Clinical meaning
T2DM features insulin resistance and progressive beta-cell dysfunction. Insulin resistance from TNF-alpha, IL-6, free fatty acids impairs IRS phosphorylation. Beta-cell compensation fails through glucotoxicity and lipotoxicity. First-line: metformin + lifestyle. Second-line based on comorbidities: SGLT2i or GLP-1RA for ASCVD, HF, CKD.
Diagnosis & workup
Diagnostics & workup: - Dexamethasone suppression test (1mg overnight) for Cushing screening - TSH (most sensitive for primary thyroid dysfunction) - Free T4 and Free T3 for thyroid hormone assessment - IGF-1 for growth hormone excess or deficiency screening - Cosyntropin stimulation test for adrenal insufficiency - PTH with calcium and phosphorus for parathyroid evaluation - Prolactin level for pituitary evaluation
Risk factors: - Prior radiation to head/neck affecting thyroid or pituitary - Family history of endocrine disorders (autoimmune thyroid, T2DM) - Obesity (BMI >30) with insulin resistance - Pregnancy altering hormonal milieu (gestational DM, thyroiditis) - Iodine deficiency or excess affecting thyroid function - Medication-induced endocrinopathy (lithium-thyroid, statin-DM) - Metabolic syndrome (waist circumference, triglycerides, HDL, BP, glucose)