Endo Block 1 Flashcards
Facts about polypeptide/protein hormones
Facts about Steroids/Thyronines
Large and insoluble
Interact w/ receptors on surfaces
Binding causes cascades of events
Small and lipid soluble that can’t pass through membranes, require ‘chaperone’ to go directly to nucleus and cause change
What is the body’s negative feedback response when hormones levels are high or low?
What is the body’s positive feedback response when hormone levels are high or low?
High- dec production
Low- inc production
High- stimulate release
Low- inhibit release
What are the three hyperfunction alterations in endocrine tissue function?
Primary- alteration of the hormone secreting gland
Secondary- alteration in pituitary* or hypothalamus
Ectopic- hormone secreted from tissue other than usual source
What are the 3 hypofunction alterations in endocrine tissue function?
Primary- alteration of the hormone secreting gland
Secondary- alteration in pituitary/hypothalamus
Resistance- inability of target tissue to recognize the hormones
Define Adenoma
Define Neoplasm
Benign enlargement of cluster of glandular cells
Abnormal new grwoth of tissue, usually malignant
Define Hyperplasia
Define Atrophy
Benign enlargement of the entire gland
Wasting away of existing cells, hypoplasia form is congenital
What are the hormone levels in hypothyroidism?
Primary hypofunction
Starts in thyroid not secreting T3
Hyperplasia of thyroid
High TRH
High TSH
Low T3
A high serum osmolality correlates to a high serum ? level?
What medications/drugs stimulate ADH secreation?
Na
SSRI/TCA Ecstasy/MDMA NSAIDs Amiodarone Neuroleptics
What are the CNS/pulmonary Dzs that can cause SIADH?
Trauma STEMS
Trauma Stroke, Tumor, Encephalitis, Meningitis, SAH
No Pos TP
Neoplasm Pos Press Ventilation TB Pneumonia
All PTs with unexplained hyponatremia and oliguria/anuria need to get what test?
What medications can cause SIADH
Chest CT/MRI
MOAAN MDMA- inc ADH release Opiates Antineoplastics- powerful Antidepressants- TCA, SSRI, MAOIs NSAIDs- inc ADH via prostaglandin inhibition
Since SIADH is a ? problem, not a ? problem, what S/Sxs will they present with?
What will their serum Na be at?
Water, not Na
Fatigue, HA, Nausea
125-135 (N=135-145)
How is euvolemic/ASx/Mild SIADH Tx?
How are Sev cases Tx?
Water restriction (500-1L/day) Democlocycline if PT can't tolerate water restriction Dietary Na intake
Raise serum Na by 0.5-1mEq/hr w/:
3% hypertonic saline
Furosemide- H2O excretion
Tulvaptan- V2 antagonist
What are the etiologies of central DI?
Brain surgery
Damage to infundibulum
Infection
Pituitary infarct- Sheehan Syndrome
What are the etiologies of nephrogenic DI?
Meds: Lithium, Demeclocycline, Orilistat, Caffeine
Hypercalcemia
Hypokalemia
Renal Dz
What labs are ordered when working a PT up for suspected DI?
What results will normally be seen?
24hr UA (<2L/day rules out DI Dx) CMP w/ uric acid and osmolality
Labs will be normal except high Uric Acid and Na
How are PTs tested for central DI?
12hr urine measurement
Desmopressin acetate administration
12hr urine measurement
+ test= dec thirst, dec urine output, inc urine osmolality
How are PTs tested for nephrogenic DI?
What are 3 DDx for PTs w/ DI?
Measure serum vasopressin during fluid restriction, elevated= + test
Psychogenic water drinker
DM Type 1
Cushing’s Syndrome
How is Central DI Tx?
DDAVP w/ E+ monitoring @ lowest possible dose 2-3x/day
Avoid N/V/D or exertion
Acute= Indomethacin Chronic= Nephrologist for Indomethacin and HCTZ, Desmopressin Acetate/Amiloride combo
What is the overall function of the anterior pituitary?
Command center of majority of endocrine organs
Regulates Adrenal, Thyroid, Gonads, and GH and Prolactin release
What hormones are released by the Ant Pit?
FSH/LH ACTH TSH PRL Endorphines GH
What hormones are produced in the AntPit?
Most hormone release are controlled by ? with ? big exception
GH, ACTCH, TSH, PRL, FSH, LG, MSH
Stimulating hormones
Prolactin- continuous secretion unless inhibited by Prolactin Inhibitory Hormone (dopamine)
What are the S/Sxs of an adenoma that begins to cause space occupying effects?
What are 3 types of vision defects that could be seen?
CSF rhinorrhea
HA
Unilateral CN3-6 defects
Bitemporal hemianopsia
Unilateral field loss
Bitemporal/Homonymous hemianopsia
Any PT w/ HA or visual field defects need to have ? issue ruled out?
How are pituitary adenomas Tx?
Pituitary/Hypothalamus masses via MRI
Surgery
Except- prolactinomas- Tx w/ medical therapy w/ Dopamine agonists and Somatostatin analogs
Prolactin release is normally stimulated by ?
Pregnancy/Feeding Piercing/Surgery Chronic chest wall stimulation Hypothyroidism- TSH stimulates PRL Infundibulum lesion Prolactinoma