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clin med IV > pituitary > Flashcards

pituitary Flashcards

1
Q

what does the anterior pituitary produce

A
  • GH*- majority of cells
  • prolactin
  • ACTH
  • TSH
  • FSH
  • LH
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2
Q

waht does the posterior pituitary produce

A
  • ADH

- oxytocin

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3
Q

what hormone inhibits GH

A
  • somatostatin
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4
Q

what is normal serum osmolality

A
  • 285- 295
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5
Q

what is normal urine osmolality

A
  • 500- 800
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6
Q

what is diabetes insipidus

A
  • not enough ADH
  • results in passage of large volumes of dilute urine
  • urine > 3 L in 24 hours
  • < 300 mosm
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7
Q

what are the major causes of diabetes insipidus

A
  • central- decreased secretion of ADH
  • nephrogenic- kidneys dont respond to ADH
  • usu in US d/t autoimmune destruction of ADH prod cells
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8
Q

si/sx of DI

A
  • polyuria, nocturia, enuria
  • intense thirst with polydipsia- up to 20 L/day
  • hypernatremia with severe dehydration
  • hypotension, tachycardia
  • dry membranes
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9
Q

dx of DI

A
  • 24 hour urine collection
  • hyperNa
  • normal glucose
  • elevated BUN
  • random urine osmolality
  • plasma ADH
  • water deprivation test for DI vs. primary polydipsia
  • desmopressin challenge
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10
Q

how can you dx central vs nephrogenic ADH

A
  • central= low ADH

- nephrogenic= high ADH

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11
Q

treatment for DI

A
  • mild- fluid intake
  • D5W
  • desmopressin for central
  • HCTZ for nephrogenic
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12
Q

SIADH

A
  • too much ADH
  • promotes absorption of water
  • decreased urinary output
  • dilutional hyponatremia
  • cerebral edema possible
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13
Q

causes of SIADH

A
  • head trauma
  • pulmonary dz
  • malignancy: small cell, pancreatic
  • meningitis
  • drugs
  • genetics
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14
Q

si/sx of SIADH

A
  • sometimes asymptomatic
  • HA
  • anorexia
  • N/V
  • muscle cramps
  • seizures
  • AMS/ LOC
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15
Q

work up for SIADH

A
  • often incidental finding on BMP
  • high urine Na, urine osmols, spec gravity
  • hypoNa
  • elevated ADH
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16
Q

treatment for SIADH in asymptomatic

A
  • fluid restriction < 1.5 L/d

- demeclocycline

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17
Q

treatment for SIADH in symptomatic

A
  • 3% hypertonic solution
18
Q

sheehan syndrome

A
  • infarction/ necrosis of pituitary after severe PPH
  • usu occurs gradually 10-20 years pp
  • common in underdev countries
19
Q

si/sx of sheehan

A
  • lethargy, anorexia, weight loss
  • failed PP lactation
  • failure to resume menses weeks/mo pp
  • loss of sexual hair
20
Q

dx of sheehan

A
  • MRI: early shows enlargement, late shows empty sella

- hormone eval

21
Q

treatment for sheehan syndrome

A
  • treat adrenal insufficiency first
  • treat other hormonal def 4-6 weeks later
  • no tx for prolactin decrease
22
Q

achondroplasia

A
  • most common cause of dwarfism
  • results in asymmetric dwarfism
  • short limbs, enlarged skull
  • d/t genetic defect
23
Q

dwarfism

A
  • height 2 std dev below mean in kids

- 4”10’ and under

24
Q

causes of proportionate dwarfism

A
  • GH def
  • GH receptor mutations
  • hypothyroidism
  • turner’s
  • nutritional deficiencies
25
Q

causes of disproportional dwarfism

A
  • achondroplasia
  • spondyloepiphyseal dysplasia
  • diastrophic dysplasia
26
Q

spondyloepiphyseal dysplasia

A
  • adult ht 3-4 ft
  • short trunk, barrel chest
  • severe OA
  • assoc with orthopaedic issues
27
Q

diastrophic dysplasia

A
  • rare, autosomal recessive cause of dwarfism
  • short forearms and calves
  • limited ROM
  • cleft palate
  • deformed hands/ feet
28
Q

what causes isolated GH deficiencies?

A
  • sellar and parasellar tumors that destroy pituitary
29
Q

si/sx of GH def

A
  • severe postnatal growth failure
  • delayed one age
  • hypoglycemia
  • prolonged jaundice
  • micropenis
  • increased fat
  • high pitched voice
30
Q

dx of GH def

A
  • first r/o other causes of growth failure
  • if no other causes then order IGF-1, IGFBP-3, and bone age
  • if IGF-1 and IGFBP-3 are low get provocative testing
  • MRI to r/o structural causes
31
Q

treatment for GH def

A
  • SQ GH injections
32
Q

laron syndrome

A
  • most common cause of genetically induced GH insensitivity

- mutation in GH receptor

33
Q

si/sx of laron syndrome

A
  • severe postnatal growth factor
  • small genitalia
  • short limb length
  • prominent forehead, depressed nasal bridge
  • osteopenia
  • obesity
34
Q

what are pts with laron syndrome immune to

A
  • cancer
  • CVD
  • DM
35
Q

what is the most common cause of non-pathologic short stature

A
  • genetics

- constitutional short stature

36
Q

steps to assessing a child who appears proportional but small

A
  • interpret growth chart
  • assess child’s growth potential
  • calculate height velocity
  • assess bone age
  • lab screenings for underlying systemic endocrine diseases
37
Q

height velocity requiring referral in 2-4 years old

A
  • < 2.2 in/year
38
Q

height velocity requiring referral in 4-6 years old

A
  • < 2 in/year
39
Q

height velocity requiring referral in 6- puberty

A
  • < 1.6 in/year in males

- <1.8 in/ year in females

40
Q

how do you estimate a female childs height

A
  • [moms ht + (dads ht -5 in)] / 2

- done at 12-15 mo

41
Q

how do you estimate a male childs height

A
  • ([moms ht + 5 in) + dads height] / 2

- done at 12-15 mo

clin med IV (23 decks)

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