Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 2 FCM > Pituitary Disorders III > Flashcards

Pituitary Disorders III Flashcards

1
Q

Anterior Pituitary Six major hormones

A 
o	Growth Hormone (GH)
o	 Adrenocorticotropin Hormone (ACTH)
o	Luteinizing Hormone (LH )
o	Folllicle Stimulating Hormone ( FSH)
o	Thyroid Stimulating Hormone (TSH)
o	Prolactin (PRL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
Posterior Pituitary (Neurohypophysis)
hormones
A
  • Vasopressin (ADH)- also called AVP

- Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

This disease is the Exact opposite of gigantism, there is a deficiency of growth hormone

A

Pituitary Dwarfism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pituitary Dwarfism is also called

A

short stature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is Pituitary dwarfism noticed/diagnosed?

A

Starts early in life, sometimes picked up at birth but typically seen when they first start school and on the onset of puberty.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pituitary dwarfism body characteristics

A

Abnormally short stature with normal body proportions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is Pituitary dwarfism Congenital or acquired?

A

it can be both, Congenital or acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can Pituitary dwarfism be acquired?

A

any damage to pituitary gland that would affect the growth hormone cells could cause pituitary dwarfism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk Factors for Pituitary dwarfism

A

Associated with deficiencies of: Thyrotropins, vasopressor, gonadotropins, ACTH

Genetic, pituitary adenoma, empty sella turcica

Trauma, infections (in utero)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pituitary dwarfism can be caused by GH deficiency or ______.

A

panhypopituitarism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pituitary dwarfism In US occurs in how many births?

A

1/3,500 births

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Male to female ratio for Pituitary dwarfism

A

2:1 M:F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is there race predilection for Pituitary dwarfism?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Average adult height for untreated Pituitary dwarfism patients

A

M: 143 cm (56in) and F:130 cm (51in)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In Pituitary dwarfism Mortality is related to___.

A

other hormonal deficiencies /CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pituitary dwarfism peak diagnosis

A

school age and puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

There is a hereditary form of pituitary dwarfism that keeps the pt from ever going through _____.

A

puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

pituitary dwarfism will look like what on growth chart?

A

Persistently under growth chart, If acquired may be normal growth chart and then flat lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pituitary Dwarfism Work-up

will include

A

Hand XR: bone age
GH/IGF-1 levels
Hormone levels
MRI Brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is a Hand XR: bone age used in work up?

A

can look at it and determine how old pt is or how old they should be and they can determine if they are much below the expected growth rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why order an MRI for pituitary dwarfism work up?

A

look for any masses or structural changes around the pituitary gland

22
Q

Pituitary Dwarfism Prognosis

A

growth rate improves if caught early and with administration of Growth Hormone

23
Q

Pituitary Dwarfism treatment

A

o Synthetic GH for GH deficiency

o Hormone replacement as warranted

24
Q

What is Diabetes?

A

any of various abnormal conditions characterized by the secretion and excretion of excessive amounts of urine.

25
Q

What is Diabetes insipidus?

A

passage of a large quantity of diluted urine

26
Q

Diabetes insipidus criteria

A

Quantity >2-3L/24h of urine

Concentration <300mOsm/Kg

27
Q

This is Diabetes insipidus type caused by neurogenic or pituitary (decreases secretion of ADH) (ADH = AVP arginine vasopressin)

A

Central Diabetes insipidus

28
Q

his is Diabetes insipidus type caused by kidney resistance to ADH causing inability to concentrate urine (can be seen in CRF, lithium toxicity, hyperCa++, HypoK+)

A

Nephrogenic Diabetes insipidus

29
Q

What happens in volume depletion?

A

baroreceptors will exert effects on aldosterone release, increased thirst (in hypothalamus) and AVP release. Has these three things going on because it wants to hold on to its fluid, ADH concentrates urine and keeps water in us because we want to hold on to volume.

30
Q

Osmoreceptors (for thirst drive) are solute specific to _____.

A

sodium

31
Q

what do osmoreceptors impact?

