the endocrine system
DESCRIPTION
by C. SommersTRANSCRIPT
GLYCOSURIA HYPERCALCEMIA
GlycosuriaGlycosuria
The presence of sugar or glucose in The presence of sugar or glucose in the urinethe urine– Two basic causes:Two basic causes:
Blood glucose levels are so elevated that the Blood glucose levels are so elevated that the renal tubules are unable to reabsorb all that renal tubules are unable to reabsorb all that is presentis present
Failure of tubules to reabsorb when glucose Failure of tubules to reabsorb when glucose levels are normallevels are normal
– Renal glycosuriaRenal glycosuria
Blood Glucose LevelsBlood Glucose Levels Under normal circumstances about 10 mmol/L Under normal circumstances about 10 mmol/L It can occur in the non-diabetic if a substantial It can occur in the non-diabetic if a substantial
amount of food high in sugar is consumed and amount of food high in sugar is consumed and transiently overwhelms the insulin response transiently overwhelms the insulin response causing hyperglycemia causing hyperglycemia
Some hyperglycemia causesSome hyperglycemia causes– ThyrotoxicosisThyrotoxicosis– AcromegalyAcromegaly– Severe anxietySevere anxiety– Diabetes mellitusDiabetes mellitus– Cushing’s diseaseCushing’s disease– Pancreas dysfunctionPancreas dysfunction
Glycosuria occurs when a normal renal threshold Glycosuria occurs when a normal renal threshold has been exceeded due to hyperglycemiahas been exceeded due to hyperglycemia
Renal GlycosuriaRenal Glycosuria
In pregnancyIn pregnancy– Results from increased renal blood flow Results from increased renal blood flow – Tubules are presented with a greater Tubules are presented with a greater
volume each minutevolume each minute– May be the first sign of gestational May be the first sign of gestational
diabetes diabetes
Renal GlycosuriaRenal Glycosuria
Other causesOther causes– Fanconi’s SyndromeFanconi’s Syndrome
Inadequate proximal renal tubular Inadequate proximal renal tubular reabsorption of glucosereabsorption of glucose
Inherited or acquiredInherited or acquired Other symptoms includeOther symptoms include
– growth failure, rickets, polyuria, polydipsia, or growth failure, rickets, polyuria, polydipsia, or dehydration dehydration
Renal GlysuriaRenal Glysuria Some secondary causes:Some secondary causes:
– Oculocerebrorenal dystrophy (Lowe's syndrome) Oculocerebrorenal dystrophy (Lowe's syndrome) – CystinosisCystinosis– Wilson's diseaseWilson's disease– Interstitial nephritisInterstitial nephritis– Hereditary tyrosinemia Hereditary tyrosinemia – Heavy metal poisoning such as lead, mercury or Heavy metal poisoning such as lead, mercury or
after use of out-of-date tetracycline after use of out-of-date tetracycline – Intestinal glucose-galactose malabsorption Intestinal glucose-galactose malabsorption
(where the defective sodium-dependent glucose (where the defective sodium-dependent glucose co-transporter protein is also present in the renal co-transporter protein is also present in the renal tubules)tubules)
Benign GlycosuriaBenign Glycosuria
Occurs without significant pathology Occurs without significant pathology Divided into 3 categoriesDivided into 3 categories
– Type A Type A Classical glycosuria, with reduction in both glucose Classical glycosuria, with reduction in both glucose
threshold and maximal glucose reabsorption ratethreshold and maximal glucose reabsorption rate
– In type B In type B Reduction in the glucose threshold and a normal rate Reduction in the glucose threshold and a normal rate
of reabsorption of reabsorption
– Type O Type O Failure of glucose reabsorptionFailure of glucose reabsorption Plasma glucose, glucose tolerance test (GTT), insulin Plasma glucose, glucose tolerance test (GTT), insulin
levels and HbA1C are all normallevels and HbA1C are all normal
HypercalcemiaHypercalcemia
Condition of excessive calcium levels in Condition of excessive calcium levels in the bloodthe blood– Normal range: 9-10.5 mg/dL or 2.2-2.6 mmol/L Normal range: 9-10.5 mg/dL or 2.2-2.6 mmol/L – Symptoms are more common at high calcium Symptoms are more common at high calcium
blood values blood values 12.0 mg/dL or 3 mmol/l). 12.0 mg/dL or 3 mmol/l).
– Severe hypercalcemia Severe hypercalcemia above 15-16 mg/dL or 3.75-4 mmol/l above 15-16 mg/dL or 3.75-4 mmol/l considered a medical emergencyconsidered a medical emergency
– coma and cardiac arrest can resultcoma and cardiac arrest can result
Signs and SymptomsSigns and Symptoms
Some signs of Some signs of hypercalcemiahypercalcemia– fatiguefatigue– depressiondepression– confusionconfusion– anorexia anorexia – nausea nausea – vomiting vomiting – constipation constipation – pancreatitis pancreatitis – polyuriapolyuria
Chronic Chronic hypercalcemiahypercalcemia– Urinary calculi Urinary calculi
(renal stones or (renal stones or bladder stones) bladder stones)
– Abnormal heart Abnormal heart rhythms ECG rhythms ECG findings of a short findings of a short QT interval and a QT interval and a widened T wave widened T wave
Peptic ulcers may Peptic ulcers may also occuralso occur
Remember: "Remember: "groansgroans (constipation), (constipation), moansmoans (psychotic noise), (psychotic noise), bonesbones (bone pain, especially if (bone pain, especially if
PTH is elevated), and PTH is elevated), and stonesstones (kidney stones)” (kidney stones)”
– Excessive skeletal Excessive skeletal calcium releasecalcium release
– Increased intestinal Increased intestinal calcium absorptioncalcium absorption
– Decreased renal Decreased renal calcium excretioncalcium excretion
– Indicative of Indicative of another disease another disease
– Hyperparathyroidism Hyperparathyroidism and malignancy and malignancy account for about account for about 90% of 90% of hypercalcemiahypercalcemia
– Other causesOther causes CancerCancer Disorders related to Disorders related to
bone lossbone loss MedicationsMedications Excessive use of Excessive use of
calcium and vitamin calcium and vitamin D supplements D supplements
Follow the link…Follow the link…
… for more information on hypercalcemia!
resources citedresources cited
aafp.orgaafp.org Fremgen, Bonnie F. & Frucht, Fremgen, Bonnie F. & Frucht,
Suzanne S. Suzanne S. Medical Terminology: A Medical Terminology: A Living Language: 3e.Living Language: 3e. New Jersey: New Jersey: Pearson Education. 2005Pearson Education. 2005
patient.co.ukpatient.co.uk wikipedia.orgwikipedia.org