Endocrine Flashcards
Causes of panhypopituitarism
Anything that damages the brain
- Tumor
- Infection
- Trauma
- Stroke
In what order are hormones lost in the pituitary
GH, and LH, FSH first
ACTH last
Results of LH, FSH deficiencies
W - Amenorrhea
M - No testosterone or sperm, ED, decreased muscle
Both have decreased libido, body hair
Kallman syndrome points
Decreased GnRH causing decreased LH, FSH
Anosmia
Renal agenesis (50%)
Presentation of GH deficiency
Children - Short stature
Adults - Central obesity, Increased LDL, chol, Reduced lean muscle
Features of pituitary apoplexy
Prior adenoma
HA
Changing MS
Send to ICU for hormone replacement
What is Sheehan
Postpartum pituitary necrosis
Can’t lactate
Confirmatory test for low TSH and thyroxine
Decreased TSH response to TRH
Confirmatory test for decreased ACTH and cortisol
Normal response to cosyntropin stimulation
No response w/ CRH
Elevated cortisol excludes pituitary problem
Confirmatory test for Low GH
No response to arginine
No response to GHRH
Confirmatory test for low prolactin
No response to TRH
Failure of GH to rise in response to insulin
Pituitary insufficiency
What does metyrapone do
ACTH levels rise
Hormonal problems in empty sella
NONE
What is diabetes insipidus
Decrease in ADH amount or function on kidneys
Causes of central DI
Any destruction
- Stroke
- Trauma
- Hypoxia
- Infiltration
Causes of nephrogenic DI
Chronic pyelo
Amyloidosis
Myeloma
Sickle cell
Drugs inducing NDI
Li
Demeclocycline
Colchicine
Metabolic changes inducing NDI
Hypercalcemia
Hypokalemia
Presentation of DI
High volume urine
Excessive thirst
Volume depletion
Hypernatremia
What causes neuro sx in SI
Hypernatremia
What does water deprivation test show in DI
Urine osmolality doesn’t increase
Vasopressin effect in CDI
Decrease urine volume
Increase urine osmolality
Vasopressin effect in NDI
Nothing
Obscure manifestation of NDI
Loss of access to water
- NPO before surgery
Rx CDI
Long term desmopressin
Rx NDI
Treat underlying cause
HCTZ, amiloride, NSAIDs
What is acromegaly
Overproduction of GH
MCC acromegaly
Pituitary adenoma
Can be part of MEN
2 Conditions causing B/L carpal tunnel syndrome
Acromegaly
Hypothyroidism
Features of Acromegaly
B/L carpal tunnel Increasing hat/shoe/ring size Coarse facial features Macroglossia Colon polyps HTN Cardiomegaly/CHF Bitemporal hemianopsia ED
Best initial test for acromegaly
IGF-1
Most accurate test for acromegaly
Glucose suppression test
NL - glucose suppresses GH
What additional tests must be done for acromegaly
Prolactin (cosecreted)
MRI (after labs)
Rx acromegaly
Surgery - transphenoidal resection Meds - Octreotide (rx of choice) - Cabergoline (inhibit GH) - Pegvisomant (GHr antagonist) Radiotherapy - Non-responsive to meds/surg
MCC of hyperprolactinemia
Functional adenoma (prolactinoma)
What must always be r/o as cause of hyperprolactinemia
Hypothyroidism
- High TRH leads to prolactin secretion
ONLY CCB to raise prolactin
Verapamil
Physiological causes of hyperprolactinemia
Pregnancy, nursing
Intense exercise, stress
Renal insufficiency
Drugs raising prolactin levels
Antipsychotics Methyldopa Metoclopromide Opioids TCAs
Presentation of hyperprolactinemia
W - Amenorrhea, galactorrhea, infertility
M - ED, decreased libido, visual disturbances
First Dx test in hyperprolactinemia
Check prolactin levels
Other tests in hyperprolactinemia
Exclude pregnancy BUN/Cr LFTs Exclude thyroid and drugs MRI
Rx hyperprolactinemia
DA agaonists - Cabergoline
Transphenoid surgery - No med response
Radiation - Last resort
Who to aggressively rx for hyperprolactinemia
Pts of childbearing age to prevent infertility
Men
Complication of transphenoidal resection for hyperprolactinemia
30% get panhypopituitarism
Cause of hypothyroidism
Failure of gland from burnt out Hashimoto’s thyroiditis
Rare- Dietary def iodine, Amiodarone, Li
When to immediately treat hypothyroidism
TSH 2x NL AND NL T4
TSH
AKA Antithyroid peroxidase
Antithyroglobulin
Features of hypothyroidism
Brady Constipation Wt gain Fatigue, lethargy, coma ↓ DTRs Cold intolerance Hypothermia Pseudodementia
Features of hyperthyroidism
Tachy, palpitations, arrhythmia Diarrhea Wt loss Anxiety, restlessness ↑ DTRs Heat intolerance Fever
Best initial test for thyroid disorders
TSH
What to do when TSH is suppressed
Measure T4
What is seen in exogenous T4 ingestion
Decreased TBG
Rx hypothyroidism
Lifelong thyroxine
Secondary hypothyroid - Add hydrocortisone
Diagnosis hyperthyroidism w/ proptosis and skin findings
Graves
Diagnosis hyperthyroidism w/ tender thyroid
Subacute
Diagnosis hyperthyroidism w/ nontender, normal exam
Painless thyroiditis
Diagnosis hyperthyroidism w/ Involuted gland (not palpable)
Exogenous thyroid use
Diagnosis hyperthyroidism w/ high TSH
Pituitary adenoma
TSH receptor Abs are in
Graves
Features of Graves
Women, 40s Exopthalmos (can get worse w/ rx) High output cardiac failure Pretibial myxedema RAIU - diffuse uptake
Features of subacute thyroiditis
Elevated ESR
May spontaneously resolve
Rx w/ ASA, steroids
Rx graves
Radioactive iodine ablation