Download - Parathyroid adrenal pancreas dr faeza
![Page 1: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/1.jpg)
ParathyroidParathyroid
AdrenalAdrenal
PancreasPancreas
![Page 2: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/2.jpg)
PTH
• Hypocalcemia is main stimulus (9-10.5 mg/dl)• Antagonize Calcitonin
35-50 mg
![Page 3: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/3.jpg)
![Page 4: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/4.jpg)
Parathyroid Gland – note small dark staining chief cells and larger, eosinophilic oxyphil cells
![Page 5: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/5.jpg)
PARATHYROID DISORDERS
• Primary Hyperparathyroidism – Adenoma: 85% to 95% – Primary hyperplasia (diffuse or nodular): 5% to 10% – Parathyroid carcinoma: 1%∼
• Secondary Hyperparathyroidism- (LOW CA++ of Renal Failure)
• Hypoparath-: Surgical, congenital, familial, idiopathic• Pseudo - hypoparath.
– (end organ resistance)
![Page 6: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/6.jpg)
Parathyroid adenoma. A, Solitary chief cell parathyroid adenoma revealing clear delineation from the residual gland below. B, High-power detail of a chief cell parathyroid adenoma. some slight tendency to follicular formation
![Page 7: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/7.jpg)
HYPER-PARATHYROIDISM
– Bone pain, fractures– Nephrolithiasis– Constipation, ulcers, gallstones– Depression, lethargy– Weakness, fatigue– Calcifications, esp. Lung, VALVES
![Page 8: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/8.jpg)
HYPO-PARATHYROIDISM
– Neuromuscular irritability– Mental status change– Parkinsonism like effects– Widened QT interval– Defective, carious, teeth
![Page 9: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/9.jpg)
MEN-1, Wermer Syndrome (3 P’s)
• HYPERPARATHYROIDISM, chiefly hyperplasia
• Pancreatic endocrine tumors• Pituitary adenoma, usually prolactinoma
![Page 10: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/10.jpg)
MEN-2
• MEN-2A (SIPPLE): Pheochromo, Medullary Thyroid CA., Parathyroid hyperplasia
• MEN-2B: NO hyperparathyroidism, but neuromas present
• Familial Medullary Thyroid CA
![Page 11: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/11.jpg)
ADRENAL CORTEX
• Glomerulosa (Salt), mineralocorticoids– ALDOSTERONE
• Fasciculata (Sugar), glucocorticoids– CORTISOL
• Reticularis (Sex), gonadocorticoids– ANDROGENS, ESTROGENS
![Page 12: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/12.jpg)
4 g.
![Page 13: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/13.jpg)
![Page 14: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/14.jpg)
Adrenal Cortex
Zona Glomerulosa
(clumps, cords, and follicle like structures
Zona Fasciculata
(cords of spongiocytes)
![Page 15: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/15.jpg)
SALT
SUGAR
SEX
STRESSSTRESS
![Page 16: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/16.jpg)
HYPERADRENALISM
• HYPERALDOSTERONISM (G).• CUSHING SYNDROME (CORTISOL) (F).• ADRENOGENITAL (VIRILIZING)
SYNDROME (R).
![Page 17: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/17.jpg)
CUSHING SYNDROME
• Exogenous steroid (90%)***• ACTH-DEPENDENT ** - pituitary adenoma; - Ectopic corticotropin syndrome (ACTH-secreting
pulmonary small-cell carcinoma, bronchial carcinoid)
• Adrenal adenoma• Adrenal Carcinoma• Hyperplasia.
![Page 18: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/18.jpg)
CUSHING SYNDROME
• CENTRAL OBESITY
• MOON FACIES• WEAKNESS• HYPERTENSION• DIABETES• OSTEOPOROSIS• HIRSUTISM• STRIAE
![Page 19: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/19.jpg)
CUSHING SYNDROME
![Page 20: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/20.jpg)
MOON FACIES BUFFALO HUMP
STRIAE
![Page 21: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/21.jpg)
Cushing syndrome
• Depending on the cause of the hypercortisolism the adrenals have one of the following abnormalities:
• (1) cortical atrophy,• (2) diffuse hyperplasia, • (3) macronodular or micronodular hyperplasia, • (4) an adenoma or carcinoma.
