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endoII exam2 > Darrow pituitary diseases part II > Flashcards

Darrow pituitary diseases part II Flashcards

1
Q

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

A

hypothyroidism

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2
Q

most common cause of increased unconj bilirubin in US

A

gilberts and other conjugation defects

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3
Q

what hormone is lost first in pituitary insufficiency

A

GH

then gnRH

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4
Q

deficiency in GH has what Sx

A

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

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5
Q

deficiency GnRH has what Sx

A

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

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6
Q

deficiency of TSH causes what

A

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

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7
Q

what is Queen Annes sign

A

alopecia from TSH deficiency

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8
Q

what are signs of ACTH deficiency

A

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

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9
Q

what are vascular causes of pituitary insufficiency

A

pituitary apoplexy, sheehans, ischemic strokes, DM

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10
Q

what are infectious causes of pituitary insufficiency

A

syphilis, TB, fungal, parasite

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11
Q

what are the infiltrative disorders that can cause pituitary insufficiency

A

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

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12
Q

what neoplastic disorders can cause pituitary insufficiency

A

adenoma, metastasis, meningioma, optic glioma, craniopharyngioma

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13
Q

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

A

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

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14
Q

what is the autoimmune cuase of pituitary insufficiency

A

lymphocytic hypophysitis

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15
Q

what type of trauma causes pituitary insufficiency

A

surgery, post CABG, head trauma

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16
Q

what are the endocrine causes pituitary insufficienc

A

hypothalamic or pituitary disease like MEN1

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17
Q

tests to order if suspect pituitary insufficiency

A 
PRL
GH, IGF-1
TSH, T4
testosterone, estradiol, FSH, LH
cortisol, ACTH, DHEA
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18
Q

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

A

<85 mcg/L

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19
Q

what can you use to stimulate GH

A

glucagon, insulin induced hypoglycemia, argining GHRH

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20
Q

What will TSH T4 look like in pituitary insufficiency

A

TSH tends to be normal in macroadenomas, T4 low

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21
Q

what tells you there is a GN deficiency in M

A

low total testosterone at 8 AM with non elevated LH

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22
Q

what tells you there is a GN deficiency in F

A

low estradiol with non elevated FSH

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23
Q

if cortisol is less than 3 ug at 8 AM

A

cortisol deficiency

24
Q

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

A

adrenal insufficiency

25
Q

what causes the hyponatremia in pituitary insufficiency

A

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

26
Q

how does pituitary insufficiency cause low BP

A

cortisol is needed to make epi

so without cortisol and epi there is dec BP

27
Q

what type of hyponatremia is from hypothyroidism?

A

euvolemia

28
Q

what type of hponatremia is from adrenocorticotropin deficiency

A

euvolemic

29
Q

which hormones keep glucose from dropping too low

A

epinephrine

glucagon, cortisol and GH

30
Q

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

A

epinephrine and glucagon

31
Q

what must you do before MRI for pituitary insufficiencu

A

confirm with lab tests

32
Q

how do you replace hormones in pituitary insufficiency

A

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

33
Q

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

A

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

34
Q

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

A

hypophysitis, metastatic cancer or sarcoidosis

35
Q

Signs hemochromatosis

A 
DM
grey skin
joint pain
dilated CM
heart rhythm disturbances
high Fe:TIBC ratio
elevated liver enzymes
36
Q 
F with HA has enlarged sella tursica
no mesntrual abnormalities
BP and sugars normal
complexion and skin normal
msot likely?
A

empty sella syndrome

37
Q

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

A

DI

38
Q

what will serum uric acid be in psychogenic polydipsia

A

low

39
Q

BUN in DI and psychogenic polydipsia

A

low

40
Q

desmopressin causes increase in osmolality

A

central DI

41
Q

central DI on MRI

A

thickened pituitary stalk

42
Q

Causes for polyuria

A 
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
Q

how to calculate serum osmolality

A

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

44
Q

V1 R in kidneys

A

cause uric acid excretion

45
Q

initial NA levels of psychogenic polydipsia

A

<140 meq/L

46
Q

what can cause thickening of pituitary stalk

A

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

47
Q

genetic disorder with central DI

A

wolfram DIDMOAD on chrom 4

48
Q

Tx DI

A

desmopressin BID orally

watch for suicide

49
Q

what is Tx for partial DI

A

hydrochlorothizide 50-100 mg daily

50
Q

how does lithium look like DI

A

messes the collecting ducts in kidneys

“pseudo DI”

51
Q

water restriction test will increase Uosm in what syndrome

A

PP

52
Q

what will desmopressin do in lithium caused DI

A

nothing

53
Q

congenital causes of nephrogenic DI

A

x linked defective X linked V2 R or aquaporin AQP2

54
Q

what drugs can cause nephrogenic DI

A

coticosteroids

55
Q

electrolyte imbalance caused nephrogenic DI

A

low K, low Mg, hyperCa

56
Q

what drugs can cause nephrogenic DI

A

lithium, demeclocycline, foscarnet, methicillin, amphotericin b

endoII exam2 (18 decks)

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