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GI Block > Endo: Pituitary Dysf 2 > Flashcards

Endo: Pituitary Dysf 2 Flashcards

1
Q

Describe the HPA axis for FSH and LH

A
  1. Hypothalamus releases GnRH
  2. GnRH stimulates gonadotropes in anterior pituitary to release FSH, LH
  3. FSH and LH stimulate gonads to release sex hormones
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2
Q

When should you test a female’s LH, FSH, estradiol?

A

During the first 5 days of her cycle (follicular phase)

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3
Q

What is the definition of hypogonadism?

A

Reduced hormone release from the gonads (ovaries/testes)

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4
Q

A patient has hypogonadism and low FSH/LH.

Where is the problem.

A

The hypogonadism is being driven by the low FSH/LH

Problem is in the pituitary or hypothalamus (central)

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5
Q

These are all symptoms of what?

  • Hot flashes
  • Decreased libido
  • Breast atrophy
  • Osteoporosis
  • Vaginal dryness
  • Amenorrhea
A

Hypogonadism in females!

same symptoms as menopause

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6
Q

Reduced libido, erectile dysfunction, infertility, decreased muscle mass, testicular atrophy are all symptoms of __________

A

Hypogonadism in men

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7
Q

What are the typical symptoms of gonadotropinoma?

A

Gonadotropinoma (pituitary tumor secreting FSH/LH) will be asymptomatic until mass effects occur

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8
Q

Describe the HPA axis for thyroid

A
  1. Hypothalamus secretes TRH
  2. TRH stimulates thyrotropes in anterior pituitary to release TSH
  3. TSH stimulates thyroid to release T3, T4

*Somatostatin also inhibits TSH release

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9
Q

What are the T3/T4 and TSH levels in central hyperthyroidism?

A

T3/T4 elevated

TSH elevated

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10
Q

How is T3 made?

A

5’ deiodinase converts T4 to T3 (5,4,3)

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11
Q

What are the effects of T3? (6)

A
  • Brain maturation
  • Bone growth
  • B-adrenergic stimulation
  • Basal metabolic rate increased
  • Blood sugar increased
  • Breakdown of lipids is increased
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12
Q

Symptoms of hyperthyroidism

  • Body habitus 2
  • GI 2
  • Bones 1
  • Neuro 2
  • Repro 1
  • Temp 1
  • CV 2
A
  • Body habitus: weight loss, goiter
  • GI: diarrhea, increased appetite
  • Bones: osteoporosis
  • Neuro: tremor, hyperactive
  • Repro: irregular menses
  • Temp: heat intolerant
  • CV: HTN, palpitations
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13
Q

Symptoms of hypothyroidism

  • Temp: 1
  • Body habitus/skin: 4
  • GI: 1
  • Neuro: 2
  • CV: 1
  • Repro: 1
A
  • Temp: cold intolerant
  • Body habitus/skin: weight gain, dry skin, hair loss, edema
  • GI: constipation
  • Neuro: lethargy, delayed DTR’s
  • CV: Bradycardia
  • Repro: irregular menses
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14
Q

Define hypopituitarism

A

Deficiency of 1+ pituitary hormones

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15
Q

What is hypophysitis?

What cell type is most commonly involved?

What is one cause?

A

Hypophysitis is inflammation of pituitary

Usually lymphocytic

Side effect of antibody cancer therapy

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16
Q

Define apoplexy

How is it diagnosed?

A

Sudden hemorrhage of pituitary gland

Diagnosed with MRI or CT

17
Q

What is empty sella syndrome?

Compare primary and secondary

A

Empty sella syndrome: sella turcica is mostly filled with CSF instead of pituitary

Primary: Herniation of arachnoid layer presses on pituitary and causes atrophy

Secondary: due to pituitary disease

18
Q

ADH deficiency is most commonly seen with which type of tumor?

A

Metastatic tumors (not pituitary adenomas)

19
Q

What are the hormone levels in central hypothyroidism?

A

Free T4 is low

TSH is normal or low (it should be very high in response to low T4, but it’s insufficient)

20
Q

ADH is released in response to ____________ (2)

This is sensed by ______________ (2)

A

ADH is released in response to increased plasma osmolality and hypovolemia

This is sensed by hypothalamic chemoreceptors and baroreceptors

21
Q

Effects of ADH binding to…

  • V1:
  • V2
A

Effects of ADH binding to…

  • V1: vasoconstriction, platelet aggregation
  • V2: aquaporin translocation in collecting duct -> increased water reuptake
22
Q

In SIADH, there is

  • _____ water retention
  • __volemic hyp__natremia
  • hyp__tonic plasma
  • urine osmolality ___ plasma osmolality
A

In SIADH, there is

  • increased water retention
  • euvolemic hyponatremia
  • hypotonic plasma
  • urine osmolality >> plasma osmolality
23
Q

Tx of SIADH

Mild/Moderate (4)

Severe (1)

A
  • Mild/Moderate: Fluid restriction, salt tablets, diuretics, vaptans/demeclocyline
  • Severe: Hypertonic saline
24
Q

With severe hyponatremia from chronic SIADH, should we correct the sodium quickly or slowly? Why?

A

Correct is SLOWLY (less than 12 mmol decrease in first 24 hrs)

Too rapid correction will cause central pontine myelinolysis

25
Q

A marathon runner comes into the ED with severe hyponatremia. Should we correct their sodium quickly or slowly?

A

Correct it quickly - it onset was quick, correction can be quick

26
Q

What is Diabetes Insipidus? What is the primary feature?

A

Diabetes Insipidus is insufficent ADH release by pituitary or insufficient renal response to ADH

Pts have LOTS of dilute urine

27
Q

What drug is most responsible for diabetes insipidus?

A

Lithium

28
Q

Describe the triphasic response of ADH following trauma

A
  1. Axon shock -> decreased hormone release -> diabetes insipidus
  2. Axon degeneration -> release of stored granules -> SIADH
  3. After axons degenerate and ADH stores are depleted, get permanent Diabetes Insipidus
29
Q

Is cerebral edema possible in hypo or hypernatremia?

A

Cerebral edema is a possible consequence of hyponatremia

30
Q

Tx of central and nephrogenic DI

A
  • Central DI: desmopressin
  • Nephrogenic DI: NSAID, HCTX, amiloride
31
Q

Why are patients with SIADH euvolemic?

A
  • Pts with SIADH have excess ADH, causing water retention
  • The body responds by decreasing the Renin-Agtn system
  • This leads to decreased sodium reabsorption (which worsens the hyponatremia and causes total body water to be normal)

GI Block (77 decks)

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