Others Flashcards
Most common feature of MEN1 (occurs in 90%)
Primary hyperparathyroidism
MEN1
Pancreatic tumors
Parathyroid
Pituitary
Medical treatment MEN1 Dillinger Ellison syndrome goal and drug of choice
Basal acid output
Treatment of disseminated gastrinomas
Chemo Streptomycin 5- fluorouracil Hormone therapy Ocreotide Lanreotide
MC pancreatic tumors in MEN 1 (>50%)
Gastrinomas
Characteristic clinical manifestations of glucagon a
Skin rash (necrolytic migratory erythema)
Weight loss
Anemia
Stomatitis
Medical treatment of insulinoma
Frequent carbohydrate meals
Diazoxide
Ocreotide
Reported in few patients with MEN1
(+) watery diarrhea
Hypokalemia
Achlorydia
VIPomas (vasoactive intestinal peptide)
Aka
VERNER MORRISON SYNDROME
VIPomas
WDHA (watery diarrhea, hypokalemia and achlorydia) syndrome
Dx of VIPoma
Stool volume >0.5-1L / day during a fast
Markedly increased plasma VIP concentration
The most common enterobacter iv NET associated with MEN1
Nonfunctioning pancreatic NET
Criteria metabolic syndrome
Central obesity waist circumference >102 M, >88 cm
Hypertriglyceridemia >=150
Low HDL =130 or >=85 diastolic
FPG >= 100 mg/dl
Hypertension 130/80
3 or more!!!
Most accepted and unifying hypothesis to describe the pathophysiology of metabolic syndrome
Insulin resistance
Onset of insulin resistance in metabolic syndrome is heralded by
Post prandial hyperinsulinemia
Excellent marker of the insulin resistant condition
Hypertriglyceridemia
Why is there an assoc of insulin resistance and hypertension when insulin is a vasodilator?
In insulin resistance, vasodilator Y effect of insulin is lost, but renal effect on sodium reabsorption is preserved
How does reduction of Uric acid normalize blood pressure?
Uric acid has an adverse effect on nitric oxide synthase in the macula densa of the kidney
This drug may increase fasting glucose levels in patients with metabolic syndrome
Nicotinic acid
Effect of nicotinic acid on fasting triglycerides
20-35% lowering
The only currently available dude with predictable HDL cholesterol raising properties
Nicotinic acid
Drug of choice to lower fasting triglyceride levels
Fibrates
gem fibrosis or fenofibrate
% reduction of Tg by fibrates
30-45%
When is bariatric surgery an option for patients with metabolic syndrome?
BMI >= 40
Or >35 with comorbidities
Precursor of Votamin D from the skin
7- dehydrocholesterol
