From the Guidelines
The management of hypertriglyceridemia should prioritize lifestyle interventions, including dietary changes and regular aerobic physical activity, as the first line of treatment, with a goal of reducing triglyceride levels by 20% to 50%. This approach is supported by the 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia 1.
Diagnosis and Classification of Hypertriglyceridemia
The diagnosis of hypertriglyceridemia is based on fasting serum triglyceride levels, with cutoffs defined by the Endocrine Society as follows:
- Mild hypertriglyceridemia: 150 to 199 mg per dL (1.7 to 2.3 mmol per L)
- Moderate hypertriglyceridemia: 200 to 999 mg per dL (2.3 to 11.3 mmol per L)
- Severe hypertriglyceridemia: 1,000 to 1,999 mg per dL (11.3 to 22.6 mmol per L)
- Very severe hypertriglyceridemia: 2,000 mg per dL (22.6 mmol per L) or greater 1.
Lifestyle Interventions for Hypertriglyceridemia
Lifestyle interventions for hypertriglyceridemia include:
- Dietary changes: restriction of added sugars and total fat, with individualized nutrition therapy based on the predominant contributors to hypertriglyceridemia
- Regular aerobic physical activity: at least 150 minutes per week of moderate intensity or 75 minutes per week of vigorous, high-intensity aerobic physical activity
- Weight loss: a goal of 5% to 10% of body weight 1.
Musculoskeletal Manifestations of Pediatric Endocrine Disorders
Musculoskeletal manifestations of pediatric endocrine disorders include:
- Growth abnormalities in growth hormone disorders
- Delayed bone age and short stature in hypothyroidism
- Accelerated bone age and osteoporosis in hyperthyroidism
- Limited joint mobility and diabetic cheiroarthropathy in diabetes mellitus
- Bone pain, pathological fractures, and radiographic subperiosteal bone resorption in hyperparathyroidism
- Osteoporosis, pathological fractures, and growth retardation in Cushing syndrome
- Hyperpigmentation of joints and bony tenderness in adrenal insufficiency
- Bowing of legs, rachitic rosary, and craniotabes in rickets from vitamin D deficiency.
Merits and Demerits of Newer Oral Anti-Diabetic Drugs
The merits of newer oral anti-diabetic drugs include improved efficacy and safety profiles, while the demerits include potential side effects and high costs.
Autoimmune Hypothyroidism
Autoimmune hypothyroidism is a condition in which the immune system attacks the thyroid gland, leading to hypothyroidism.
Diabetic Ketoacidosis in Children
Diabetic ketoacidosis in children is a serious complication of diabetes mellitus, characterized by hyperglycemia, metabolic acidosis, and ketosis.
Thyroid Storm
Thyroid storm is a life-threatening complication of hyperthyroidism, characterized by extreme hyperthyroidism, fever, and cardiovascular instability.
Management of Hypertriglyceridemia
The management of hypertriglyceridemia should prioritize lifestyle interventions, with pharmacological therapy reserved for patients with severe or very severe hypertriglyceridemia, or those with persistent hypertriglyceridemia despite lifestyle interventions 1. Fibrates are the first-line treatment in patients with hypertriglyceridemia who are at risk of pancreatitis, while statins may be useful to modify cardiovascular risk in patients with moderately elevated triglyceride levels 1.
From the Research
Objective Questions (CVS)
- What is second stenosis in Mitral stenosis: There are no research papers to assist in answering this question.
- Murmurs in Mitral stenosis: There are no research papers to assist in answering this question.
- Ortner's syndrome: There are no research papers to assist in answering this question.
- Signs of predominant MR in a MS/MR valvular disease: According to 2, the presence of MR in patients with severe AS characterizes a high-risk population.
- What is Shone's complex: There are no research papers to assist in answering this question.
- Coanda effect in supravalvular aortic stenosis: There are no research papers to assist in answering this question.
- Mechanism of syncope in Aortic stenosis: There are no research papers to assist in answering this question.
- What is Bernheim effect: There are no research papers to assist in answering this question.
- Mechanism of Austin Flint Murmur: There are no research papers to assist in answering this question.
- What is Harvey sign: There are no research papers to assist in answering this question.
Musculoskeletal Manifestations of Endocrine Disorders in Paediatrics
- There are no research papers to assist in answering this question.
Notes on Various Topics
Merits and De-merits of Newer Oral Anti-Diabetic Drugs
- There are no research papers to assist in answering this question.
Autoimmune Hypothyroidism
- There are no research papers to assist in answering this question.
Diabetic Ketoacidosis in Children
- There are no research papers to assist in answering this question.
Features and Management of Thyroid Storm
- There are no research papers to assist in answering this question.
Management of Hypertriglyceridemia
- There are no research papers to assist in answering this question.
Aortic Stenosis and Mitral Regurgitation
- According to 3, aortic stenosis presenting as part of a multiple valve disease scenario or as mixed valve disease is frequent.
- According to 2, the presence of MR in patients with severe AS characterizes a high-risk population, and timely aortic valve intervention confers a survival benefit.
- According to 4, simultaneous replacement of both aortic and mitral valves is linked to significantly higher morbidity and mortality.
- According to 5, the hemodynamic interdependency of AS and MR confounds the assessment of the severity of each valve disease.
- According to 6, moderate or severe mitral regurgitation is a common finding in patients with severe aortic stenosis, and TAVI may provide a reasonable therapeutic strategy with an expectation in selected patients that MR may improve.