enrinology內分泌總論(完整版)
【正文】 y diverse. ? They may vary from generalized, such as fatigue, to localized, such as weakness of the extraocular muscles. Generalized symptomes ? Weakness and fatigue ? Mental changes ? Unintended weight loss ? Weight gain ? Abnormal body temperature Hypersecretion of Adrenal Cortex Symptomes ? Ophthalmic abnormalities ? Abnormal skin pigmentation ? Hirsutism ? Gyneastia ? Galactorrhea ? Abnormal appetite ? Diarrhea Symptomes ? Anemia ? Tachycardia and bradycardia ? Polyuria ? Amenorrhea or oligomenorrhea ? Infertility ? Bone pain and pathologic fracture Hyposecretion of TH ?GH = pituitary dwarfism Physical and laboratory examination and diagnosis History and physical examination ? Many syndromes of hormonal excess or deficiency display manifestations that are readily apparent at the time of initial presentation, ., severe thyrotoxicosis and cushing’s syndrome. ? In other instances, the clinial presentation is more subtle and the physician must rely on laboratory testing to establish a diagnosis. Laboratory testing ? The level of free rather than total hormone is usually the best index of the effective hormone concentration in plasma. ? A measurement of the 24h urine free cortisol usually provides a reasonable estimate of the integrated levels of free plasma hormone. 正常人 75502502550751002400 0800 1600 庫欣病患者 1520253035402400 0800 1600 正常人和庫欣患者的血 F晝夜節(jié)律 Clinical interpretation ? The clinicians must remember that in both mormal subjects and patients with endocrine and other diseases, hormone levels are extensively regulated. ? For instance, plasma insulin levels should be evaluated in relation to the plasma glucose concentration, and PTH levels should be considered in relation to serum calcium levels. Clinical interpretation ? Since cortisol production integrated over a 24h period is increased in cushing’s syndrome, the 24h urinary free cortisol provides a more accurate index of cortisol hypersecretion. Clinical interpretation ? Sometimes the significance of hormone levels can be evaluated only by the simultaneous measurement of more than
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