Cushing's Syndrome.

-Cushing syndrome is a disorder that occurs when your body is exposed to high levels of the hormone cortisol. It may also occur if you take too much cortisol or other steroid hormones.
or
-chronic increased in free circulating level of glucocorticoids.

Causes:
ACTH dependent(80%)
-cushing's disease, ectopic ACTH syndrome(CA pulmonary, prostate,  ???
-ACTH administration
-
-
Non ACTH dependent
-adrenal gland adenoma, CA adrenal, glucocorticoids administration,alcohol

Immune Thrombocytopenic Purpura/ITP

-previously idiopathic TP
-Primary and secondary types:
-Primary
-autoimmune, no predisposing factors

secondary:
-virus-mumps, HSV, CMV, HIV---->Ag<----Ab.. destruction.
Acute-in children-2-6 yrs
after virus infection, mumps, herpes zoster, measles,
self-limiting
-mucocutaneous bleeding.

Chronic ITP
mainly 20-40 yrs
-associated with other autominnume disease, SLE, thyroid disease
-months to years
-
Clinical features:
epitaxis, purpura
easy briusing
menorrhagia
in severe thrombocytopenia-ICH
1-5%--spleenomegaly-less work for spleen.

Investigation:                                
FBC-<150*10^9/L
-rbc-normal
BM-increased megakaryocytes
autoimmune Ab-Gp iib ?

Treatment:
children-high dose prednesolone
i.v.IgG
will increased platelet count.
usually not required.

Adult:
>30x10^9-doesnt need urgent but can b monitored platelet count.

<30-1st line treatment-
-oral corticosteroids(1mg/kg)-prednisolone--short course(3 weeks))----66%-short course and gains back the normal count, 33% longer course, remission.
-i.v. IgG, if reoccurs without recovery after prednisolone.--

2nd line treatment:
spleenectomy-decrease destruction of platelet
                     -decreases the rproduction of Ab
                      -2/3 pt gains normal platelet count
                      -lifelong antibiotics
                      -contraindicated in pregnancy and children <6 years.
3rd Line
-after failed splectomy-predisolone, dapsone, azapthioprine, Rh IgG.
-Thrombopoeisis protein-romiplotin(s.c), eltrobopag(oral)

In emergency, platelet transfusion, ICH, steroid infusion like dexamethasone and methyl prednisolone

Thrombocytopenia

-low level of platelets.
-150-400*10^9/L-normal
-purpura and bleeding from mucous membrane when low

-Features according to levels:
 >500-thrombosis or haemorrhages
>500-100-no clinical effect/ manifestation
100-50-moderate clinical manifestationemorrhage after injury
50-20-purpura may occur after injury
<20-purpura(common), sponstanous haemorrhage from mucous membrane, ICH

Causes:
-decreased production
-excessive peripheral destruction
-sequestration in enlarged spleen

Impaired production:
-selective megakaryocyte depression(rare congenital defect, drugs, chemical, viral)
-as a part of general bone marrow failure.
-cytotoxic drugs and chemicals.
-megaloblastic anaemia
-leukaemia
-myelodysplastic syndrome.
-myelofibrosis
-solid tumour of infiltration
-aplastic anemia
-HIV infection

Excessive peripheral destruction:
-Immune-
   autoimmune:
             -autoimmune ITP(-immune -mediated thrombocytopenia purpura)
             -drug induced.-penicillin, thiazide
              systemic immune-sle, chronic lympocytic leukemia
             -alloneonatal thrombocytopenia(genetic differnces between mom and fetus-Ag by fetus-->therefore Mother produces Ab by mother against it)
             -post transfusion purpura(after 5-7 days transfusion)
             -DIC-pathological activation of coagulation pathway in response to different clinical conditions)
             -thrombotic thrombocytic purpura

Excessive Consumption/sequestration
-spleenomegaly
-hyperspleenism(overactive spleen)

Diabetes Mellitus

Definition
-is a multi-factorial disorder caused by diminished insulin action due to its decreased availability or effectiveness in varying combinations.
-or, is a syndrome of chronic hyperglycaemia due to relative insulin deficiency, resistance or both.

Reasons for increasing Prevalence:
1.rapid urbanization.
2.lack of exercise
3.mental stress
34.diet
5.undiagnosed gestational  DM.