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76 Cards in this Set
- Front
- Back
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Hypothalamic stimulatory and inhibitory hormones are directly transported via?
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the hypotholamic-pituitary portal circulation
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Name the anterior pituitary hormones.
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ACTH, GH, PRL, TSH, LH and FSH.
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Name the posterior pituitary hormones and where are they synthesized?
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ADH (Arginine Vasopressin AVP) and Oxytocin.
*Synthesized in hypothalamus and stored in posterior lobe. |
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Most common secretory pituitary tumor?
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Prolactinomas
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What is the hormonal pattern loss of destructive pituitary lesions?
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GH, LH and FSH, TSH, and then ACTH.
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Microadenomas are defined as?
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lesions less than 10 mm in diameter
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Macroadenomas are defined as?
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lesions more than 10 mm in diamter
*>15 mm usually have supraseller extension |
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Tests for GH deficiency?
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*Insulin induced hypoglycemia by the Insulin Tolerance Test (ITT). Give 0.05-0.15 U/Kg IV to lower BS 50% or to 40mg/dL.
*IGF-1 |
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Test for GH hypersecretion?
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*Oral glucose tolerance test (OGTT). Give 100 g of glucose orally should supress GH levels to less than 1 ng/mL after 120 mins in normal.
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Tx of GH deficiency and hypersecretion?
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*Deficiency: GH Subq daily (0.1 - 0.3 mg/day)
*Hypersecretion: Surgery. If not somatostatin analog (Octreotide) or GH receptor antagonists (Pegvisomant). |
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How will pt present w/ Prolactinomas? Diagnosis?
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Women: Oligomenorrhea (early), Amenorrhea, Infertility, Galactorrhea.
Men: Decreased libido and impotence Diagnosis: PRl level above 200 ng/mL |
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Tx of Prolactinomas?
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Tx w/ dopamine agonist 1st (bomocriptine). usually very effective, if not surgery.
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Clinical features of hypothyroidism?
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lethargy, constipation, cold intolerance, bradycardia, weight gain, poor appetite, dry skin, and delayed relaxation time of peripheral reflexs.
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Tx of Secondary Hypothyroidism?
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Thyroxine 75 - 150 mcg/day. check with serum FT4 levels.
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Cushing Dx vs Cushing Syndrome?
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Disease: Tumor in Pituitary
Syndrome: Ectopic Tumor |
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In a pt with Hypothyroidism Supressed vs Elevated TSH level?
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*Supressed= Central (Secondary)
*Elevated= Primary |
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Plasma ACTH levels in adrenal insufficiency?
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*Primary= Normal to High
*Secondary= Low to Absent |
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Tests for Hypo ACTH?
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*ACTH
*ITT *Metyrapone *Cortrosyn-Stimulating Test |
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Tests for Hyper ACTH?
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*24-hr Urinary Free Cortisol
*Midnite Plasma Cortisol Levels -or- *Lack of supression of 8 am cortisol level after 1 mg of dexamethasone at 11 pm. |
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Symptoms of ACTH deficiency?
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*Adrenal Failure
*Lethargy *Weakness *N/V *Dehydration *Orthostatic Hypotension |
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How will pt present w/ Prolactinomas? Diagnosis?
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Women: Oligomenorrhea (early), Amenorrhea, Infertility, Galactorrhea.
Men: Decreased libido and impotence Diagnosis: PRl level above 200 ng/mL |
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Tx of Prolactinomas?
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Tx w/ dopamine agonist 1st (bomocriptine). usually very effective, if not surgery.
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Clinical features of hypothyroidism?
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lethargy, constipation, cold intolerance, bradycardia, weight gain, poor appetite, dry skin, and delayed relaxation time of peripheral reflexs.
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Tx of Secondary Hypothyroidism?
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Thyroxine 75 - 150 mcg/day. check with serum FT4 levels.
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Cushing Dx vs Cushing Syndrome?
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Disease: Tumor in Pituitary
Syndrome: Ectopic Tumor |
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In a pt with Hypothyroidism Supressed vs Elevated TSH level?
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*Supressed= Central (Secondary)
*Elevated= Primary |
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Plasma ACTH levels in adrenal insufficiency?
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*Primary= Normal to High
*Secondary= Low to Absent |
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Tests for Hypo ACTH?
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*ACTH
*ITT *Metyrapone *Cortrosyn-Stimulating Test |
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Tests for Hyper ACTH?
