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Jingdong book

临床诊疗指南·内分泌及代谢性疾病分册

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Jingdong book

临床诊疗指南·内分泌及代谢性疾病分册

Name: 临床诊疗指南·内分泌及代谢性疾病分册
Brand: Jingdong book
SKU: 3117013351
Price: 17.35 USD
Availability: OutOfStock

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《临床诊疗指南：内分泌及代谢性疾病分册》系中华医学会委托内分泌学分会组织全国部分内分泌学专家编写、审定的内分泌代谢性疾病临床诊疗指南。全书共32章，分别介绍了垂体、甲状腺、肾上腺、性腺等内分泌系统主要疾病，以及主要代谢性疾病的临床诊治要点和区别。《临床诊疗指南：内分泌及代谢性疾病分册》可供内科、内分泌科医师诊治相关疾病时作为依据和参考。

Catalogue

第一章下丘脑综合征
第二章垂体前叶功能减退症
第三章生长激素缺乏性侏儒症
第四章肢端肥大症
第五章泌乳素瘤
第六章尿崩症
第七章抗利尿激素不适当分泌综合征
第八章甲状腺功能亢进症（附：甲亢危象）
第九章甲状腺功能减退症
第十章亚急性甲状腺炎
第十一章慢性淋巴细胞性甲状腺炎
第十二章单纯性甲状腺肿
第十三章甲状腺结节与肿瘤
第十四章原发性甲状旁腺功能亢进症
第十五章继发性甲状旁腺功能亢进症
第十六章原发性甲状旁腺功能减退症（附：假性及假-假性甲状旁腺功能减退症）
第十七章皮质醇增多症
第十八章肾上腺皮质功能减退症
第十九章原发性醛固酮增多症
第二十章先天性肾上腺皮质增生症
第二十一章嗜铬细胞瘤
第二十二章多发性内分泌腺肿瘤综合症
第二十三章异位激素分泌综合征
第二十四章性早熟
第二十五章曲细精管发育不全症
第二十六章糖尿病
第二十七章糖尿病酮症酸中毒
第二十八章高渗性非酮症糖尿病昏迷
第二十九章胰岛素瘤
第三十章痛风
第三十一章肥胖症
第三十二章原发性骨质疏松症

Book Abstract

第一章下丘脑综合征
【概述】
下丘脑综合征系由基因缺陷、肿瘤、肉芽肿、结核及药物等病因使下丘脑的结构及功能受损，而引起神经、内分泌、体温调节等方面出现功能障碍的临床综合征。
【临床表现】
（一）内分泌功能障碍
依据下丘脑全部或部分结构损害，可致不同程度、不同范围的功能障碍。如全下丘脑损害可因全部下丘脑释放激素缺乏而致全腺垂体功能减退，出现生长发育障碍（青春期前得病者），以及性腺、甲状腺和肾上腺皮质功能减退的相关临床表现。孤立的生长激素释放激素（GRH）分泌过多导致巨人症（青春期前得病者）或肢端肥大症，GRH分泌减少出现生长激素缺乏性侏儒症。泌乳素释放因子或抑制因子分泌失常可致闭经—溢乳综合征。促性腺激素释放激素（GnRH）分泌过多可引起性早熟；分泌过少可致女性中枢性闭经，两性性腺发育不全。促肾上腺皮质激素释放激素（CRH）分泌过多可致皮质醇增多症，促甲状腺激素释放激素（TRH）分泌过少可致甲状腺功能减退，下丘脑视上核及室旁核或视上核—垂体束损害可致中枢性尿崩症。
（二）神经系统表现
下丘脑病变如为局限性，可出现损害部位相关功能的临床表现。
1.嗜睡和失眠下丘脑后部病变，大多数患者可表现为嗜睡，其类型有：①发作性睡眠，较常见，患者可随时睡眠发作，持续数分钟至数小时；②深睡眠症，发作时可持续睡眠数天至数周，但睡眠发作期常可被唤醒，但易再度入睡；③发作性睡眠强食症，患者不可控制地出现发作性睡眠，每次睡眠持续数小时至数天，醒后暴饮暴食，多伴有肥胖。
2.多食肥胖或顽固性厌食消瘦病变累及下丘脑腹内侧核或结节附近（即饱食中枢）时，患者可因多食而肥胖，常伴肥胖生殖无能综合征。累及腹外侧核（即摄食中枢）时，有厌食、体重下降、皮肤萎缩、毛发脱落、肌肉软弱、畏寒、心动过缓、基础代谢率降低等。
（三）发热或体温过低病变累及下丘脑前部或后部时，可出现体温调节障碍，如：
1.低热体温一般在37.5℃左右；
2.体温过低体温可低至36℃以下；
3.高热可呈弛张型或不规则型，一天内体温可多变，但高热时四肢冷凉而躯干温热，对一般退热药无效。
（四）性腺功能障碍
可能因下丘脑垂体纤维受损，影响垂体促性腺激素释放，或因下丘脑脊髓纤维受损，影响脊髓各中枢活动所致。可表现为性欲减退、月经失调、闭经不育、阳痿及性发育延迟等。
（五）精神障碍
当病变累及下丘脑后腹下核及视前区时，常可有精神症状，表现为过度兴奋、哭笑无常、定向力障碍、幻觉及易怒等。
（六）其他
常见头痛，亦可出现多汗或汗闭、手足发绀、括约肌功能障碍及下丘脑性癫痫。当腹内侧部视交叉受损时，可伴有视力减退、视野缺损或偏盲。可出现血压波动大，瞳孔散大、缩小或两侧不等大。病变累及下丘脑前方及下行至延髓自主神经纤维时，可引起胃和十二指肠溃疡等表现。
【诊断要点】
由于病因众多，损害部位的大小、程度不同，故临床表现错综复杂，有时诊断不易。应详问病史，联系下丘脑结构与功能的关系，结合相关检查结果，综合分析后作诊断。
1.具有各种下丘脑损害的病史。
2.有上述内分泌功能障碍的临床表现、体征和实验室证据。
3.各种影像学及其他检查，如头颅X线平片、蝶鞍薄层扫描、头颅CT或MRI。可示蝶鞍扩大、鞍背、后床突吸收或破坏、鞍区病理性钙化等颅内病变和性质。
最后要与原发于垂体、靶腺的疾病相鉴别。
……

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