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Samenvatting endocrinologie
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Samenvatting endocrinologie uit Problemen van Digestief stelsel, endocrien stelsel en voeding met toevoeging van notities uit de les
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InhoudDeel 3: Endocrinologie ............................................................................................................................ 4
Hoofdstuk 1: Diabetes mellitus ........................................................................................................... 4
1.1 Definitie en classificatie ............................................................................................................. 4
1.2 Pathofysiologie .......................................................................................................................... 5
1.3 Type 1 Diabetes Mellitus ........................................................................................................... 6
1.4 Type 2 Diabetes Mellitus ......................................................................................................... 10
1.5 Klinisch onderzoek ................................................................................................................... 13
1.6 Diagnostiek .............................................................................................................................. 14
1.7 Behandeling van DM ............................................................................................................... 15
1.8 Follow – up van diabetestherapie ........................................................................................... 32
1.9 Chronische verwikkelingen van DM ........................................................................................ 33
1.10 Enkele specifieke problemen ................................................................................................. 38
Hoofdstuk 2: Hypoglycemie............................................................................................................... 45
2.1 Oorzaken.................................................................................................................................. 45
2.2 Insulinoom ............................................................................................................................... 45
Hoofdstuk 3: Hypofyse ...................................................................................................................... 47
3.1 Basisbegrippen ........................................................................................................................ 47
3.2 Indeling hypofyseadenomen ................................................................................................... 48
3.3 Kliniek hypofyse ....................................................................................................................... 50
3.4 Hypofysestimulatietesten ........................................................................................................ 57
Hoofdstuk 4: Hypogonadisme en gynaecomastie ............................................................................. 59
4.1 Mannelijk endocrien hypogonadisme ..................................................................................... 59
4.2 Gynaecomastie ........................................................................................................................ 64
4.3 Turner syndroom, endocrinologische aandachtspunten op volwassen leeftijd ...................... 65
Hoofdstuk 5: Bijniercortex ................................................................................................................ 67
5.1 Investigatie van bijniercortexfunctie ....................................................................................... 67
5.2 Ziekten van de bijniercortex .................................................................................................... 69
5.3 Corticotherapie ........................................................................................................................ 77
Hoofdstuk 6: Bijniermerg................................................................................................................... 80
6.1 Investigatie van bijniermergfunctie ......................................................................................... 80
6.2 Ziekten van het bijniermerg .................................................................................................... 80
Hoofdstuk 7: Neuro – endocriene tumoren ...................................................................................... 83
7.1 Histopathologie en classificatie ............................................................................................... 83
7.2 Pathofysiologie en kliniek ........................................................................................................ 83
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, 7.3 Carcinoïd – syndroom .............................................................................................................. 83
7.4 Diagnose .................................................................................................................................. 84
7.5 Therapie ................................................................................................................................... 84
Hoofdstuk 8: Hirsutisme .................................................................................................................... 85
8.1 Definitie ................................................................................................................................... 85
8.2 Etiologie ................................................................................................................................... 85
8.3 Differentiaaldiagnose............................................................................................................... 85
8.4 Therapie ................................................................................................................................... 85
8.5 Organisch hirsutisme ............................................................................................................... 86
Hoofdstuk 9: Variaties van de seksuele ontwikkeling en genderdysforie.......................................... 87
9.1 Indeling .................................................................................................................................... 87
9.2 Transgenderzorg ...................................................................................................................... 87
Hoofdstuk 10: De schildklier .............................................................................................................. 88
10.1 Basisbegrippen ...................................................................................................................... 88
10.2 Diagnostische exploratie bij schildklierlijden ........................................................................ 90
10.3 Thyrotoxicose ........................................................................................................................ 94
10.4 Hypothyroïdie ...................................................................................................................... 101
