) c. RET RET Page 287 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. 3. 4. 5. 6. insulin glucagon somatostatin cortisol epinephrine growth hormone. Insulin and glucagon are the key hormones that regulate glucose levels. They have opposing synthesis. It also has anticatabolic properties by sparing protein catabolism, lipolysis, and acts to inhibit both insulin and glucagon. Thus, it acts in a paracrine manner on the alpha and beta eaten. Cortisol, epinephrine, and growth hormone act in a manner similar to glucagon, maintaining whereby insulin is present but there are problems involving insulin binding to the insulin receptor, Page 288 that means sweet siphon) is the end result. 1. 126 mg/dl 2. 3. a glucose measurement greater than or equal to 200 mg/dl at any time during an oral glucose tolerance test 4. 5. hyperglycemia. 100 mg/dl but less than or equal to 125 mg/dl. Impaired glucose tolerance is a blood glucose measurement greater than or equal to 140 mg/dl but less than 200 mg/dl at any time during a 1. 2. 3. 4. type 1 type 2 other gestational. are calling this type, “double diabetes.” Those with this type are mostly children and adolescents, who are overweight or obese, and yet have antibodies to insulin, islet cells, and glutamic acid decarboxylase. In other words, they present like type 2 diabetics, however, have an autoimmune Type 1 Diabetes Mellitus type 1 diabetes involves multiple genes (i.e., polygenic inheritance) and likely some environmental Page 289 ALU 201: Intermediate Medical Life Insurance Writing related islet antigen, or insulin antibodies.) susceptible to degradation by stomach acid and enzymes, it can only be administered by injection. injections daily or by a portable subcutaneous insulin pump. With both, the goal is to provide insulin replacement as close to normal physiologic secretion as possible. insulins include aspart, lispro, glulisine, glargine, and detemir. Insulin can be given by subcutaneous acceptance due to improvements in pump technology and glucose monitoring systems. In the motivated individual, insulin pump therapy improves glucose control. Type 1 diabetics must monitor their blood glucose levels several times a day. Continuous glucose sensors are now in high adoption, whereby a person can instantaneously look at glucose or glucose is detected. Type 2 Diabetes Mellitus type 2 diabetes. In addition, there are some type 2 diabetics who, over many years (10 to 20), have 2 diabetics, obesity is the greatest culprit that causes insulin resistance. higher genetic predisposition than type 1 DM. Certain ethnic groups are also at higher risk. For Page 290 subcutaneous adipose tissue. Visceral adipose tissue is that which deposits around deep organs to continue to improve. needs like cost, wanting to avoid hypoglycemia, promote weight loss, or minimize weight gain. insulin. The desired goal is to achieve normal glucose homeostasis. Also, an astute underwriter 1. 2. 3. Page 291 ALU 201: Intermediate Medical Life Insurance Writing drug. th than 105mg/dl, one hour greater than 190mg/dl, two hours greater than 165 mg/dl, and three hours 1. 2. diabetic hyperosmolar coma that occurs in type 2 3. acute hypoglycemia that can occur in all types. All the acute complications have some mortality risk with the acute episode. For example, the chain. When glucose levels are high, more glucose binds to the hemoglobin. There are situations Page 292 Fructosamine is another available blood test to monitor glucose control. It closely correlates ® ® remains to be determined. glucose measurements. 1. neuropathy (both peripheral and autonomic). 2. Page 293 ALU 201: Intermediate Medical Life Insurance Writing risk in a diabetic. cardiac output with standing. Diabetics with cardiac autonomic neuropathy have very high Macrovascular disease, in particular cardiovascular disease (CVD), in diabetics is the leading CVD events, as nicotine can contribute to vasospasm, platelet stickiness, plaque rupture, and intensively treated type 1 diabetics compared to conventionally treated type 1 diabetics (EDIC death in diabetics taking these medications. More medications in development are poised to work Page 294 Finally, uncontrolled DM contributes to changes in cholesterol patterns, especially in overweight oxidized and incorporated into atheromatous plaque. Complications Trial studied 1,441 type 1 diabetics who demonstrated near normal glucose control 1. 2. The symptoms must correspond to documented low blood glucose (less than 50 mg/dl in 3. Page 295 ALU 201: Intermediate Medical Life Insurance Writing metabolic syndrome predisposes those individuals to increased cardiovascular disease and overall mortality. parameters evaluated in underwriting. Metabolic syndrome is coded as E88.81 by the International th requires insulin resistance to be present, plus two additional criteria. Women >35 inches (88cm) Triglycerides > Blood pressure > Fasting glucose > Page 296 Waist to hip ratio Triglycerides > Blood pressure > 140 / > Microalbuminuria >30kg/m Men >0.9 Women >0.85 >30mg/g loss. Targeted therapy is also used to treat hypertension, lipids, and abnormal glucose control. rosiglitazone and pioglitazone. The overall goal is to reduce the cardiovascular risk associated with the syndrome. This chapter introduced the principles behind disorders in endocrinology and metabolism. It is Page 297