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*24-hr Urinary Free Cortisol
*Midnite Plasma Cortisol Levels -or- *Lack of supression of 8 am cortisol level after 1 mg of dexamethasone at 11 pm. |
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Symptoms of ACTH deficiency?
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*Adrenal Failure
*Lethargy *Weakness *N/V *Dehydration *Orthostatic Hypotension |
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Tx of Adrenal insufficiency?
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Hydrocortisone 15-25 mg/day BID
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Symptoms of hypercortisolemia?
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*Obesity
*Moon facies *Striae *Thinning of Skin *Hirsutism *HTN *Menstrual Irregularities *Glucose intolerance *Mood Changes *Osteopenia |
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Tx of Hyper ACTH?
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Surgery or Medical Therapy such as Metyrapone.
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In women with amenorrhea, what three problems must be thought of?
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1) Primary Ovarian Failure= elevated FSH and LH, normal PRL.
2) Hyperprolactinemia= elevated PRL and normal to low follicular phase LH, FSH and Estradiol. 3) Pregnancy= + hCG, normal LH, normal to high PRL, and high Estradiol. |
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How to confirm GnRH deficiency?
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Low or normal levels of FSH and LH in the presence of: *Low Estradiol in Women
*Low Testosterone in Men |
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General symptoms of GnRH deficiency during childhood?
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Failure to enter normal puberty and Growth continues since Sex steroids is needed to close epiphyseal plates (eununchoid proportions).
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Tx for GnRH deficiency?
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*Men= Testoterone enanthanate 200 to 300 mg x 2-3 weeks
*Women= (Premenopausal) Estrogen. Also, Progesterone if they have a uterus. |
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Most common cx of hypothlamic dysfunction in children and young adults?
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Craniopharyngioma
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Symptoms of Hypothalamic tumors?
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*Visual Loss
*ICP (Headaches and Vomiting) *Hypopituitarism (including growth failure) *Diabetes Insipidus *Polydipsia and polyuria *Hyperphagia *Obesity |
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What is Hypopituitarism?
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Results from diminish secretion os one or more pituitary hormones.
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Tx of Panhyporpituitarism?
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replacement of T4, Glucocorticoids, and appropriate Sex Steroids.
*Caution: If combined TSH and ACTH dificiency, replace glucosteriods before T4 because T4 may precipitate acute adrenal failure. |
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What are the cx's of Diabetes Insipidus?
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1) Neurogenic= Posterior Lobe fails to secrete adequete amounts of ADH
2) Nephrogenic= failure of the kidney to respond to adequate amounts of ADH |
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Symptoms of Diabetes Insipidus (DI)?
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Polyuria and Polydipsia
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Hypersecretion of ADH is called? What does it cause?
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Syndrome of Inappropriate ADH (SIADH) and is causes Hyponatremia
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what is primary polydipsia?
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a compulsive disorder in which one drinks excess of 5 to 10 L of water a day resulting in decreased ADH secretion and thus diuresis.
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Primary test used to differentiate b/w DI and primary polydipsia?
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Water deprevention test.
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Describe the Water Deprevention Test.
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1) Pt denied fluids for 12-18 hrs
2) body weight, BP, urine volume, urine specific gravity, and plasma and urine osmolarity are measured every 2 hours. *Caution: Pt w/ DI may become rapidly dehydrated and hypotensive. |
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Normal Results after Water Deprevention Test?
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decrease urine output to 0.5 ml/min as well as increase in urine concentration to greater than that of plasma.
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Abnormal Results of Water Deprevation Test?
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*DI (neuro or nephro)= maintain high urine output with dilute urine (specific gravity 1.005) despite water deprevention.
*Primary Polydipsia= urine osmolarity increases to values greater than plasma osmolarity |
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How to differentiate b/w Neuro/Nephro DI and Primary Polydipsia?
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Once Urine Osmo plateaus, 5 units of Vasopressin Subq is given and urine osmolarity is measured. Results:
*DI Neuro= urine osmo increases above plasma osmo. ADH supressed. *DI Nephro= urine osmo increases less than 50%. ADH levels normal to high. *Primary Polydipsia= urine osmo increases less then 10% |
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Tx of Neurogenic DI?
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Desmopressin Acetate (DDAVP) a synthetic ADH analog
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Tx of Nephrogenic DI?
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Diuretics w/ dietary salt restriction
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How is Iodine essential for thyroid hormone synthesis?
