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25 Cards in this Set
- Front
- Back
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Causes of diabetes insipidus (neurogenic)
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-Vasopressin deficiency
-Acquired: idiopathic, trauma, tumor, granuloma, infx, vascular, familial |
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treatment of diabetes insipidus
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1. Vasopressin preparations: IM, nasap spray
2. Potentiators of vasopressin activity: 3. Diuretics: |
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SIADH - criteria for the dx
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1. hyponatremia
2. ECF hypoosmolality (<275) 3. inappropriate urinary concentration (Uosm >100 mOSM/kg) 4. Clinical evolemia 5. elevated urinary sodium excretion 6. absence of other causes: hypothyroidism |
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causes of SIADH
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1. tumors (lungs, CNS)
2. CNS disorders 3. Drug induced 4. Pulmonary diseases 5. Other |
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Pituitary neoplasia - clinical manifestations
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1. pituitary mass: HA (stretching of dura), visual field defects, CN palsies (lat extension of tumor), CSF rhinorrhea (downward extension of tumor)
2. Pituitary hormone deficiency: LH, FSH, GH def more common 3. Pituitary hormone excess |
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Common ssx of acute pituitary vascular accident (pituitary apoplexy)
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-large pituitary tumors that infarct
1. HA 2. Visual apparatus disturbances (Diplopia, blurred vision, decreased visual acuity, extraocular muscle weakness or paralysis, pupillary abnormalities) 3. Changes in sensorium: lethargy, drowsiness, altered consciousness 4. N/V 5. Nuchal rigidity 6. Fever |
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Growth hormone deficiency
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1. growth failure in kids
2. metabolic abnormalities in adults -loss of muscle mass -increase intra-abd fat -bone loss -fatigue; lack of well being -? poor cardiac function -? poor HDL |
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Causes of hypopituitarism
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1. Pituitary tumors: adenoma, craniopharyngioma, metastatic tumor
2. Hypothalamic/parasella tumors: meningiomas, gliomas, chordoma, third ventricle cyst 3. Radiation therapy: pituitary, cranial, nasopharyngeal 4. Pituitary apoplexy 3. Infxs: TP, syphillis 4. Granulomatous diseases: sarcoidosis 5. Immunologic 6. Internal carotid aneurysm 7. Trauma 8. Hemochromatosis 9. empty sella |
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Evaluation of hypopituitarism
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-asses each hormone specifically
-stimulaiton tests of reserve capacity inc diagnostic sensitivity -more common loss: GH, FSH, LH -less common loss: TSH, ACTH, Prl |
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Cosyntropin Stimulation Test in Adrenal Insufficiency
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-give synthetic ACTH to pt and look at serum cortisol response
-with primary adrenal insufficiency --> no response -with secondary --> blunted response -should be at least 20 |
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Treatment of hypopituitarism
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-replace missing end-prgan hormones
1. Thyroxine 2. Cortisol 3. Sex steroids: DHEA 4. Gonadotropins for fertility 5. Growth hormone in selected instances 6. Vasopressin (ADH) |
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CNS regulation of GH release: Stimulatory
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1. hypoglycemia
2. amino acids 3. peptides 4. monoamines |
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CNS regulation of GH release: inhibitory
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1. hyperglycemia
2. somatostatin 3. monoamines |
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Acromegaly
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-combination of a characteristic clinical syndrome and an elevation of mean basal GH level, usually greater than 2 ng/ml
-onset: 30-50 yrs old -5-15 year delay before dx typical |
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clinical manifestations of growth hormone exces
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1. Bone soft tissue: acral enlargement, increased soft tissue
2. Joints: arthralgias, deforming arthritis 3. compression neuropathy: peripheral n. entrapment, cauda equina, cord compresison 4. Metabolic effects: gluc intol, hypercaliuria, hyperphosphatemia 5. Viscermegaly 6. CV disease: HTN 7. HA |
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Causes of acromegalit
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1. Primary pituitary tumor MOST COMMON!
2. GHRH hypersecretion -eutopic (hypothalamus) -ectopic (tumors) |
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new clinical associations with acromegaly
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Multiple Endocrine Neoplasia
Type 1 Syndrome of: Spotty mucocutaneous pigmentation Cardiac and cutaneous myxomas Endocrine overreactivity Sleep Apnea Seen in 40% of patients Colon Polyps / Cancer Seen in 45% of patients Associated with multiple skin tags |
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Acromegaly- mortality
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-2-5 fold increase in mortality rate
-significantly lower rate after treatment -causes of death: 1. CV 2. Cerebrvascular 3. Respiratory 4. Malignancy |
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acromegaly- tx
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1. Surgica
2. Medical: Bromocriptine (decreases GH-many SE), somatostatin*, GH receptor antagonist 3. Radiaiton 4. combination |
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Actions of prolactin in Vertevrate animals
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1. Osmoregulation
2. Growth and/or development 3. Metabolic 4. Reproduction 5. Integumental |
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Main regulator of prolactin release is....
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DOPAMINE
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factors affecting prolactin secretion- stimulatory
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1. Preg
2. nursing 3. nipple stimulation 4. sex 5. exercise 6. sleep 7. stress 8. prot containing meals (slide 73) |
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hyperprolactinaemia- clinical manifestations
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Women:
1. galactorrhea 2. menstrual irreg 3. infertility Men: 1. galactorrhoea 2. visual field abnormalities 3. HA 4. impotence 5. E.O.M paralysis 6. ant. pit malfunction |
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Hormone testing
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-Elevated serum prolactin (nml 15--20)
problems: stress-related other causes: drugs, hypothyroidism, renal failure, chest wall dz, -idiopathic -increased prolactin in 25-40% of acromegaly |
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Hyperprolactinemia Treatment
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1. Medical:
-Dopamine agonists: bromocriptine, cabergoline, quinagolide SE: N/V, dizziness, nasal stuffness, HA, valvular heart disease |
