Darrow pituitary diseases part II Flashcards Preview

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Flashcards in Darrow pituitary diseases part II Deck (56):
1

37 M weakness, lethargy, coldness, decreased libido, hair loss arthralgias RUQ pain

hypothyroidism

2

most common cause of increased unconj bilirubin in US

gilberts and other conjugation defects

3

what hormone is lost first in pituitary insufficiency

GH
then gnRH

4

deficiency in GH has what Sx

decreased muscle and bone mass, increased central fat, decreased CO, increased cholesterol

5

deficiency GnRH has what Sx

fine wrinkling of skin, decreased libido, hair loss, gyncecomastia, atrophic testicles, vaginal dryness, alopecia

6

deficiency of TSH causes what

fatigue, constipation, dry skin, puffiness, alopecia, cold intolerance, weight gain, increased cholesterol

7

what is Queen Annes sign

alopecia from TSH deficiency

8

what are signs of ACTH deficiency

weakness, fatigue, low grade fever, orthostasis, loss of sex hair, pallor, hypoglycemia, abdominal pain, nausea, vomiting, weight loss, low Na and normal K

9

what are vascular causes of pituitary insufficiency

pituitary apoplexy, sheehans, ischemic strokes, DM

10

what are infectious causes of pituitary insufficiency

syphilis, TB, fungal, parasite

11

what are the infiltrative disorders that can cause pituitary insufficiency

langerhands histiocytosis, wegeners, leukemia, lymphoma, hemochromatosis, amyloid, sarcoid

12

what neoplastic disorders can cause pituitary insufficiency

adenoma, metastasis, meningioma, optic glioma, craniopharyngioma

13

what are the familial/genetic disorders that can cause pituitary insufficiency

kallmanns yndrome- GnRH stays in nose(loss of sense of smell), prader-willi syndrome

14

what is the autoimmune cuase of pituitary insufficiency

lymphocytic hypophysitis

15

what type of trauma causes pituitary insufficiency

surgery, post CABG, head trauma

16

what are the endocrine causes pituitary insufficienc

hypothalamic or pituitary disease like MEN1

17

tests to order if suspect pituitary insufficiency

PRL
GH, IGF-1
TSH, T4
testosterone, estradiol, FSH, LH
cortisol, ACTH, DHEA

18

at what level IGF-1 do you suspect GH will be low as well

<85 mcg/L

19

what can you use to stimulate GH

glucagon, insulin induced hypoglycemia, argining GHRH

20

What will TSH T4 look like in pituitary insufficiency

TSH tends to be normal in macroadenomas, T4 low

21

what tells you there is a GN deficiency in M

low total testosterone at 8 AM with non elevated LH

22

what tells you there is a GN deficiency in F

low estradiol with non elevated FSH

23

if cortisol is less than 3 ug at 8 AM

cortisol deficiency

24

give ACTH and then after 45 minutes cortisol is <18 ug/dL

adrenal insufficiency

25

what causes the hyponatremia in pituitary insufficiency

low thyroxine and cortisol dec CO so there is increased ADH secretion
cortisol normally inhibits CRH and ADH so even more ADH

26

how does pituitary insufficiency cause low BP

cortisol is needed to make epi
so without cortisol and epi there is dec BP

27

what type of hyponatremia is from hypothyroidism?

euvolemia

28

what type of hponatremia is from adrenocorticotropin deficiency

euvolemic

29

which hormones keep glucose from dropping too low

epinephrine
glucagon, cortisol and GH

30

what hormones that keep glucose from dropping too low act the fastest

epinephrine and glucagon

31

what must you do before MRI for pituitary insufficiencu

confirm with lab tests

32

how do you replace hormones in pituitary insufficiency

cortisol 1st then thyroid then testosterone and sometimes at the end GH

33

if you give someone with pituiatary insufficiency cortisol and then they have polyuria what should you suspect

DI because cortisol increases the GFR but fi there is no ADH, patient will have polyuria

34

in anterior piruirary failure with central DI what should you suspect instead

hypophysitis, metastatic cancer or sarcoidosis

35

Signs hemochromatosis

DM
grey skin
joint pain
dilated CM
heart rhythm disturbances
high Fe:TIBC ratio
elevated liver enzymes

36

F with HA has enlarged sella tursica
no mesntrual abnormalities
BP and sugars normal
complexion and skin normal
msot likely?

empty sella syndrome

37

F with polyuria and polydipsia
craving ice water
elevated Na and uric acid

DI

38

what will serum uric acid be in psychogenic polydipsia

low

39

BUN in DI and psychogenic polydipsia

low

40

desmopressin causes increase in osmolality

central DI

41

central DI on MRI

thickened pituitary stalk

42

Causes for polyuria

C DRIPPEd
C- cortisol excess
D- DI
R- Recovery from Renal failure
I- ions, hyper Ca and hypo K
Parkinsons
Psychogenic polydipsia
Enzyme- autoimmune DI
Drugs- lithium, demeclocycline, cis-platinum

43

how to calculate serum osmolality

2xNa + glucose/18 + (BUN/2.8)

44

V1 R in kidneys

cause uric acid excretion

45

initial NA levels of psychogenic polydipsia

<140 meq/L

46

what can cause thickening of pituitary stalk

lymphocytic hypophysitis(autoimmune), sarcoidosis (infiltrative diseases),

47

genetic disorder with central DI

wolfram DIDMOAD on chrom 4

48

Tx DI

desmopressin BID orally
watch for suicide

49

what is Tx for partial DI

hydrochlorothizide 50-100 mg daily

50

how does lithium look like DI

messes the collecting ducts in kidneys
"pseudo DI"

51

water restriction test will increase Uosm in what syndrome

PP

52

what will desmopressin do in lithium caused DI

nothing

53

congenital causes of nephrogenic DI

x linked defective X linked V2 R or aquaporin AQP2

54

what drugs can cause nephrogenic DI

coticosteroids

55

electrolyte imbalance caused nephrogenic DI

low K, low Mg, hyperCa

56

what drugs can cause nephrogenic DI

lithium, demeclocycline, foscarnet, methicillin, amphotericin b