![Page 22: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/22.jpg)
Diffuse hyperplasia of the adrenal contrasted with normal adrenal gland
![Page 23: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/23.jpg)
Cushing syndrome
Dx: • (1) Increased the 24-hour urine free-cortisol
concentration.• (2) loss of normal diurnal pattern of cortisol
secretion.
![Page 24: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/24.jpg)
Cushing syndrome
• Dx the cause of Cushing syndrome depends on;
• Serum ACTH and • Dexamethasone suppression test;
Measurement of urinary steroid excretion after administration of dexamethasone.
![Page 25: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/25.jpg)
PRIMARY HYPERALDOSTERONISM(Conn’s Syndrome)
• Na+ RETENTION• K+ EXCRETION• HYPERTENSION
![Page 26: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/26.jpg)
![Page 27: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/27.jpg)
Secondary hyperaldosteronism
• Activation of the renin-angiotensin system, (increased plasma renin)
• In the following conditions: • Decreased renal perfusion (arteriolar nephrosclerosis, renal
artery stenosis) • Arterial hypovolemia and edema (CHF, cirrhosis, nephrotic
syndrome) • Pregnancy (due to estrogen-induced increases in plasma
renin substrate)
![Page 28: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/28.jpg)
SECONDARY HYPERALDOSTERONISM
• DECREASED RENAL PERFUSION
• EDEMA (HEART, LIVER, KIDNEY)
• PREGNANCY
![Page 29: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/29.jpg)
ADRENOGENITAL SYNDROME
• VIRILIZATION/feminization• CORTICAL NEOPLASM• CORTICAL HYPERPLASIA• 21-Hydroxylase Deficiency
![Page 30: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/30.jpg)
![Page 31: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/31.jpg)
ADRENAL INSUFFICIENCY
• PRIMARY ACUTE (ADRENAL CRISIS)• PRIMARY CHRONIC (auto-immune ADDISON
DISEASE)• SECONDARY (PITUITARY)
• hyperkalemia, hyponatremia, volume depletion, and hypotension
![Page 32: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/32.jpg)
PRIMARY ACUTE
• Rapid withdrawal of steroid• Massive adrenal hemorrhage - Newborns with difficult delivery - Anticoagulant RX - Postsurgical DIC patient - MASSIVE ADRENAL HEMORRHAGE
(WATERHOUSE-FRIDERICHSEN, if it follows infection and shock)
![Page 33: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/33.jpg)
Waterhouse-Friderichsen Syndrome septicemia , shock,DIC, adrenocortical insufficiency with bilateral adrenal hemorrhage
![Page 34: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/34.jpg)
PRIMARY CHRONIC
• Most of Addison disease is auto-immune adrenalitis• INFECTIONS (Tuberculosis, fungal)• METASTASES (adrenals are preferred site for early lung
carcinoma metastases)• AIDS• Acute hemorrhagic necrosis (Waterhouse-Friderichsen
syndrome) • Amyloidosis, sarcoidosis, hemochromatosis,
lymphoma. • GENETIC DISORDERS
![Page 35: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/35.jpg)
Autoimmune adrenalitis.
![Page 36: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/36.jpg)
NEOPLASMS• ADENOMAS of ADRENAL CORTEX
• CARCINOMAS of ADRENAL CORTEX
![Page 37: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/37.jpg)
Adrenocortical adenomas; a well-circumscribed, nodular lesion up to 2.5 cm expands the adrenal.Most are clinically silent
![Page 38: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/38.jpg)
Adrenocortical Adenoma
![Page 39: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/39.jpg)
Adrenocortical Adenoma
![Page 40: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/40.jpg)
Carcinoma of the adrenal cortex
![Page 41: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/41.jpg)
Carcinoma of the adrenal cortex
![Page 42: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/42.jpg)
Low magnification of the Adrenal Gland
Medulla
Cortex
![Page 43: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/43.jpg)
Adrenal Medulla
![Page 44: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/44.jpg)
ADRENAL MEDULLA
• PHEOCHROMOCYTOMAS, “rule of 10s”. Primary tumors of adrenal medulla
– 10% arise in an MEN setting– 10% are EXTRA-adrenal– 10% are bilateral– 10% are malignant– 10% are not associated with hypertension,
(hypertension in 90%).– 10% are in childhood– can only call them malignant if they metastasize.
![Page 45: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/45.jpg)
PHEO
![Page 46: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/46.jpg)
TWO crucially important points specific for endocrine tumors:
• 1. FUNCTIONING carcinomas are very RARE in ANY endocrine gland.