A

Impact thirst drive and AVP secretion only

–will not affect aldosterone

32
Q

Primary causes of central diabetes insipidus

A 
o	Idiopathic (we haven’t figured it out) 30%
o	Hypothalamic damage, autoantibodies?
o	Familial/hereditary 10%
33
Q

Secondary causes of central diabetes insipidus

A

Brain/Pituitary Tumors 25%

Cranial surgery 20%

10-20% s/p transsphenoidal adenectomy vs 60-80% s/p larger tumour resection

34
Q

Head Trauma causes what percentage of central diabetes insipidus ?

A

16%

35
Q

Rare causes of Central DI

A
  • Cancer, Hypoxic encephalopathy, Anorexia nervosa, AtrioVenous Malformation (AVM), Sheehan’s
  • Temperature Targeted Management (TTM) after cardiac arrest
36
Q

Epidemiology of DI

A
  • 3/100k
  • M=F
  • No racial predilection
37
Q

Presentation of DI

A
  1. Polyuria (2-20L/day)
  2. Polydipsia
  3. Nocturia
  4. +/-Dehydration
  5. Signs of hypernatremia: irritability, ataxia, lethargy, seizures, coma, brain hemorrhage
38
Q

When doing a workup for DI, a 24-hour urine collection for volume and specific gravity volume shows less than 2 Liters. Do they have DI?

A

< 2L rules out DI (They should have at least 2-3 L per day for urine output if they have DI)

39
Q

In DI work up, what should specific gravity be to indicate DI is present?

A

Urine Specific Gravity <1.005

40
Q

In DI workup, you look for glucosuria. Should this be present in pt with DI?

A

no, there should be no sugar in urine of DI patient

41
Q

What two osmolality tests will you perform at the same time in a DI work up?

A

Plasma (blood osmolality) & Urine osmolality

42
Q

Why would you perform a Uric acid level test on pt suspected with DI?

A

if you don’t have ADH then you will have increased uric acid level.

*should also take plasma ADH levels

43
Q

On DI pt a pituitary MRI is performed, what will you find?

A

the posterior pituitary will not be bright due to lack of ADH

44
Q

What is the Vasopressin Challenge Test?

A
  • Desmopressin given IN, IM or SC
  • Measurements of urine output 12 h prior and after and then compare
  • Pts will have a reduction in thirst and volume
  • This is if they have central diabetes insipidus, if they have nephrogenic then it doesn’t help.
45
Q

What is the water deprivation test procedure?

A

Patient deprived of water until two urine samples have Osmolalities within 30 mOsm of each other or weight reduced by 3%

5 U of aqueous ADH or desmopressin given SC. Urine obtained 60 minutes later for osmolality measurement.

46
Q

What would normal water deprivation test results be?

A

water deprivation leads to a urinary osmolality that is 2-4 times greater than plasma osmolality & administration of ADH produces an increase of less than 9% in urinary osmolality.

47
Q

What would water deprivation test results be for central DI?

A

In central DI urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI –it will go up meaning the kidneys are accepting it, it is not nephrogenic, it is central.

48
Q

What would water deprivation test results be for nephrogenic DI?

A

In nephrogenic DI: urine osmolality <300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will NOT rise at all

49
Q

Management for DI

A
  • Most can replace fluid by PO
  • If PO replacement not adequate & hypernatremia present: dextrose w/water or IVF w/dextrose (that is more hypo-Osmolar then serum)
  • Slow reduction of sodium! Don’t correct to quickly because it can cause cerebral edema and end up killing pt.
50
Q

Pharm Management for DI

A
  • Desmopressin (DOC for Central DI) as needed for thirst and polyuria
  • Synthetic Vasopressin
  • Chlorpropamide
  • Thiazides
  • Carbamazepine- anti convulsant- last resort medication, doesn’t work that great
51
Q

Diabetes insipidus Prognosis

A
  • Excellent depending on underlying cause
  • Mortality rare unless hydration not available
  • Complications: fever, CV collapse

Block 2 FCM (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions