0000 103594 GRMAT E#41353E.book Page 7 Tuesday, August 13, 2013 4:37 PM Innhold del i grunnleggende endokrinologi........................................ 17 kapittel 1 endokrinologiens historie........................................ 19 Endokrinologiens tidlige historie....................................................... 19 Indresekresjon og gangløse kjertler................................................... 19 Organoterapi..................................................................... 19 Endokrine kjertler................................................................. 19 Hormoner........................................................................ 20 Skjoldbruskkjertelen.................................................................. 20 Hva gjør tyreoidea?................................................................ 20 Myksødemet og livreddende terapi................................................... 21 Binyrene............................................................................ 21 Mellom barken og margen.......................................................... 21 Kortikosteroidene kommer......................................................... 21 Binyrebark og blodtrykk............................................................ 22 Gonadene.......................................................................... 22 Testiklene lagelig for hogg.......................................................... 22 Eggstokkene og kvinnelige kjønnshormoner........................................... 23 Utviklingen av kjønn............................................................... 23 Diabetes mellitus.................................................................... 24 Sukkersykens grusomme spor....................................................... 24 Bukspyttkjertelens øyceller er nøkkelen............................................... 24 En røverhistorie om insulin.......................................................... 25 Moderne diabetesomsorg.......................................................... 25 Biskjoldbruskkjertlene................................................................ 25 Kalsium og bein................................................................... 25 Parathormon og Albrights syndromer................................................ 25 Vitamin D-dualismen.............................................................. 26 Beinskjørheten kommer............................................................ 26 Hypotalamus og hypofyse............................................................. 26 Hva er hjernevedhenget?........................................................... 26 Harvey Cushing går løs på hypofysen................................................. 26 En ufattelig kompleksitet........................................................... 27 Hans Selye og syndromet å være syk.................................................. 27 Hormonanalyser..................................................................... 28 Å måle er å vite................................................................... 28 Hva måler vi?..................................................................... 28
0000 103594 GRMAT E#41353E.book Page 8 Tuesday, August 13, 2013 4:37 PM 8 innhold Molekylær endokrinologi............................................................. 29 Fra organer til celler............................................................... 29 Hormoner og gener............................................................... 29 Hva er et gen?.................................................................... 29 Fra DNA til livets kode............................................................. 29 Epigenetikken står over DNA....................................................... 31 Hormonreseptorer................................................................ 31 Arvelige sykdommer.............................................................. 31 Produksjon av hormoner........................................................... 32 Fra organekstrakt til rekombinant hormon............................................ 32 Framtidsendokrinologi............................................................... 33 kapittel 2 endokrinologiske prinsipper..................................... 34 Regulering av hormoner.............................................................. 34 Reguleringssløyfer................................................................ 34 Hypotalamus og hypofysen......................................................... 34 Andre hormonsystemer........................................................... 34 Endokrinologisk diagnostikk.......................................................... 35 Endokrine sykdommer diagnostiseres biokjemisk...................................... 35 Klinisk mistanke.................................................................. 35 Tolkning av hormonanalyser........................................................ 35 Stimulasjonstester og suppresjonstester.............................................. 37 Bildediagnostikk.................................................................. 37 Venesampling.................................................................... 37 Hormoners struktur og virkningsmekanismer............................................ 38 Molekylær endokrinologi.......................................................... 38 Protein- eller peptidhormoner...................................................... 38 Steroidhormoner................................................................. 39 Endokrinologiske målemetoder........................................................ 39 Hormonanalyser.................................................................. 39 Bioassay......................................................................... 39 Immunoassay.................................................................... 40 Kromatografi og massespektrometri................................................. 40 Endokrin substitusjonsbehandling...................................................... 41 Steroidhormoner................................................................. 41 Protein- og peptidhormoner....................................................... 41 Kontroll av substitusjonsbehandlingen............................................... 42 Behandling av endokrine svulster og hormonoverproduksjon............................... 42 Indikasjon for behandling.......................................................... 42 Behandlingsformer............................................................... 42
0000 103594 GRMAT E#41353E.book Page 9 Tuesday, August 13, 2013 4:37 PM innhold 9 del ii endokrine pankreas og metabolisme................................. 45 kapittel 3 insulin og diabetes mellitus....................................... 47 Sammendrag........................................................................ 47 Regulering av energimetabolismen...................................................... 47 Diagnostikk av diabetes mellitus........................................................ 49 Klassifikasjon av diabetes.............................................................. 49 Etiologisk diagnostikk av diabetes....................................................... 50 Organisering av diabetesomsorgen..................................................... 50 kapittel 4 diabetes mellitus type 1............................................ 52 Bakgrunn........................................................................... 52 Symptomer og tegn.................................................................. 53 Diagnostikk......................................................................... 53 Behandling.......................................................................... 53 Insulinbehandling................................................................. 53 Behandlingsmål................................................................... 54 Framtidige behandlingsformer....................................................... 55 kapittel 5 diabetes mellitus type 2............................................ 56 Bakgrunn........................................................................... 57 Symptomer og tegn.................................................................. 58 Behandling.......................................................................... 58 Livsstilstiltak...................................................................... 59 Perorale antidiabetika.............................................................. 59 Injeksjonsbehandling............................................................... 60 Behandlingskontroll............................................................... 61 kapittel 6 overvekt............................................................ 62 Bakgrunn........................................................................... 62 Symptomer og tegn.................................................................. 63 Diagnostikk......................................................................... 63 Behandling.......................................................................... 63 kapittel 7 diabetes mellitus i svangerskap og svangerskapsdiabetes...... 65 Bakgrunn........................................................................... 65 Diabetes i svangerskap................................................................ 65 Svangerskapsdiabetes................................................................. 66 kapittel 8 akutte diabeteskomplikasjoner................................... 68 Diabetisk ketoacidose og nonketotisk hyperosmolær tilstand............................... 68 Bakgrunn........................................................................ 68
0000 103594 GRMAT E#41353E.book Page 10 Tuesday, August 13, 2013 4:37 PM 10 innhold Symptomer og tegn............................................................... 68 Diagnostikk...................................................................... 69 Behandling...................................................................... 69 Hypoglykemi....................................................................... 70 Bakgrunn........................................................................ 70 Symptomer og tegn............................................................... 71 Diagnostikk...................................................................... 71 Behandling...................................................................... 71 kapittel 9 kroniske diabeteskomplikasjoner................................ 72 Bakgrunn.......................................................................... 72 Diabetesretinopati.................................................................. 72 Diabetesnevropati................................................................... 73 Diabetesnefropati................................................................... 74 Diabetes og hjerte- og karsykdom...................................................... 74 Diabetesfot........................................................................ 75 kapittel 10 hypoglykemi uten diabetes....................................... 78 Bakgrunn.......................................................................... 78 Symptomer og tegn................................................................. 79 Diagnostikk........................................................................ 79 Behandling......................................................................... 80 del iii tyreoidea............................................................... 83 kapittel 11 tyreoideahormoner............................................... 85 Sammendrag....................................................................... 85 Struma............................................................................ 85 Fysiologi........................................................................... 86 Laboratorieprøver................................................................... 87 Bildediagnostikk.................................................................... 89 kapittel 12 hypotyreose....................................................... 90 Bakgrunn.......................................................................... 90 Symptomer og tegn................................................................. 90 Diagnostikk........................................................................ 91 Behandling......................................................................... 91 Hypotyreose i graviditet.............................................................. 92 kapittel 13 hypertyreose...................................................... 93 Bakgrunn.......................................................................... 93 Symptomer og tegn................................................................. 95
0000 103594 GRMAT E#41353E.book Page 11 Tuesday, August 13, 2013 4:37 PM innhold 11 Diagnostikk......................................................................... 95 Behandling.......................................................................... 96 Spesielle former for hypertyreose....................................................... 98 Hypertyreose ved svangerskap og fødsel.............................................. 98 Amiodaronindusert hypertyreose.................................................... 98 Forhøyede FT4 og FT3 uten suppresjon av TSH......................................... 99 kapittel 14 tyreoiditter........................................................ 100 Bakgrunn........................................................................... 100 Symptomer og funn.................................................................. 100 Diagnostikk......................................................................... 100 Behandling.......................................................................... 101 kapittel 15 tyreoideaknuter og tyreoideacancer............................ 102 Bakgrunn........................................................................... 102 Symptomer og funn.................................................................. 102 Diagnostikk......................................................................... 103 Behandling og oppfølging............................................................. 