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27 Cards in this Set
- Front
- Back
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Diabetes types |
2 types 1. CENTRAL decrease in ADH/vasopressin secretion 2. PERIPHERAL/NEPHROGENIC ADH activity at kidney level which increases expression of aquaporins to increase absorption of water |
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CENTRAL DIABETES ADH LEVELS |
Low levels |
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Peripheral diabetes ADH levels |
High levels |
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Copeptin |
Precursor of ADH, reflects ADH secretion |
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ADH in blood |
Not found, because short half life and only made of 9 amino acids so very small |
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Diabetes insipidus and Mellitus coexistence |
Very rare, genetic, leads to deafness and blindness, wolframs syndrome |
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Removal of hypophyseal adenoma: iatrogenic diabetes insipidus Iatrogenic=treatment side affects |
Does not affect ADH levels because its cut bellow pituitary stalk, doesn’t work perfectly but is still functional |
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Removal of craniopharyngioma: iatrogenic diabetes insipidus Iatrogenic=treatment side affects |
Affects ADH levels, because part of hypothalamus containing ADH producing neurons is cut, so it can lead to diabetes Craniopharyngioma is usually benign but still dangerous and reoccurring |
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Causes of nephrogenic diabetes |
Mutations on ADH receptor V2, renal diseases, drugs, hematological conditions, myeloma, leukemias, granulomatous infectious diseases like amyloidosis or sarcoidosis |
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Water balance and osmolarity receptors |
Baroreceptors= at the carotid level in the heart communicating with hypothalamus Osmoreceptors= in hypothalamus |
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Osmolarity characteristics |
Determined my sodium, urea, and glucose |
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Diabetes mellitus polyuria cause |
Caused by osmotic pressure of glucose that draws water in the urine |
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Endocrinological deprivation test |
No food/ drink, measurement for several hours of plasmatic osmolarity Diabetes incipidous= plasmatic osmolarity increases, urine osmolarity remains low, without drinking water |
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Psychogenic polydipsia |
Psychiatric disorder where the patient denies drinking a lot |
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Acromegaly |
Onset adulthood, typical puberty onset, slow symptom progression |
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Gigantism |
Onset childhood, delayed onset of puberty, rapid symptom progression, tall height |
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Common characteristics between acromegaly and gigantism |
Enlarged extremities, growth of facial features, weight gain |
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Linear growth of gigantism |
Increased linear growth, no closure of the epiphyseal growth plates |
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Linear growth of acromegaly |
Closure of the epiphyseal growth plates |
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Symptoms of acromegaly |
Headaches, diplopia, lethargy, blindness, goiter, enragement of visceral organs, diabetes mellitus, thickened heel pads, enlarged but weak skeletal muscles, cardiomyopathy, thickening of skull, protruding supraorbital ridges, coarsening of facial features, prognathism causing gap bite, broadening of grands and feet due to gross increase in soft tissue, increased ring and shoe size |
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Diagnoses of acromegaly |
1.history and physical examination 2.biochemical evaluation through: a) GH hyper-secretion assessment b)evaluation of the remaining pituitary functions 3.morphological evaluation (after clinical observation and blood sample)
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Diagnosis and follow up of complications in acromegaly |
Colonoscopy, trans abdominal ECG, DEXA scans, OGTT glucose tolerance test, dyslipidemia to see cholesterol levels, transracial to check prostatic hypertrophy, thyroid to detect goiter, polysomnography diagnoses of sleep apnea syndrome |
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Treatment of acromegaly |
1. Neurosurgery 2. Medical therapy 3. Radiotherapy |
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Neurosurgery-treatment acromegaly |
First line treatment, transnasosphrnoidal access or trans-cranial approach, based on IGF-1 and GH levels |
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Medical therapy-treatment of acromegaly |
1. Used in invasive adenomas, long acting somatostatin analogues (octreoitide and lanreoitide), reduce the hyper-secretion of GH and IGF-1, causes GI tracts side effects 2. Pasireotide more effective than octreoitide and lanreoitide, side effect higher risk of hyperglycemia and diabetes 3. Dopamine agonists, particularly D2 receptor agonists (bromocripitine and cabergoline) 4. GH receptor antagonists, pegvisomant: blocks peripheral GH receptors dimerization and inhibition of peripheral effect of GH, NORMALIZATION of IGF-1 levels |
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Symptoms of hyperprolactinemia |
Menstrual alterations, reduction of libido, galatrorrhea (milky nipple discharge), ludopathy, gynecomastia in men (boobies) |
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Radiotherapy- therapy in acromegaly |
Second line treatment, used when surgery fails or contraindications to surgery; conventional stereotactic radiotherapy performed Effects of radiotherapy are not immediate: GH and IGF-1 levels drop after months or years after therapy Side-effects: Hypopituitarism (most common), cerebral ischemia, optic nerve damages Alternative to conventional radiotherapy is gamma knife, (high number of radiation in small period of time, less side-effects) |
