Parrot CIS 1 Flashcards
What did the first girl in the case have?
- no periods
- ….. Rewatch the first part (30 min or so) of this lecture
Acquired PANhypopituitarism
What should we do about it?
MRI to rule out masses
- the CBC was normal
- Urine and serum osmolality, 24 her urine collection volume (?)
- Assays on releasing hormones to differentiate between hypothalamic cause or pit cause
- REPLACE, re-evaluate, and keep replacing as needed*
Congenital isolated hypogonadotropic hypogonadism
- Occurs in any of the many genes that cause production of GnRH, LH, and FSH
- Prader Willi Syndrome
- Kallmann syndrome
- Occurs with the syndrome of congenital adrenal hypoplasia
Prader Willi syndrome
- they eat a lot
- have a child like genitalia
Kallmann syndrome
-can’t smell (anosmia)… Food doesn’t taste like anything to them
What are the only hormones that are affected by the congenital isolated hypogonadotropic hypogonadism?
- just GnRH, LH, andFSH
- everything else should be normal (like TSH and the other ant pit hormones)
Kallmann syndrome
- 1/3 have deficiency in GH
- some have decreased sense of smell or no sense of smell
What did that second patient present with?
-galctorrhea
What did we think of when we saw the galactorrhea?
-lactotroph adenoma
What are the benefits of cabergaline vs bromocriptine?
- better dosing schedule and less side effects
- but bromo is less expensive so watch out
What did that guy have?
-prolactinoma
What social issues did he discuss?
Hard to be male lactating
Financial strain, delayed marriage
Overall worry , when can I put this behind me?
Time consuming
22 yo female and she’s thirsty as shit….and she pees a lot, thoughts?
- Diabetes insipid us: central vs nephrogenic
- UTI
- preggo!
- psychogenic polydipsia
What labs would we order?
- urinalysis: results- completely normal except for almost clear or pale/light yellow…. And spec grav 1.002 (norm is 1.005)
- blood glucose via finger stick
- Desmopressin suppression test…. Maybe says parrot
- 24 hour urine collection test (normal is 2 liters): result is 4.7 liters
- CMP: lytes, renal, and liver function, Ca2+ and glucose
- ADH for sure!… Maybe the ant pit hormones just to cover bases
What is that wierd thing about water temperature with ppl with DI?
-they like their water super cold
What should we do for imaging?
-Brain MRI
What is the imaging of choice for all things pituitary?
- MRI*
- not CT or plain film
Why do we want to do an MRI?
- could have mass or adenoma
- on the posterior pituitary: that’s where adh
What is the differential with this case?
- central DI
- nephrogenic DI
- psychogenic polydipsia
What should we do for her?
- Desmopressin (DDAVP) that is the nose spray
- order the MRI
- RTC in 2-4 weeks, go to ED for any serious concerns that you think may be life threatening
What if she were not permitted to drink water? (Plane wreck in the desert)
-she would get dehydrated
Next case, guy with pain in his hips and shoulders and stuff like hands…. Can’t play guitar (that’s his income)…. He also has paresthesias and stuff… What is it?
-acromegaly
What tests should we order?
- GH, TSH, Prolactin, ACTH, FSH, LH
- IGF-1
- Glucose
- Ionized calcium
- X-ray of hands
What is he at risk for?
Diabetes Osteoporosis Gonadal dysfunction Heart disease GI cancer Colon polyps- which may be colon cancer precursors
If we go in an respect the tumor, what would we want to do with him in the postoperative period?
- replace the corticosteroids with something…. Do a taper**
- probably a test question
Going back to the guy with prolactinoma, what would we want to do with him for replacement after done with cabergaline?
-give testosterone…. But it won’t always help with the symptoms