103 del iv binyrer.................................................................. 105 kapittel 16 kortikosteroider og katekolaminer............................. 107 Sammendrag........................................................................ 107 Fysiologi............................................................................ 108 Laboratorieanalyser.................................................................. 110 Bildediagnostikk..................................................................... 111 kapittel 17 primær binyrebarksvikt........................................... 113 Bakgrunn........................................................................... 113 Symptomer og tegn.................................................................. 113 Diagnostikk......................................................................... 115 Behandling.......................................................................... 115 Spesielle former for binyrebarksvikt..................................................... 116 kapittel 18 cushings syndrom................................................. 118 Bakgrunn........................................................................... 118 Symptomer og tegn.................................................................. 118 Diagnostikk......................................................................... 120 Behandling og oppfølging............................................................. 121
0000 103594 GRMAT E#41353E.book Page 12 Tuesday, August 13, 2013 4:37 PM 12 innhold kapittel 19 primær hyperaldosteronisme.................................... 123 Bakgrunn.......................................................................... 123 Klinikk............................................................................. 123 Diagnose.......................................................................... 123 Behandling......................................................................... 124 Spesielle former for hyperaldosteronisme............................................... 125 kapittel 20 feokromocytom og paragangliom.............................. 127 Bakgrunn.......................................................................... 127 Symptomer og tegn................................................................. 127 Diagnostikk........................................................................ 127 Behandling......................................................................... 128 kapittel 21 binyreincidentalom............................................... 130 Bakgrunn.......................................................................... 130 Symptomer og tegn................................................................. 130 Diagnostikk........................................................................ 130 Behandling......................................................................... 131 del v gonader................................................................. 135 kapittel 22 kjønnshormoner................................................. 137 Sammendrag....................................................................... 137 Fysiologi........................................................................... 138 Intersex eller disorders of sex development (DSD)........................................ 142 Infertilitet.......................................................................... 142 Hormonell antikonsepsjon............................................................ 142 Misbruk av anabole androgene steroider................................................ 143 Laboratorieanalyser................................................................. 143 kapittel 23 mannlig hypogonadisme......................................... 145 Bakgrunn.......................................................................... 145 Symptomer og tegn................................................................. 146 Diagnostikk........................................................................ 146 Behandling og oppfølging............................................................ 147 kapittel 24 kvinnelig hypogonadisme....................................... 148 Bakgrunn.......................................................................... 148 Symptomer og tegn................................................................. 149 Diagnostikk........................................................................ 149 Behandling og oppfølging............................................................ 150
0000 103594 GRMAT E#41353E.book Page 13 Tuesday, August 13, 2013 4:37 PM innhold 13 kapittel 25 hyperandrogenisme og polycystisk ovarialsyndrom.......... 151 Bakgrunn........................................................................... 151 Symptomer og tegn.................................................................. 152 Diagnose........................................................................... 152 Behandling.......................................................................... 153 del vi hypofysen............................................................... 157 kapittel 26 hypofysehormoner............................................... 159 Sammendrag........................................................................ 159 Fysiologi............................................................................ 159 Laboratorieanalyser.................................................................. 160 Suppresjonstester og stimulasjonstester................................................. 161 Hypofysesvulster og overaktivitet....................................................... 161 Hypofysesvikt....................................................................... 162 kapittel 27 prolaktinom og hyperprolaktinemi............................. 163 Bakgrunn........................................................................... 163 Symptomer og tegn.................................................................. 164 Diagnose........................................................................... 165 Behandling.......................................................................... 165 Prolaktinom og graviditet........................................................... 166 kapittel 28 akromegali........................................................ 167 Bakgrunn........................................................................... 167 Symptomer og tegn.................................................................. 167 Diagnostikk......................................................................... 169 Behandling.......................................................................... 169 kapittel 29 hypofysesvikt...................................................... 171 Bakgrunn........................................................................... 171 Sekundær binyrebarksvikt............................................................. 172 Symptomer og tegn................................................................ 172 Diagnostikk...................................................................... 173 Behandling....................................................................... 173 Sekundær hypotyreose............................................................... 174 Sekundær gonadesvikt................................................................ 174 Veksthormonmangel................................................................. 175 Symptomer og tegn................................................................ 175 Diagnostikk...................................................................... 175 Behandling....................................................................... 175
