☉OHA:	Sulfonylurea :(Amaryl...) : (kill Liver) Thiazolidinedione(TZD) :(Actos, Avandia) : kill Liver A-Glucosidase inhibitor :Acarbose(Glucobay) : kill Liver Biguanide :Metformin(Glucophage): lactic acidosis/monitor Kidney（「沒蜂蜜」所以太酸）
☉Insulin resistance syndrome	→characterized by hyperinsulinemia and an increased prevalence of obesity, hypertension, dyslipemia and type 2 diabetes mellitus. →decreased HDL cholesterol levels (a significant risk factor for heart disease), increased serum VLDL cholesterol and TG levels and, sometimes, a ★decreased LDL cholesterol level.
☉Thyroid  ca	Thyroid medullary ca: MEN II: RET mutation: Calcitonin ↑↑ papillaruy ca: Thyroglobulin ↑↑ for f/u
☉MEN	MEN-I : parathyroid glands, pancreatic islet cells(Insulinoma)(gastrinoma：ZE), and pituitary gland.（3P） MEN-IIA : medullary carcinoma of the thyroid, pheochromocytoma, and hyperparathyroidism. MEN-IIB : multiple mucosal neuromas, medullary carcinoma of the thyroid, and pheochromocytoma（doctor of MED, Phil）
☉glucose intolerance	IGT(impaired glucose test): OGTT(2hr): 140-200 mg/dl IFG(impaired fasting glucose): FPG(fasting plasma glucose): 110-126 mg/ml
☉Insulinoma	→Preoperative portal venous sampling →Approximately 10% of insulinomas are malignant (metastases are present), and 10% are multiple, particularly in patients with multiple endocrine neoplasia type 1 (MEN 1). →Adrenergic symptoms (hypoglycemia causes adrenalin release) include weakness, sweating, tachycardia, palpitations, and hunger. →Serum insulin levels of 10 mU/mL or more (normal <6 mU/mL) Glucose levels of less than 40 mg/dL C-peptide levels exceeding 2.5 ng/mL (normal <2 ng/mL)
☉Conn's syndrome	→primary hyperaldosteronism. →curable cause of hypertension
☉Leptin	(from the Greek leptos, meaning thin) →a protein hormone with important effects in regulating body weight, metabolism and reproductive function. →approximately ~16 kDa in mass and encoded by the obese (ob) gene →Genetically obese mice with inactivating mutations in the ob gene or the gene encoding the leptin receptor (db gene) →weight loss resulting from administration of leptin appears to result from a combination of at least two fundamental effects: 1.Decreased hunger and food consumption, mediated at least in part by inhibition of neuropeptide Y synthesis.(very potent stimulator of feeding behavior) 2.Increased energy expenditure, measured as increased oxygen consumption, higher body temperature and loss of adipose tissue mass. →the ability of leptin to enhance secretion of gonadotropin-releasing hormone, and thus luteinizing and follicle-stimulating hormones from the anterior pituitary. →The amount of leptin↓ expressed by adipocytes correlates well with the lipid content↑ of the cells. →Blood concentrations of leptin are usually increased in obese humans, suggesting that they are in some way insensitive to leptin, rather than suffering from leptin deficiency.
☉Rheumatic factor:	Fc of IgG （GG變濕了）
☉hereditary angiooedema:	C1 esterase inhibitor(A-1都是第一名)
☉Arthritis D/D:	1.OA: weight bearing/ used joints, DIP, PIP, 1st CMC, but MCP rare use-related pain, morning stiffness, crepitation bony swelling of joints, eg. Heberden's node(DIP), Bouchard's node(PIP)（很深的Hebride懸崖） CXR: osteophytes 2.RA: PIP, MCP pain, tenderness, swelling, morning stiffness, swan neck(intrinsic m. atrophy), deviate to ulnar side CXR: osteopenia, marginal erosions ★KCS, episcleritis,marginal ulcer of cornea, BOOP, Caplan's syndrome(pneumoconiosis) →→Tumor necrosis factor (TNF) inhibitors, Soluble Interleukin–1 (IL–1) Receptor Therapy 3.AS: SI, hip HLA B-27 CXR: bamboo spine(calcification of annulus fibrosis & ant. long. lig.) →→Enthesopathy :involving an attachment of a tendon or ligament to bone (enthesis). Inflammatory abnormalities of entheses are prominent findings in seronegative spondyloarthopathies (ankylosing spondylitis, Reiters syndrome, psoriatic arthritis) and may also be present to a lesser extent in rheumatoid arthritis. 4.Gout: podagra(attack in the great toe): 90% pain, fever tophi, MSU urate nephrosis, UA nephropathy/ nephrolithiasis definite Dx: aspiration
☉Septic arthritis:	WBC > 50000/mm3←→2000-20000/mm3 in RA
☉JRA	→systemic onset JRA: a high intermittent fever and one of the following: lymphadenopathy, hepatomegaly, splenomegaly, pericarditis, or a ★transient maculopapular rash. →Polyarticular onset JRA: affecting 5 or more joints during the first 6 months of disease. About 25% of these children are seropositive and these are not at excess risk for developing uveitis. →Pauciarticular onset JRA: affects 4 or fewer joints, and this type being most prevalent, occurs in about 60% of patients. Some of these patients might progress to polyarticular involvement .
☉PM/DM	→proximal m. weakness, dyspnea, interstitial lung dz., Raynaud's phenomenon →Helicotrope rash on eyelids...: lilac-colored, Gottron rash →perivascular inflammation, perifascicular atrophy →CK elevation
☉Sjoegren's syndrome	（飢渴的休葛蘭） →destruction of exocrine glands(parotid gland...), eye/mouth dryness →Criteria: Keratoconjunctivitis sicce(KCS), Xerostomia, Serologic autoAb, Labial salivary gland biopsy →ANA, RF, anti-La(SS-B) > anti-Ro(SS-A)
☉MCTD	→anti-nuclear rebonucleoprotein(RNP) →SLE/SSc/polymyositis/RA
☉Systemic Sclerosis	→CREST:★ anti-centromere
☉antimitochondrial antibody	→positive in up to 94% of people with biliary cirrhosis, and 25% of those with chronic active hepatic or iodophathic (of unknown cause) cirrhosis. →helpful in distinguishing biliary (bile system) cirrhosis from liver problems due to obstruction outside of the liver, viral hepatitis, and alcoholic cirrhosis.