endocrine Flashcards
which type of pituitary tumor is the most common, micro or macro
microadenomas are more common
what is the most common type off functional adenoma
prolactin 50-60%
growth hormone 15-20%
ACTH 10-15%
gonadotrophin 10-15%
what hormones are secreted by the anterior pit
TSH, GH, ACTH, prolactin, FSH, LH
PAO posterior ADH/oxytocin
what hormones are secreted by the posterior pit
ADH and oxytocin
PAO posterior ADH/oxytocin
what is the measurement for microadenoma
<1 cm \
what is the measurement for macroadenome
> 1 cm
are prolactin levels correlated with the size of the adenoma?
YES. 1cm = 100ng\ml; 2 cm = 200ng/ml
how does hyperprolactinemia present in men and women
men: decreased libido, erectile dysfunction, RARE for men to get gynecosmastia or galactorrhea but can happen.
women: galactorrhea, amenorrhea. osteoporosis and osteopenia. infertility and gynecomastia
what medication can treat hyperprolactinemia
bromocroptine or cabergoline
what is acromegaly
excessive growth hormone secretion That causes insidious, chronic debilitating disease associated with overgrowth of the bony and soft tissues. diagnosis made by determining the levels of IGF-1.
what is the cause of acromegaly
75% of cases are caused by macroadenomas.
what is the medical treatment for acromegaly and what are the SE
octreotide or lanreotide.
these are somatostatin analogs
cholestasis and cholecystitis
what is the second line agent for the treatment of acromegaly
pegvisomant
what is the most common cause of panhypopituitarism
pituitary adenomas through pressure, trauma and necrosis
what is the order of hormone loss typically seen
LH/FSH
growth hormone deficiency
thyrotropin
adrenocorticotropin
what is the most common presentation of loss of LH and FSH
loss of axillary and pubic hair
leads to genital atrophy in women
what is the common demographic for empty sella
multiparous, obese women with headaches
30% have headaches
what is the treatment for empty sella
reassurance
what does a deficiency in ADH cause
diabetes insipidus
what does excess ADH cause
SIADH
what is central diabetes insipidus
this is caused by the loss of most or all ADH secretion from the neurohypophyseal system. results in excessive dilute urine and increased thirst associated with hypernatremia.
what are the causes of mental diabetes insipidus
neoplastic or infiltrative lesions, pituitary or hypothalamic surgery, radiotherapy, severe head injuries, anoxia, hypertension\, meningitis
what is nephrogenic DI
renal resistance to the action of vasopressin.
what are the causes of nephrogenic DI
hypercalcemia, hypokalemia, sickle cell disease, amyloidosis, myeloma, pyelonephritis, sarcoidosis, sjrogens disease.
what drugs can cause neprhogenic DI
lithium, demeclocycline colchicine
what are the diagnostic criteria for diabetes insipidus
excessive thirst, polydipsia, polyuria. hypernatremia, with high serum osmolarity, and coexisting low urine osmolarity, and a urine specific gravity of < 1.010
how do we diagnose DI
water deprivation test; in someone with DI the urine output is the same and the osmolarity doesn’t change.
what is the normal response to water deprivation test
increased urine osmolarity, decreased urine output,
what happens to ADH in someone with nephrogenic
increased
what happens to the ADH in someone with central DI
decreased
what drugs can stimulate the secretion of ADH
carbamazepine, chlorpropamide, clofibrate
what drugs can treat nephrogenic DI
hydrochlorothiazide or ameloride to increase the retention of fluids.
what are the common carinomas cause of SIADH
small cell lung cancer and pancreatic carcinoma
what infections can cause SIADH
TB, pneumonia and lung abscess
what drugs can cause SIADH
carbamazepine, vinblastine, vincristine, clofibrate, cyclophopsphamide, chlorpropamide
what are some of the treatments for SIADH
hypertonic saline, fluid restriction, demeclocycline
what is the most sensitive test for thyroid function
TSH levels. if they are normal then the person is euthyroid.
what is thyroid binding globulin and how does it effect labs
this is the protein in serum that binds thyroid hormone. If there is an increase TBG, then the t4 levels will be off because it be bound…
what can cause increases in TBG
pregnancy and oral contraceptives.
what antibody is causal for Graves
TSI thyoid stimulating immunoglobulin
what is the causal antibody in hashimotos
antimicrosomal and antithyroglobulin
what is the most common cause of hyperthyroid
graves disease
what are some other causes of hyperthyroidism
hyper functioning adenoma, toxic multi nodular goiter, simple goiter
what drugs can cause thyrotoxicosis
lithium, amiodorone, alpha interferon
what is the thyroid presentation of graves
painless, diffuse enlargement
what is the thyroid presentation of subacute thyroiditis
painful and diffuse enlargment
what is the thyroid presentation of Plummer thyroiditis
painless nodules
what is the thyroid presentation of factitious
no thyroid enlargement or the thyroid not palpated
what is the presentation of graves disease
goiter, exopthalmus, dermatopathy,
nervousness, a fib, emotional lability, frequent bowel movements, sweating and heat intolerance, weight loss, oliogomenorrhea, osteoporosis
what are some common triggers for graves
stress, pregnancy, infection.
another autoimmune disease
what causes exacerbation of graves
smoking
what are the treatments for graves
propanolol for adrenergic hyperfunctioning. methimazole or propylthioluracil
what thyroid treatment can be used in pregnancy
propylthiouyracil, but only in the first trimester
how does thyroid storm present
extreme irritability, delirium, coma, tachycardia, restlessness, vomiting, jaundice, diarrhea, hypertension, dehydration and fever
what is the treatment for thyroid storm
propylthiopuracil
adrenergic agonists
dexamethasone to support adrenal function
what are the symptoms of hypothyroidism
constipation, lethargy, cold intolerance, stiffness and cramping of the muscles, carpel tunnel, menorrhagia, intellectual slowing, weight gain, dry hair and skin.
How does myxedema present
expressionless face, puffy eyes, large tongue, pale, cool skin that feels doughy.
how long does it take for TSH top normalized after dosage changes of T4
6 weeks.
