Endocrinology

P.E.P.S.I. & C.O.K.E. – make sure it’s diet!

Primary

Type 1: Autoimmune destruction of β-cells of pancreatic islets of Langerhans; always leads to insulin dependency. https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">

Epi:

Inc: Prevalence = 1–2% population, and rising   Age: Children to 30 y   Aet: Genetic: DR3, 4 increases risk, but MZ concordance = 50%

Infection: CMV, EBV, Coxsackie, congenital rubella (seasonal onset of diabetes)

  PATH: Anti-islet-cell Abs (esp. glutamic acid dehydrogenase) and/or anti-insulin Abs

Type 2: Peripheral insulin resistance ± insulin ↓ ± hepatic glucose efflux ↑ https://www.niso.org/standards/z39-96/ns/oasis-exchange/table"> Epi: Inc: Prevalence = 5%   Age: Increases with age, but inherited types occur in children   Geo: Indian, African   Aet: Genetic: MZ concordance = 90%

Syndrome X = DM + central obesity + ↑ABP +↑lipids, due to ↑ liver fat synthesis

Amylin deposition in islets (= hypoglycaemic hormone secreted by islet cells)

Hereditary: Insulin hyposecretion: MODY (maturity-onset diabetes of young) – like type 2 DM

Aet: Glucokinase deficiency (rare)

Insulin resistance: Donohue syndrome; lipodystrophy

Endocrine

Stress hormone excess: in temporal order of release:

Adrenaline → glucagon → glucocorticoid → growth Hormone → T4

(phaeochromocytoma) (glucagonoma) (Cushing) (acromegaly) (thyrotoxicosis)

Stress response: Sepsis, surgery, trauma → hypercortisolaemia → insulin resistance

Oestrogen: Gestational diabetes; polycystic ovaries syn.; oral contraceptive pill

Pancreatic disease: Chronic pancreatitis, (alcohol, cystic fibrosis, malnutrition); haemochromatosis; pancreas ca. (late)

Steroids

Inherited:

Neurological: Myotonic dystrophy; Friedreich ataxia; ataxia telangiectasia; Huntington chorea

Glycogen storage disease

Other: Lawrence–Moon–Biedl syn; DIDMOAD (Diabetes Insipidus, DM, Optic Atrophy, Deafness) syn.

Chromosomal: Down, Turner, Kleinfelter syndrome

Organ failure: Liver/congestive cardiac failure

Kidney failure: Due to insulin resistance; insulin hyposecretion; peritoneal dialysis (glucose in dialysate)

Exogenous: Diuretics (thiazides, loop), adrenergic stimulants (salbutamol, amphetamines), pancreatic toxins (pentamidine), chemo Rx (e.g. alloxan) https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429446405/b9046b8d-f890-4c55-a52a-551490b30e56/content/fig7_1.tif" xmlns:xlink="https://www.w3.org/1999/xlink"/>