• 2. Benign adenomas may have extremely bizarre nuclei, but are most usually BENIGN!!!
![Page 47: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/47.jpg)
MEN-1, Wermer Syndrome (3 P’s)
• HYPERPARATHYROIDISM, chiefly hyperplasia
• Pancreatic endocrine tumors• Pituitary adenoma, usually prolactinoma
![Page 48: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/48.jpg)
MEN-2
• MEN-2A (SIPPLE): Pheochromo, Medullary Thyroid CA., Parathyroid hyperplasia
• MEN-2B: Pheochromo, Medullary Thyroid CA., neuromas, NO hyperparathyroidism.
![Page 49: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/49.jpg)
ENDOCRINEENDOCRINE
PANCREASPANCREAS
![Page 50: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/50.jpg)
High mag of an Islet – note Beta cells and more eosinophilic Alpha2 cells
Acini
Alpha Cells
![Page 51: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/51.jpg)
Exocrine
Endocrine
Islets
Alpha Cells
Beta Cells
Delta Cells (suppress insulin and glucagon)
Pancreatic Polypeptide (PP) cells
Epsilon Cells make gherlin, which causes hunger
![Page 52: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/52.jpg)
Glucagon Insulin
Immunohistochemistry of a pancrearic Islet of Langerhans
![Page 53: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/53.jpg)
• β cell produces insulin, • α cell secretes glucagon,• δ cells contain somatostatin, which suppresses both
insulin and glucagon• PP cells contain pancreatic polypeptide that exerts
secretion of GIT enzymes and inhibits its motility. • D1 cells elaborate vasoactive intestinal polypeptide
(VIP), that induces glycogenolysis and hyperglycemia; • Enterochromaffin cells synthesize serotonin and are
the source of pancreatic tumors that cause the carcinoid syndrome
Pancrearic Islet of Langerhans
![Page 54: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/54.jpg)
DIABETES MELLITUS• 16 Million in the USA• 1 Million/yr
![Page 55: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/55.jpg)
How to Diagnose Dm:
• Glucose >200• Or…………….• Fasting glucose >126 trice• Or…………….• Post-prandial glucose > 200, 2 hrs AFTER standard
OGTT (Oral Glucose Tolerance Test)
![Page 56: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/56.jpg)
Classification of Diabetes MellitusAmerican Diabetes Association
1. Type 1 diabetes (β-cell destruction, usually leading to absolute insulin deficiency) Immune – mediated Idiopathic
2. Type 2 diabetes (combination of insulin resistance and β-cell dysfunction)
3. Genetic defects of β-cell function; Maturity-onset diabetes of the young (MODY)4. Exocrine pancreatic defects5. Endocrinopathies6. Genetic defects in insulin action7. Infections8. Drugs9. Gestational diabetes mellitus10.Genetic syndromes associated with diabetes
![Page 57: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/57.jpg)
TWO* Types of DM
•1• Genetic• Autoimmune• Childhood (juvenile) onset• Antibodies to beta cells• Beta cell depletion• NON-OBESE patients
•2• Genetic, but diff. from Type 1• NOT autoimmune• Adult, or maturity onset, e.g.,
40’s, 50’s• Insulin may be low, BUT,
peripheral resistance to insulin is the main factor
• OBESE patients
![Page 58: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/58.jpg)
Type 1 Diabetes Mellitus Type 2 Diabetes MellitusCLINICAL
Onset: usually childhood and adolescence
Onset: usually adult; increasing incidence in childhood and adolescence
Normal weight or weight loss preceding diagnosis
Vast majority are obese (80%)
Progressive decrease in insulin levels
Increased blood insulin (early); normal or moderate decrease in insulin (late)
Circulating islet autoantibodies (anti-insulin, anti-GAD, anti-ICA512)
No islet auto-antibodies
Diabetic ketoacidosis in absence of insulin therapy
Nonketotic hyperosmolar coma more common
![Page 59: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/59.jpg)
GENETICS Major linkage to MHC class I and II genes; also linked to polymorphisms in CTLA4 and PTPN22, and insulin gene VNTRs
No HLA linkage; linkage to candidate diabetogenic and obesity-related genes (TCF7L2, PPARG, FTO, etc.)
