Endo Flashcards
Type of inheritance in familial hyper cholesterolemia?
Autosomal co-dominance with high penetrance.
What is the defect in familial vs polygenic hyper cholesterolemia?
Familial: Defect in LDL receptor on cell membrane.
Polygenic: Defect in cholesterol metabolism.
Labs in familial vs polygenic hypercholestrolemia?
Both show high TC + LDL
Clinical presentation in familial vs polygenic hyper cholesterolemia?
Familial:
Lipid deposits => tendinous xanthomatosis + xanthelasmata + arcus cornealis
Polygenic:
Asymptomatic
Risk of CAD in familial hypercholestrolemia. (Heteo vs homo)
Heterozygotes: 50% risk of MI in men by age 30
Homozygotes: CAD and vascular disease early in childhood
Rx of familial (hetero/homo) vs polygenic hypercholestrolemia.
Hetero Familial: HMG-coA reductase inhibitors + niacin / ezetimibe / bile acid sequestrant
Homo familia: portocaval shunt or LDH apheresis + niacin / atorvastatin
Polygenic: HMG-CoA reductase inhibitors, ezetimibe, niacin or bile acid sequestrant
Causes of 2ry hypercholestrolemia?
Endo: hypothyroidism Renal: nephrotic syndrome Hepatic: PBC Immune: monoclonal gammopathy Diet: anorexia nervosa Drugs: cyclosporin + carbamazepine + anabolic steroids.
What are the syndromes of 1ry hyper-Triglyceridemia?
- Familial lipoprotein lipase deficiency
2. Familial hyper-triglyceridemia
Pathophysiology of familial lipoprotein lipase deficiency vs familial hyper-triglyceridemia?
Familial lipoprotein lipase: deficiency or lipoprotein lipase or its co-factor.
Familial hyper-TG: increased hepatic VLDL production or decreased VLDL clearance.
Lab findings in familial lipoprotein lipase vs familial hyper-TG?
Familial lipoprotein lipase: high TG, VLDL, chylomicrons.
Familial hyper-TG: high TG + VLDL
Sx of familial lipoprotein lipase vs hyper-TG?
1.Familial lipoprotein lipase: Hepatosplenomegaly + splenic infarcts => anemia, granulocytopenia, thrombocytopenia. Pancreatitis Lipemia retinalis Eruptive xanthomata
- Familial hyper-TG:
Premature CAD
Syndrome of obesity, high TG, high insulin, high urea.
Treatment of familial lipoprotein lipase vs familial hyper-TG?
- Familial lipoprotein lipase:
Fat intake
When is hyper-triglyceridemia associated with pancreatitis?
When Serum TG > 1000 mg/dL
Drugs cause 2ry hyper-Triglyceridemia?
Alcohol Steroids Estrogen OCP Hydrochlorothiazide Retinoic acid Anti-retrovials Atypical antipsychotics
Side effects of atypical antipsychotics?
Dyslipidemia
HTN
Hyperglycemia
Metabolic syndrome
Types of combined hyperlipidemia?
Both 1ry.
- Familial combined hyperlipidemia
- Dysbetalipoproteinemia
Path physiology of familial combined hyperlipidemia vs Dysbetalipoproteinemia?
- Familial combined:
Excess hepatic synthesis of ApoB - Dysbetalipoproteinemia: abnormal ApoE
Labs in familial combined hyperlipidemia vs Dysbetalipoproteinemia?
- Familial combined: high TC, TG, VLDL, LDL
2. Dysbetalipoproteinemia: high TC, TG, VLDL, IDL
Sx of familial combined hyperlipidemia vs Dysbetalipoproteinemia?
- Familial combined:
CAD
Xanthelasma - Dysbetalipoproteinemia:
Tuberous, eruptive, palmar xanthomata
Impaired glucose tolerance
CAD + PAD.
Rx of familial combined hyperlipidemia vs Dysbetalipoproteinemia?
Both: Weight reduction Low fat, carbs intake + stop EtOH HMG-CoA reductase inhibitors Niacin, fibrates
Types of dyslipidemias?
Hyper cholesterolemia
Hyper triglyceridemia
When to screen to dyslipidemias?
- Healthy men at 40 women after menopause.
- Children with FHx
- At any age if patient has:
- DM
- HTN
- Smoker
- Obese
- Sx of hyperlipidemia (xanthomata, arcus cornealis)
- FHx of premature CAD
- Atherosclerosis
- Rheumatoid arthritis / SLE / psoriasis
- HIV on HAART
- CKD (GFR
What’s the effect of high LDL on CAD risk?
Each 40mg/dL (1 mmol/L) reduction in LDL = 20% relative risk reduction in CAD.
Labs for statin F/U?
- Liver profile: before Rx and after initiation.
- Lipid profile: after stabilization check annually.
- CK at baseline + if patient complains of myalgia.
NB: D/C statins if CK>10x upper limit.