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F3 E4 Shea > Pituitary Disorders- DI and SIADH > Flashcards

Pituitary Disorders- DI and SIADH Flashcards

1
Q

Which condition?

Decreased or absent ADH or receptor issue

A

DI

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2
Q

MCC of central DI?

A

idiopathic MC
Tumor, neurosurgery

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3
Q

Central vs nephrogenic DI diagnostics:

  • Water Deprivation Test: If you restric water and then give a patient vasopressin (ADH), what do you expect to happen in central DI? In nephrogenic?
A

Central: increase urine osmolality

Nephrogenic: No change in urine osmolality

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4
Q

How do you diagnose DI? (6)

A
  • 24hr urine
  • Urine specific gravity (< 1.005)
  • Urine osmolality (<200)
  • Plasma osmolality (>287)
  • Water Deprivation test (incr. urine osmolality in central DI, no change in nephrogenic)
  • ADH- plasma, urine
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5
Q

Sxs of what?

  • Lrg volume, dilute urine
  • Excess thirst
  • 24hr urine 2.5-20L
A

Diabetes Insipidus

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6
Q

Is nephrogenic or central DI more common?

A

nephrogenic

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7
Q

Are the following causes of nephrogenic or central DI?

  • chronic Lithium
  • hypercalcemia
  • hypokalemia
A

Nephrogenic

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8
Q

Is nephrogenic DI abrupt or gradual onset of polydipsia? Central DI?

A

Nephrogenic (or primary) DI: gradual

Central DI: abrupt

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9
Q

Central or nephrogenic DI?

Deficient secretion of ADH

A

Central

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10
Q

Central or nephrogenic DI?

Kidneys resistant to effects of ADH

A

Nephrogenic

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11
Q

How do you tx Central DI?

A
  1. Replacement of fluid losses (can get hypernatremic if no access to water)
  2. Desmopressin
  3. 2nd line: Chlorpropamide, Carbamazepine, Clofibrate
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12
Q

How do you tx Nephrogenic DI?

A
  1. Tx cause (d/c lithium or correct hypercalcemia)
  2. Thiazide diuretic + low salt diet
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13
Q

What 2 patient populations have less TBW? Which has more?

A

Less= elderly and obses

more= kids

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14
Q

What condition?

Abnormal increase in ADH w/o appropriate stimulus

A

SIADH

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15
Q

What is the primary manifestation of what?

Hyponatremia w/o clinical edema (euvolemia)

A

SIADH

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16
Q

You should suspect what in all patients with:

  1. Hyponatremia
  2. Serum hyposmolality
  3. Continued urinary sodium excretion >20
A

SIADH

17
Q

How do you dx SIADH?

A

Hyponatremia w/ continued sodium excretion >20mmol / 24hrs

18
Q

What 2 conditions must be ruled out when working up SIADH

A

**must r/o hypothyroidism and adrenal insufficiency b/c both are causes of hyponatremia/euvolemia**

19
Q

What are the 5 major causes of SIADH?

A
  1. Ectopic ADH–> MCCly due to Small cell carcinoma of the lung (oat cell)
  2. Pulmonary Disease (ex: PNA)
  3. Major abd/thoracic surgery
  4. CNS disturbances (CVA, hemorrhage, infection, trauma)
  5. Drugs: Chlorpropamide, carbamazepine, clofibrate
20
Q

How do you treat SIADH? (3)

A

1. Water Restriction

2. Salt administration

  1. other option: Salt + loop diuretic

F3 E4 Shea (12 decks)

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