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46 Cards in this Set

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Deficiency in adulthood causes mild to mod obesity
increased systolic BP and ldls
and depression Reduced cardiac output
mm & bone mass
physical and mental energy
concentration and memory. Short stature in children.
Reduced GH
Inhibits postpartum lactation.
Reduced prolactin
Diminished cortisol
testosterone
& epinephrine
but aldosterone is intact. Sx: weakness
fatigue
weight loss
hypotension & hyponatremia. May have partial deficiency.
Reduced Adrenocorticotropic hormone (ACTH): not Addison's Dz
Hypothyroidism with fatigue
weakness
weight change
and hyperlipidemia.
Reduced TSH
Hypogonadism & infertility
(aka: Kallmann syndrome).

Also exhibit cryptorchidism
sensorineural deafness
cerebellar dysfunction
bilat. Synkinesis
nystagmus
cleft lip
or high-arched palate.
Reduced Luteinizing Hormone
(LH)
(FSH)
Follicle-stimulating Hormone
Primary central Diabetes Insipidus
Immune suppression of AVP
Most common cause of sellar masses from the third decade on
accounting for up to 10 percent of all intracranial neoplasms.
Pituitary adenomas
Physiologic enlargement of the pituitary and benign and malignant tumors.
Other causes and presentation of sellar masses
besides pituitary adenomas
Visual impairment or headache
hormonal abnormalities
Think of sellar masses
Most common presenting complaint and physical exam finding in pituitary adenomas.
Headache and bitemporal hemianopsia
Due to autoimmunity against hypothalamic arginine vasopressin (AVP). Found on MRI as thickened pituitary stalk
can be genetic.
Primary central diabetes insipidus
Due to damage to the;
hypothalamus or pituitary stalk by;
tumor,
hypophysitis,
anoxic encephalopathy,
surgical or accidental trauma,
infection,
sarcoidosis,
or multifocal Langerhans cell granulomatosis.
All ofm these cause?
Secondary central diabetes insipidus
Last trimester of preg. & in the Puerperium. Associated with oligohydramnios
preeclampsia
or hepatic dysfunction.
Vasopressinase-induced DI
Disorder caused by a defect in the kidney tubules that interferes with water reabsorption. Pts have normal secretion of vasopressin
and the polyuria is unresponsive to it.
Nephrogenic DI
Intense thirst (ice water)
&
polyuria (2L- 20L/ day).

May present with
hypernatremia and dehydration.
Aggravated w/
high-dose corticosteroids.
DI
Causes of hyperprolactinemia in women and men.
Pregnancy
Suckling
pharmacologic
pathologic
Women: oligomenorrhea
amenorrhea
galactorrhea
infertility.

Men: Hypogonadism
decreased libido
erectile dysfunction
infertility.

Both: elevated serum PRL
CT or MRI
shows pituitary adenoma.
Clinical presentation of

hyperprolactinemia
in
women and men.
Most common cause of hypoparathyroidism.
Thyroidectomy
This Endocrine Dz causes: +h
Tetany with muscle cramps
carpopedal spasm
convulsions;
tingling of:
circumoral area
hands
feet.

Lethargy
personality changes
anxiety
blurry vision due to cataracts
parkinsonism
mental retardation.
Hypoparathyroidism
It is a decrease, a hypo
Facial muscle contraction on tapping the facial nerve in front of the ear.
Chvostek sign
Carpal spasm after application of a sphygmomanometer cuff.
Trousseau phenomenon
Thin and brittle nails
dry skin
scaly with fungus
loss of hair
DTR may be hyperactive. Papilledema
elevated cerebrospinal fluid pressure. Teeth may be defective if onset is in childhood.
Hypoparathyroidism (low serum calcium)
Levels usually fall if calcium does
and if so this exacerbates symptoms and decreases parathyroid function.
Magnesium
Hypersecretion of PTH
usually by a single parathyroid adenoma (80%)
and less commonly by hyperplasia by two or more parathyroid glands (20%)
or carcinoma (< 1%).
Hyperparathyroidism
Causes hypercalcemia and an increase in calcium in the glomerular filtrate that overwhelms tubular reabsorption capacity
resulting in hypercalciuria.
Hyperparathyroidism
Bone pain
renal stones
polyuria
hypertension
constipation
fatigue
mental changes
urine and serum calcium elevated
urine phosphate high
Hyperparathyroidism
Account for 90% of all cases of hypercalcemia.
Primary hyperparathyroidism and malignancy
Many malignant tumors
breast
lung
pancreas
uterus
hypernephroma
paraganglioma
etc.

can result in what lab finding?

Hint:
Hypercalcemia
many tumors secrete PTH-related protein (pthrp)
which has tertiary structural homologies to PTH
An uncommon disorder caused by destruction or dysfunction of adrenal cortices with chronic deficiency of cortisol
aldosterone and adrenal androgens.
Addison disease
Autoimmune destruction of the adrenals is the most common cause (about 80% of cases). Occurs alone or as part of polyglandular autoimmune syndrome (PGA).
Addison disease
Pigmentary changes consist of diffuse tanning over non exposed areas as well as exposed areas. Hyperpigmentation over knuckles
elbows
knees
areolas
nail beds. Vitiligo. Emotional changes common. Patients tend to be hypotensive.
Addison disease
Low plasma cortisol (<3 mcg/dcl) at 8 am is diagnostic especially if accompanied by elevated ACTH.
Addison disease
Management of chronic renal insufficiency
Hydrocortisone is drug of choice 15-30 mg orally bid.
Manifestations of excessive corticosteroids
usually due to supra physiologic doses of corticosteroid drugs.
Cushing syndrome
Manifestations of hypercortisolism due to ACTH hypersecretion by the pituitary.
Cushing disease
Central obesity with moon face
buffalo hump
supraclavicular fat pad
protuberant abdomen and thin extremities.
Cushing disease
Dexamethasone suppression test. 24 hour urine for free cortisol and creatinine. Midnight urine cortisol (or salivary). What is this workup for?
Workup for cushings disease
Weakness
hypertension. Superficial skin infections. Thirst
polyuria. Impaired wound healing. Susceptible to opportunistic infections. Mental six’s from impaired concentration to increased mood lability to psychosis.
S and sx of cushings disease
Complications associated with untreated Cushing syndrome.
Htn
DM
depressed immune
osteoporosis
nephrolithiasis
psychosis.
What is Nelson’s syndrome?
Pituitary adenoma enlarges and causes visual field impairment and hyperpigmentation.
Accounts for 5-10% of HTN. Peak incidence is 30-60 yo. Increases sodium retention and suppresses plasma renin.
Primary hyperaldosteronism
37% have hypokalemia and therefore muscle weakness
paresthesias sometimes with tetany
headache
polyuria
polydipsia. Can have HTN that may be severe or drug resistant
Hyperaldosteronism
T or F: Testing for primary aldosteronism should be done for all hypertensive pt's with hypokalemia whether it is spontaneous or diuretic induced.
True
HTN
frequently sustained but often paroxysmal
especially during surgery or delivery. Headache
perspiration
palpitations
tachycardia
anxiety. Drugs
exercise
lifting
bending
stress
surgery etc can bring out symptoms.
Pheochromocytoma
Work Up: Plasma fractionated metanephrines and creatinine is single most sensitive test.
Pheochromocytoma
When this is suspected - CT scan of abdomen with thin sections through adrenals.
Pheochromocytoma