PATHOGENESIS Dysfunction in regulatory T
cells (Tregs) leading to breakdown in self-tolerance to islet auto-antigens
Insulin resistance in peripheral tissues, failure of compensation by β- cells
Multiple obesity-associated factors (circulating nonesterified fatty acids, inflammatory mediators, adipocytokines) linked to pathogenesis of insulin resistance
![Page 60: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/60.jpg)
PATHOLOGY Insulitis (inflammatory
infiltrate of T cells and macrophages)
No insulitis; amyloid deposition in islets
β-cell depletion, islet atrophy
Mild β-cell depletion
![Page 61: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/61.jpg)
Dm• POLY-• POLY-• POLY-
![Page 62: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/62.jpg)
Metabolic actions of insulin
![Page 63: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/63.jpg)
PATHOGENESIS• 1• T-Lymphocytes
reacting against poorly defined beta cell antigens
• Inflammatory inflitrate, chronic, i.e., “INSULITIS”
• 2• Diet• Life Style• Obesity• INSULIN RESISTANCE• Beta cells UN-able to
adapt to the “long term demands of insulin resistance”
![Page 64: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/64.jpg)
MODY (Maturity Onset Diabetes of the Young)
• Multiple types• 2-5% of diabetics• Primary beta cell defects• Multiple genetic mechanisms, especially
GLUCOKINASE mutations
![Page 65: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/65.jpg)
PANCREAS in Dm
![Page 66: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/66.jpg)
PANCREAS in Dm
![Page 67: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/67.jpg)
COMPLICATIONSMORPHOLOGY
• (MACRO-vascular) Atherosclerosis• MICRO-vascular
– Retinopathy– Nephropathy- glomerular, vascular, KW– Neuropathy (most common cause of
neuropathy)
• Infections
![Page 68: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/68.jpg)
ATHEROSCLEROSIS
![Page 69: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/69.jpg)
ATHEROSCLEROSIS
![Page 70: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/70.jpg)
Diabetic Nephropathy• Renal failure is second only to MI as a cause of death from
DM. • Three lesions are encountered: (1) Glomerular lesions; capillary BM thickening, diffuse
mesangial sclerosis, and nodular glomerulosclerosis (2) vascular lesions, arteriolosclerosis; (3) PN, including necrotizing papillitis.
![Page 71: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/71.jpg)
NEPHROPATHYGBM thickening
![Page 72: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/72.jpg)
NEPHROPATHY
Kimmelstiel-Wilson (KW) Kidneys
Is…………
“Nodular” glomerulosclerosis
![Page 73: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/73.jpg)
Diffuse and nodular diabetic glomerulosclerosis (PAS stain). Note the diffuse increase in mesangial matrix and characteristic acellular PAS-positive nodules.
![Page 74: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/74.jpg)
Severe renal hyaline arteriolosclerosis
![Page 75: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/75.jpg)
NEPHROPATHYNEPHROSCLEROSIS
![Page 76: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/76.jpg)
RETINOPATHY in DmShows microaneurysms,
areas of hemorrhage,
cotton wool spots,
hard exudates,
venous beading,
neovascularization,
retinal detachment,
vitreous detachment,
pre retinal hemorrhage
![Page 77: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/77.jpg)
![Page 78: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/78.jpg)
INFECTIONS in Dm• SKIN• TUBERCULOSIS• PNEUMONIA• PYELONEPHRITIS• CANDIDA
![Page 79: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/79.jpg)
NEOPLASMS of the Endocrine Pancreas
• Islet cell tumors– Beta cells INSULINOMAS (NOT rare)– Alpha cells GLUCAGONOMAS (rare)– Delta cells SOMATOSTATINOMAS (rare)
– GASTRINOMAS, producing ZOLLINGER-ELLISON SYNDROME, consisting of increased acid and ulcers
![Page 80: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/80.jpg)
The Adrenal Glands
![Page 81: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/81.jpg)
Pineal Body
The Seat of the Soul
The Third Eye
![Page 82: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/82.jpg)
PINEAL “GLAND”
• PINEALOMAS– PINEOBLASTOMAS– PINEOCYTOMAS
![Page 83: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/83.jpg)
![Page 84: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/84.jpg)
Pineal Gland
N – neuroglia
P –pinealocytes
S – Brain Sand
![Page 85: Parathyroid adrenal pancreas dr faeza](https://reader030.vdocument.in/reader030/viewer/2022032618/55b6e1f8bb61eb5a268b468e/html5/thumbnails/85.jpg)