Darrow pituitary diseases part II Flashcards
37 M weakness, lethargy, coldness, decreased libido, hair loss arthralgias RUQ pain
hypothyroidism
most common cause of increased unconj bilirubin in US
gilberts and other conjugation defects
what hormone is lost first in pituitary insufficiency
GH
then gnRH
deficiency in GH has what Sx
decreased muscle and bone mass, increased central fat, decreased CO, increased cholesterol
deficiency GnRH has what Sx
fine wrinkling of skin, decreased libido, hair loss, gyncecomastia, atrophic testicles, vaginal dryness, alopecia
deficiency of TSH causes what
fatigue, constipation, dry skin, puffiness, alopecia, cold intolerance, weight gain, increased cholesterol
what is Queen Annes sign
alopecia from TSH deficiency
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
what are vascular causes of pituitary insufficiency
pituitary apoplexy, sheehans, ischemic strokes, DM
what are infectious causes of pituitary insufficiency
syphilis, TB, fungal, parasite
what are the infiltrative disorders that can cause pituitary insufficiency
langerhands histiocytosis, wegeners, leukemia, lymphoma, hemochromatosis, amyloid, sarcoid
what neoplastic disorders can cause pituitary insufficiency
adenoma, metastasis, meningioma, optic glioma, craniopharyngioma
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
what is the autoimmune cuase of pituitary insufficiency
lymphocytic hypophysitis
what type of trauma causes pituitary insufficiency
surgery, post CABG, head trauma
what are the endocrine causes pituitary insufficienc
hypothalamic or pituitary disease like MEN1
tests to order if suspect pituitary insufficiency
PRL GH, IGF-1 TSH, T4 testosterone, estradiol, FSH, LH cortisol, ACTH, DHEA
at what level IGF-1 do you suspect GH will be low as well
<85 mcg/L
what can you use to stimulate GH
glucagon, insulin induced hypoglycemia, argining GHRH
What will TSH T4 look like in pituitary insufficiency
TSH tends to be normal in macroadenomas, T4 low
what tells you there is a GN deficiency in M
low total testosterone at 8 AM with non elevated LH
what tells you there is a GN deficiency in F
low estradiol with non elevated FSH
if cortisol is less than 3 ug at 8 AM
cortisol deficiency
give ACTH and then after 45 minutes cortisol is <18 ug/dL
adrenal insufficiency
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
how does pituitary insufficiency cause low BP
cortisol is needed to make epi
so without cortisol and epi there is dec BP
what type of hyponatremia is from hypothyroidism?
euvolemia
what type of hponatremia is from adrenocorticotropin deficiency
euvolemic
which hormones keep glucose from dropping too low
epinephrine
glucagon, cortisol and GH
what hormones that keep glucose from dropping too low act the fastest
epinephrine and glucagon
what must you do before MRI for pituitary insufficiencu
confirm with lab tests
how do you replace hormones in pituitary insufficiency
cortisol 1st then thyroid then testosterone and sometimes at the end GH
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
in anterior piruirary failure with central DI what should you suspect instead
hypophysitis, metastatic cancer or sarcoidosis
Signs hemochromatosis
DM grey skin joint pain dilated CM heart rhythm disturbances high Fe:TIBC ratio elevated liver enzymes
F with HA has enlarged sella tursica no mesntrual abnormalities BP and sugars normal complexion and skin normal msot likely?
empty sella syndrome
F with polyuria and polydipsia
craving ice water
elevated Na and uric acid
DI
what will serum uric acid be in psychogenic polydipsia
low
BUN in DI and psychogenic polydipsia
low
desmopressin causes increase in osmolality
central DI
central DI on MRI
thickened pituitary stalk
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
how to calculate serum osmolality
2xNa + glucose/18 + (BUN/2.8)
V1 R in kidneys
cause uric acid excretion
initial NA levels of psychogenic polydipsia
<140 meq/L
what can cause thickening of pituitary stalk
lymphocytic hypophysitis(autoimmune), sarcoidosis (infiltrative diseases),
genetic disorder with central DI
wolfram DIDMOAD on chrom 4
Tx DI
desmopressin BID orally
watch for suicide
what is Tx for partial DI
hydrochlorothizide 50-100 mg daily
how does lithium look like DI
messes the collecting ducts in kidneys
“pseudo DI”
water restriction test will increase Uosm in what syndrome
PP
what will desmopressin do in lithium caused DI
nothing
congenital causes of nephrogenic DI
x linked defective X linked V2 R or aquaporin AQP2
what drugs can cause nephrogenic DI
coticosteroids
electrolyte imbalance caused nephrogenic DI
low K, low Mg, hyperCa
what drugs can cause nephrogenic DI
lithium, demeclocycline, foscarnet, methicillin, amphotericin b
