Day 3 - Endo2 Parathyroid, Pituitary & Hypothalamic Flashcards
Most common causes of primary hyperparathyroidism
(1) Parathyroid adenoma (2) Parathyroid hyperplasia
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
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
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)
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
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
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)
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
GH deficiency
growth failure; short stature
LH/FSH deficiency
Infertility, amenorrhea, genital atrophy, impotence, decreased libido, decreased pubic hair
TSH deficiency
Hypothyroidism
Prolactin deficiency
Absence of lactation postpartum
ACTH deficiency
Adrenal insufficiency (lack of glucorticoids or mineralocorticoids); Fatigue, weight loss, decreased appetite, poor response to stress, decreased skin pigmentation (MSH)
