Day 3 - Endo2 Parathyroid, Pituitary & Hypothalamic Flashcards Preview

Step 2 DIT Rapid Review > Day 3 - Endo2 Parathyroid, Pituitary & Hypothalamic > Flashcards

Flashcards in Day 3 - Endo2 Parathyroid, Pituitary & Hypothalamic Deck (13):
1

Most common causes of primary hyperparathyroidism

(1) Parathyroid adenoma (2) Parathyroid hyperplasia

2

Tx primary hyperparathyroidism

Surgical parathyroidectomy if any of following: symptomatic, serum Ca 1 mg/dL above upper limit of normal, 24 hr urinary calcium elevated (above 400), creatinine clearance reduced by 30%, bone mineral density (T score

3

Vit D def w/ malnutrition v. Vit D def w/ kidney disease

Low serum Ca, high PTH, trashed phosphate: Kidney disease (ability to trash phosphate) - Low serum Ca, high PTH, ELEVATED phosphate

4

Tx hyperparathyroidism 2/2 chronic renal disease

TX HYPERPHOSPHATEMIA: dietary restrict phosphate/protein, phosphate binders taken w/ meals (e.g., calcium carbonate - TUMS or calcium acetate, NOT use calcium citrate - increases alumnium, which is hard for kidney pts to deal w/); RENAL OSTEODYSTROPHY - lessening hyperphosphatemia, Calcitriol or other vit D analogs, calcimimetic (suppress PTH secretion)

5

Sx hyperprolactinemia

Premenopausal woman - hypogonadism (decreased LH & FSH, infertility, oligoamenorrhea), galactorrhea; Postmenopausal woman - galactorrhea ; Men Low testosterone (decreased libido, low sperm counts, infertility, ED, gynecomastia), galactorrhea; Think: check prolactin level in men w/ impotence & infertility

6

S/sx acromegaly

Onset to dx avg. 12 yrs; Enlarged jaw, spreading teeth, nose/frontal bones enlarged, coarse facial feat, hands/feet enlarged (increased ring/glove/shoe size); Macroglossia; Voice deepening; Carpal tunnel syndrome; Hypertrophy of synovial tissue & cartilage; CVD - HTN, LVH, diastolic dysfxn; Glucose intolerance; Diabetes

7

Screen, Dx, & Tx acromegaly

Screen - insulin-like growth factor (downstream hormone that GH stimulates, more consistent throughout day) & oral glucose suppression test; Test positive - pituitary MRI; Tx - Transphenoidal resection or external beam radiation; Somatostatin analog; Cabergoline (bromocriptine less effective)

8

Sheehan syndrome p/w

Hemorrhage => hypotension & infarction of pituitary gland = hypopituitarism; Severe - first few days after delivery, lethargy, anorexia, weight loss, inability to lactate; Mild - weeks to months or even years, fatigue, weight loss, anorexia, failure of postpartum lactation, failure of menses, lack of sexual hair; lack of ACTH (hypercortisolism)? or TSH (hypothyroidism) also

9

GH deficiency

growth failure; short stature

10

LH/FSH deficiency

Infertility, amenorrhea, genital atrophy, impotence, decreased libido, decreased pubic hair

11

TSH deficiency

Hypothyroidism

12

Prolactin deficiency

Absence of lactation postpartum

13

ACTH deficiency

Adrenal insufficiency (lack of glucorticoids or mineralocorticoids); Fatigue, weight loss, decreased appetite, poor response to stress, decreased skin pigmentation (MSH)

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