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Iodine is needed to form T4 and T3 by iodination of tyrosine.
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What exerts negative feedback inhibition of TRH and TSH release?
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Ciculating T3
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What cx's a goiter?
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Hypersecretion of TSH
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FT4 Levels can be done by?
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*Estimation by calculating Free T4 index (Total T4 by available T4 binding sites on Thyroxine Bind Globulin (TBG))
*Directly by dialysis or ultrafiltration (best way). |
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Serum Thyroglobulin (TgAb) measurements are useful in?
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The follow-up of pts w/ papillary or follicular carcinoma. Levels should be less than 0.5 mcg/L w/ Levothyroxine treatment. Excess means persistant metatasis.
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What is Thyrotoxic Crisis (thyroid storm)?
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A life threating complication of hyperthyroidism that can be precipitated by surgery, radioactive iodine therapy, or severe stress (i.e.- uncontrolled DM, MI, acute infections)
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S/Sx of Thyrotoxic Crisis?
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*Hyperpyrexia (Fever)
*Flushing *Sweating *Tachycardia *Severe Agitation *Restlessness *Delirium *N/V *Diarrhea *A-Fib *Cardiac Failure *Coma Also Frequently Occurs |
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Most Common cx of Thyrotoxicosis?
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Graves' Dx
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What is Graves' Dx?
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An autoimmune dx form of Primary Hyperthyroidism that is more common in women b/w 20-40. Its the overproduction of an antibody called Thyroid Stimulating Immunoglobulins that bind to TSH receptors. These increase thyroid cell growth and thyroid hormone secretion.
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Clinical Manefistations of Graves' Dx?
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*Tearing to Proptosis to Loss of EOM
*Vision Loss *Preorbital edema *Pretibial Myxedema *Onycholysis *Weight loss * |
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Lab findings of Grave's Dx?
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*Elevated T4 and/or T3
*Supressed TSH *Elevated TSH receptor Antibody (usually) |
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Tx of Grave's Dx?
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*Antithyroid Drugs= thiocarbamide drugs
*Radioactive Iodine= treatment of choice, contraindicated in women who are pregnant and during thyrotoxicosis *Surgery= subtotal or total thyroidectomy |
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What is Toxic Adenoma? It's lab values?
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Toxic adenoma are toxic nodules which are usually found in older patients, presenting like thyrotoxicosis.
Labs: *Supressed TSH *Elevated T3 *Moderate elevated T4 *Thyroid Scan shows hot nodule |
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What is Subclinical Hyperthyroidism?
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Early presentation of all Hyperthyroidism.
Labs: *T4 and T3 are normal *Supressed TSH |
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What is Subacute Thyroiditis (de Quervain's Thyroiditis or Granulomatous Thyroiditis)?
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Acute inflammatory disorder of the thyroid gland, probably secondary to a viral infection. Complain of Anterior Neck Pain and Fever. Classic feature is tenderness of thyroid gland.
*Labs finding vary with course of dx (thyrotoxcosis to thyroidism) |
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Tx of de Quervain's Thyroiditis?
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*NSAID's
*Prednisone *Levothyroxine (if in hypo stage) |
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What is Postpartum Thyroiditis?
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Postpartum Thyroiditis usually occurs 6 months after partum and resembles subacute thyroiditis, going through triphasic course.
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What is Chronic Thyroiditis (Hashimoto's Thyroiditis)?
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Most common cx of Hypothyroidism. It's an autoimmune dx in which the body's own T-Cells attack the cells of the thyroid due to Anti-Thyroid Anitbodies. Occasionally have transient hyperthyroidism w/ low iodine uptake.
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What is Thyrotoxicosis Facititia?
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Exhibits typical features of thyrotoxicosis secondary to ingestion of excessive amounts of thyroxine, often in an attempt to lose weight.
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What is Struma Ovarii?
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When an Ovarian Teratoma contains thyroid tissue, which secretes thyroid hormone. A rare condition which can cx Thyrotoxicosis.
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What is congenital hypothyroidism called?
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Cretinism; may exhibit feeding problems, hypotonia, an open posterior fontanelle
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Tx of Hypothyroidism?
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Levothyroxine 75 to 150 mcg/day
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Labs for subclinical hypothyroidism?
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*Normal to Low t4 and t3
*Mildly elevated TSH |
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Symptoms of Anaplastic Carcinoma?
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*Pain
*Dysphagia *Horseness |