0000 103594 GRMAT E#41353E.book Page 14 Tuesday, August 13, 2013 4:37 PM 14 innhold del vii mineraler og bein..................................................... 177 kapittel 30 pth og vitamin d.................................................. 179 Sammendrag....................................................................... 179 Fysiologi........................................................................... 179 Laboratoriediagnostikk............................................................... 181 kapittel 31 hypokalsemi og hypoparatyreoidisme........................... 182 Bakgrunn.......................................................................... 182 Symptomer og tegn................................................................. 182 Diagnostikk........................................................................ 183 Behandling og oppfølging............................................................ 183 kapittel 32 hyperkalsemi og hyperparatyreoidisme......................... 185 Bakgrunn.......................................................................... 185 Symptomer og tegn................................................................. 186 Diagnostikk........................................................................ 187 Behandling......................................................................... 188 kapittel 33 forstyrrelser i magnesium og fosfat........................... 190 Hypomagnesemi.................................................................... 190 Hypofosfatemi...................................................................... 190 Reernæringssyndrom.............................................................. 190 kapittel 34 osteoporose og osteomalasi.................................... 192 Bakgrunn.......................................................................... 192 Symptomer og tegn................................................................. 193 Diagnostikk........................................................................ 193 Behandling......................................................................... 194 del viii væske- og elektrolyttbalanse...................................... 199 kapittel 35 regulering av væske- og elektrolyttbalansen................. 201 Sammendrag....................................................................... 201 Fysiologi........................................................................... 201 Bedømming av elektrolyttforstyrrelser.................................................. 203 kapittel 36 hypernatremi og diabetes insipidus............................. 204 Bakgrunn.......................................................................... 204 Symptomer og tegn................................................................. 204 Diagnostikk........................................................................ 205 Behandling......................................................................... 205
0000 103594 GRMAT E#41353E.book Page 15 Tuesday, August 13, 2013 4:37 PM innhold 15 kapittel 37 hyponatremi og siadh............................................. 207 Bakgrunn........................................................................... 207 Symptomer og tegn.................................................................. 208 Diagnostikk......................................................................... 208 Behandling.......................................................................... 208 del ix polyendokrine syndromer............................................ 213 kapittel 38 polyendokrin svikt............................................... 215 Bakgrunn........................................................................... 215 Autoimmunt polyendokrint syndrom type 1.............................................. 215 Bakgrunn........................................................................ 215 Symptomer og funn............................................................... 216 Diagnostikk...................................................................... 216 Behandling....................................................................... 217 Autoimmunt polyendokrint syndrom type 2 og type 3..................................... 217 Bakgrunn........................................................................ 217 Symptomer og funn............................................................... 217 Diagnostikk...................................................................... 218 kapittel 39 multippel endokrin neoplasi..................................... 219 Sammendrag........................................................................ 219 Multippel endokrin neoplasi type 1..................................................... 221 Primær hyperparatyreoidisme....................................................... 221 Hypofyseadenomer................................................................ 221 Nevroendokrine svulster........................................................... 221 Andre manifestasjoner............................................................. 222 Multippel endokrin neoplasi type 2..................................................... 222 Medullær tyreoideacancer.......................................................... 223 Primær hyperparatyreoidisme....................................................... 223 Feokromocytomer................................................................. 223 von Hippel-Lindaus sykdom (VHL)...................................................... 223 Angiomer........................................................................ 223 Feokromocytomer................................................................. 223 Nyrecancer....................................................................... 223 Diagnostikk...................................................................... 224 Carney complex..................................................................... 224 McCune Albrights syndrom........................................................... 224
0000 103594 GRMAT E#41353E.book Page 16 Tuesday, August 13, 2013 4:37 PM 16 innhold appendiks 1 normalområder for utvalgte hormonanalyser.............. 227 appendiks 2 utvalgte endokrinologiske tester............................. 229 appendiks 3 forkortelser i alfabetisk rekkefølge........................... 232 appendiks 4 utvalgte litteratur- og internettressurser.................. 237 stikkord........................................................................ 239