10.5 Thyroiditis ............................................................................................................................ 105
10.6 Endemisch en sporadisch niet – toxisch struma.................................................................. 106
10.7 Schildkliertumoren, in bijzonder solitaire thyroïdnodule .................................................... 107
10.8 Het ‘eutyroid sick’ – syndroom ............................................................................................ 113
Hoofdstuk 11: Dyslipidemie............................................................................................................. 114
11.1 Inleiding ............................................................................................................................... 114
11.2 Metabolisme........................................................................................................................ 115
11.3 Concentraties in plasma ...................................................................................................... 116
11.4 Kliniek .................................................................................................................................. 116
11.5 Gevolgen van dyslipidemie .................................................................................................. 119
11.6 Aanpak en behandeling ....................................................................................................... 120
11.7 Medicatie ............................................................................................................................. 122
Hoofdstuk 12: Obesitas ................................................................................................................... 125
12.1 Inleiding ............................................................................................................................... 125
12.2 Definitie obesitas ................................................................................................................. 125
12.3 Etiologie en fysiologie .......................................................................................................... 126
12.4 Endocriene aspecten van obesitas ...................................................................................... 127
12.5 Functies van vetweefsel ...................................................................................................... 129
12.6 Vetverdeling......................................................................................................................... 129
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, 12.7 Somatische gevolgen obesitas ............................................................................................. 130
12.8 Diagnose .............................................................................................................................. 130
12.9 Therapie ............................................................................................................................... 130
Hoofdstuk 13: Aandoeningen van de bijschildklieren en metabole botziekten.............................. 136
13.1 Calcium en fosforhuishouden – basisbegrippen ................................................................. 136
13.2 Aandoeningen van de bijschildklieren................................................................................. 138
13.3 Metabole botaandoeningen ................................................................................................ 143
Hoofdstuk 14: Schildklier en bijschildklierchirurgie ........................................................................ 148
14.1 Chirurgie is anatomie (en embryologie) .............................................................................. 148
14.2 Potentiële complicaties ....................................................................................................... 149
14.3 De schildklierchirurgie ......................................................................................................... 150
14.4 Bijschildklierchirurgie .......................................................................................................... 152
Hoofdstuk 15: Voeding bij obesitas en diabetes ............................................................................. 155
15.1 Basisconcepten .................................................................................................................... 155
15.2 Voedingsaanbevelingen ....................................................................................................... 156
15.3 Voedingsinterventie bij obesitas en DMT2 .......................................................................... 158
15.4 DMT2 ................................................................................................................................... 160
15.5 DMT1 ................................................................................................................................... 161
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, Deel 3: Endocrinologie
Hoofdstuk 1: Diabetes mellitus
1.1 Definitie en classificatie
• = chronische stoornis in metabolisme koolhydraten, vetten en eiwitten
o Tekort aan insuline: afbraak eiwitten en vrijstelling van VVZ
• Verhoogde bloedglucosespiegel (hyperglycemie), al dan niet met glucosurie
• Veroorzaakt door
o Absoluut insuline tekort (DMT1)
o Relatief insuline tekort (DMT2), al dan niet met insulineresistentie
• Zeer frequent, met wereldwijde sterke toename in prevalentie (8.5% in België, velen die het
nog niet weten)
o Wereldwijd: 537 miljoen mensen tss 20 – 79 jaar
o → zorgt voor grote kosten op bevolkingsniveau
o Veel levendgeborenen bloodgesteld aan hyperglycemie tijdens ZS bij moeder
o 1/5 > 65j: DM (vooral DMT2)
o Nog zeer veel mensen zijn ongediagnosticeerd → nog veel mogelijk preventief
• Acute levensbedreigende situaties mogelijk door insulinegebrek
o Diabetische ketoacidose (DMT1)
o Hyperosmolair hyperglycemisch coma (DMT2)
• Op lange termijn onherstelbare schade aan ogen, nieren , zenuwen
o Diabetes: belangrijkste oorzaak van verworven blindheid en nierdialyse in westerse
wereld
• Sterk verhoogd risico op hart – en vaatziekten
• Glucosehomeostase → vitaal voor energievoorziening van alle weefsel: indeling
o Gestoorde glycemie
o Gestoorde glucosetolerantie (impaired glucose tolerance, IGT)
▪ Nuchtere glucose normaal, maar lichaam reageert niet adequaat op
glucosechallange test: 2u na glucosebelasting tussen 140 en 200 mg/dl
▪ ↑ Risico op ontwikkeling DM
▪ Vaak typisch risicoprofiel (hypertensie, obesitas, hyperlipidemie = metabool
syndroom) → risico op ontwikkeling DM en cardiovasculaire ziekte
o Verhoogde nuchtere glycemie (impaired fasted glucose)
▪ Verhoogde nuchtere glucose > 100 mg/dl maar < 126 mg/dl
o DM (volgens ADA criteria)
• Klinische vormen
o DMT1: βcel destructie = absolute insulinedeficiëntie (immuun – gemedieerd)
o DMT2: insulineresistentie (relatief tekort), variabele insulinesecretie
o Zwangerschapsdiabetes (gestational diabetes)
▪ Prevalentie: 9.5% in België
▪ Verdwijnt (tijdelijk) na bevalling, verhoogd risico op DMT2 (30 – 50%)
o Andere specifieke vormen van DM
▪ Zeer uiteenlopende etiologieën
▪ Monogenetische vormen: MODY (Maturity Diabetes of the Young)
• AR, 1 gen
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