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},
"code": "E05",
"name": "Гипертиреоз",
"icd_name": "Тиреотоксикоз [гипертиреоз]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
0,
1
],
"periodicity": 4,
"slug": "e05_gipertireoz",
"lead": "клинический синдром, обусловленный повышением уровня тиреоидных гормонов в крови и их токсическим действием на различные органы и ткани",
"description": "",
"etiology": "<p>Причины развития тиреотоксикоза:</p>\r\n<ul>\r\n<li>высокая функция тиреоцитов (образование избытка гормонов);</li>\r\n<li>секреция гормонов вне ткани щитовидной железы;</li>\r\n<li>разрушение ткани железы (временное повышение гормонов в крови);</li>\r\n<li>введение синтетических гормонов.</li>\r\n</ul>\r\n<p>Высокая функция тиреоцитов чаще всего наблюдается при первичном тиреотоксикозе. Может быть повреждена вся ткань щитовидной железы или ее локальные участки (токсические узлы). Наиболее часто эту форму тиреотоксикоза вызывает диффузный токсический зоб (Базедова болезнь, болезнь Грейвса), многоузловой и смешанный зоб, токсическая аденома, передозировка йода.</p>\r\n<p>Секреция тиреоидных гормонов вне тиреоидных тканей возможна в яичниках и в активно функционирующих метастазах рака щитовидной железы.</p>\r\n<p>Разрушение тиреоцитов приводит к резкому выделению в кровь коллоида, богатого гормонами. Такая ситуация возникает при:</p>\r\n<ul>\r\n<li>подостром тиреоидите;</li>\r\n<li>безболевом тиреоидите;</li>\r\n<li>послеродовом тиреоидите;</li>\r\n<li>йодиндуцированном тиреоидите типа 2.</li>\r\n</ul>\r\n<p>Тиреотоксикоз носит транзиторный характер. Проходит без лечения. Из-за деструкции клеток щитовидной железы со временем может формироваться гипотиреоз.</p>\r\n<p>Медикаментозный тиреотоксикоз – это либо ошибочное назначение избыточных доз синтетического тироксина, либо самолечение. Иногда пациенты принимают гормоны с целью симуляции эндокринного заболевания.</p>",
"pathogenesis": "<p>Тиреоидине гормоны увеличивают потребление кислорода тканями, повышая образование тепла и энергетический обмен <br />Повышается чувствительность тканей к катехоламинам и симпатической стимуляции <br />Увеличивается превращение андрогенов в эстрогены в тканях и возрастает содержание циркулирующего глобулина, связывающего половые гормоны, что повышает соотношение эстрогенов к андрогенам. Эти гормональные изменения могут вызвать гинекомастию у мужчин <br />Быстрое разрушение кортизола под влиянием тиреоидных гормонов обусловливает клиническую картину гипокортицизма (обратимая надпочечниковая недостаточность). </p>",
"diagnostics": "<p>Диагностика такого состояния, как тиреотоксикоз, требует тщательного анализа и сопоставления жалоб пациента, данных клинического осмотра больно в кабинете у врача-эндокринолога, а также результатов инструментальных и лабораторных обследований, выполненных по направлению доктора.</p>\r\n<p>Для установления самого факта высокого уровня тироксина, тиронина и тиреотропного гормона проводят исследование крови, а для уточнения характера поражения и выявления возможной причины развития тиреотоксикоза определяют уровень антител к клеткам щитовидной железы, некоторым вирусам и бактериям.</p>\r\n<p>Для уточнения размеров и особенностей строения органа, выявления характера патологического процесса в щитовидной железе обязательно проводят ультразвуковое исследование щитовидной железы и органов шеи. Если результатов этого исследования оказывается недостаточно, то выполняется сканирование щитовидной железы с радиоактивными изотопами (йодом или технецием), а также сцинтиграфическое исследование этого органа эндокринной системы. При необходимости результаты диагностики дополняют сведениями, полученными после компьютерной и магниторезонансной томографии.</p>\r\n<p>Если у пациента обнаруживается <a href=\"/symptom/ekzoftalm/\" title=\"Перейти на страницу симптома Экзофтальм\">экзофтальм</a>, то для уточнения его характера необходима консультация квалифицированного офтальмолога с обязательным УЗИ области глазниц (изучается состояние клетчатки, расположенной внутри глазницы за глазным яблоком). При выявлении неврологических или психологических жалоб может понадобиться консультация невропатолога, нейрохирурга или психиатра (психоневролога). При обнаружении симптомов расстройств репродуктивной системы необходим осмотр гинеколога или уролога-андролога.</p>\r\n<p>Только после проведения всех этих исследований и консультаций можно установить, какое именно заболевание или состояние спровоцировало развитие тиреотоксикоза – от этого напрямую зависит возможность лечения этого синдрома.</p>",
"treatment": "<p> </p>\r\n<p>Перед началом лечения тиреотоксикоза необходимо определить причину, вызвавшую данное заболевание.</p>\r\n<p>Самой распространенной причиной тиреотоксикоза является болезнь Грейвса. Сегодня есть три вида терапии данного недуга: медикаментозное лечение (тиреостатические препараты – Пропицил, Мерказолил, Тирозол, Метизол и проч.), терапия радиоактивным йодом и хирургическое вмешательство.</p>\r\n<p>Если заболевание вызвано деструктивными процессами в щитовидной железе, то лечение тиреотоксикоза будет заключаться в применении глюкокортикостероидных гормонов (преднизолон). Длительность терапии и дозировка подбираются индивидуально.</p>\r\n<p>Что касается оперативного лечения при тиреотоксикозе, то оно может быть выполнено только после лечения тиреостатиками.</p>\r\n<p>Если говорить о народных методах, то они, как правило, приводят к серьезным осложнениям (особенно со стороны сердечнососудистой системы). Поэтому перед тем, как прибегнуть к нетрадиционному лечению тиреотоксикоза, необходимо обязательно проконсультироваться со своим лечащим доктором, так как результаты самолечения могут быть самыми непредсказуемыми.</p>",
"prevention": "<p><br data-mce-bogus=\"1\"></p>",
"clinical_picture": "<p>Если вы чувствуете себя в последнее время раздражительным, эмоциональным, замечаете частую смену настроения, плаксивость, усиленное потоотделение, чувство жара, <a href=\"/symptom/narushenie_serdechnogo_ritma/\" title=\"Перейти на страницу симптома Нарушение сердечного ритма\">сердцебиение</a>, ощущение перебоев в работе сердца, похудели - это повод обратиться к врачу и сдать анализы на гормоны щитовидной железы.</p>\r\n<p>Cимптомы тиреотоксикоза.</p>\r\n<ul>\r\n<li>изменения метаболизма</li>\r\n<li>наблюдают повышение основного обмена и снижение веса, несмотря на хороший аппетит и достаточный приём пищи</li>\r\n<li><a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a> и непереносимость тепла отражают наличие повышенного теплообразования</li>\r\n<li>нередко — обратимая гипергликемия</li>\r\n<li>увеличение щитовидной железы</li>\r\n<li>сердечно-сосудистые эффекты:\r\n<ul>\r\n<li>ЧСС увеличивается; возникает стойкая синусовая <a href=\"/symptom/tahikardiya/\" title=\"Перейти на страницу симптома Тахикардия\">тахикардия</a> с частотой 120 в мин и более (не исчезающая во время сна и плохо поддающаяся лечению сердечными гликозидами) — больной ощущает сердцебиения в области шеи, головы и живота</li>\r\n<li>другие аритмии вследствие увеличения возбудимости миокарда, например, мерцание и трепетание предсердий</li>\r\n<li>тенденция к повышению систолического АД и снижению диастолического АД (большое пульсовое давление)</li>\r\n<li>симптомы хронической сердечной недостаточности.</li>\r\n</ul>\r\n</li>\r\n<li>симптомы со стороны ЖКТ\r\n<ul>\r\n<li>повышенный аппетит</li>\r\n<li>запоры или диарея</li>\r\n<li>приступы болей в животе</li>\r\n<li>возможна рвота</li>\r\n<li>в тяжёлых случаях — обратимое поражение печени (увеличение размеров, болезненность, возможна <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">желтуха</a>)</li>\r\n</ul>\r\n</li>\r\n<li>изменения кожи и волос. Кожа тёплая и влажная вследствие вазодилатации периферических сосудов и повышенного потоотделения. Характерны тонкие, шелковистые волосы, возможна ранняя седина.</li>\r\n<li>воздействие на ЦНС. <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">Беспокойство</a>, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, патологическая отвлекаемость, лёгкие нарушения памяти, <a href=\"/symptom/drozhanie/\" title=\"Перейти на страницу симптома Дрожание \">тремор</a>. Психические проявления гипертиреоза могут быть настолько выраженными, что напоминают клиническую картину тревожного расстройства, реже — мании или депрессии[2]:276.</li>\r\n<li>расстройства половой сферы:\r\n<ul>\r\n<li>у женщин — <a href=\"/symptom/narushenie_menstrualnogo_cikla/\" title=\"Перейти на страницу симптома Нарушение менструального цикла\">нарушение менструального цикла</a> (вплоть до аменореи)</li>\r\n<li>у мужчин — снижение потенции, возможна гинекомастия.</li>\r\n</ul>\r\n</li>\r\n<li>мышечная <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a> и <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a> (вследствие сопутствующего гипокортицизма).</li>\r\n</ul>",
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},
"code": "E15",
"name": "Недиабетическая гипогликемическая кома",
"icd_name": "Недиабетическая гипогликемическая кома",
"gender": 0,
"age_min": 20,
"age_max": 75,
"cause": [
0
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"periodicity": 1,
"slug": "e15_nediabeticheskaya_gipoglikemicheskaya_koma",
"lead": " Заболевание, характеризующееся приступами гипогликемии, обусловленными абсолютным или относительным повышением уровня инсулина.\r\n",
"description": "",
"etiology": "<p>Опухоли островков Лангерганса (инсулиномы)</p>\r\n<p>диффузная гиперплазия бета-клеток поджелудочной железы</p>\r\n<p>заболевания ЦНС, печени, внепанк-реатические опухоли</p>\r\n<p>секретирующие инсулиноподобные вещества, опухоли (чаще соединительно-тканного происхождения), усиленно поглощающие глюкозу</p>\r\n<p>недостаточная продукция контринсулярных гормонов.<br /><br /></p>",
"pathogenesis": "<p>Гипогликемия приводит к нарушению функционального состояния ЦНС, повышению активности симпатико-адреналовой системы.<br /><br /></p>",
"diagnostics": "<p>Для диагностики проводят определение уровня сахара в крови, иммунореактивного инсулина и С-пептида (натощак и на фоне пробы с голоданием и глюкозотолерантного теста). Для топической диагностики используют ангиографию поджелудочной железы, ультразвуковое исследование, компьютерную томографию, ретроградную панкреатодуоденографию.<br /><br /></p>",
"treatment": "<p>Лечение инсулиномы и опухолей других органов, обусловливающих развитие гипогликемических состояний, хирургическое. При функциональном гиперинсулинизме назначают дробное питание с ограничением углеводов, кортикостероиды (преднизолон по 5-15 мг/сут). Приступы гипогликемии купируют внутривенным введением раствора глюкозы.</p>",
"prevention": "",
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5132
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{
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}
]
}
