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Pathology 2 Thyroid, ParaTh, Adrenals > Posterior pituitary hyperfunction disorders
 > Flashcards

Posterior pituitary hyperfunction disorders
 Flashcards

1
Q
A
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2
Q

what causes Syndrome of inappropriate ADH (SiADH)?

A
  • Small cell carcinoma lung****

Most common cause

  • Central nervous system disease (injury, tumor etc.)
  • Drugs:
    • Chlorpropamide, an oral sulfonylurea
  • Lung infection (tuberculosis)
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3
Q

what are the 3 Effects of excess ADH?

A
  1. ADH acts on the distal tubules and collecting ducts to promote excessive water retention
  2. Hyponatremia
  3. Urine osmolarity > serum osmolarity
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4
Q

Clinical findings based on retention of free water in SIADH?

A
  • Hyponatremia
  • Low serum osmolality
  • Mental status changes
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5
Q

what is the diagnostic criteria for SIADH?

A
  • Hyponatremia (serum Na usually
  • Plasma hypo-osmolality
  • Increased urine sodium concentration
  • Euvolemia ( edema absent)
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6
Q

what is the treatment for SIADH?

A

Demeclocycline

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7
Q

Pituitary hypofunction (Hypopituitarism) can be of 2 types?

A
  1. Anterior pituitary hypofunction
  2. Posterior pituitary hypofunction
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8
Q

what is Anterior pituitary hypofunction?

A

Refers to partial or complete loss of anterior pituitary function.

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9
Q

what can cause Anterior pituitary hypofunction?

A
  • Non-functioning (null) pituitary adenomas**
  • Sheehan’s post partum pituitary necrosis**
  • Craniopharyngioma: (children)**
  • Pituitary apoplexy**
  • Empty Sella syndrome
  • Ablation of pituitary by surgery or radiation
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10
Q

what is MCC of hypopituitarism in adults**?

what is it associated with?

A

Nonfunctioning pituitary adenoma

multiple endocrine neoplasia (MEN) I syndrome*.

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11
Q

what are the Clinical findings for Nonfunctioning pituitary adenoma?

A

The adenoma expands causing:

  • Loss of anterior pituitary parenchyma resulting in loss of trophic hormones and hypofunction of target organs.
  • Enlarged sella turcica
  • Headache, visual field defects (bitemporal hemianopsia- due to compression of optic chiasm), diplopia (due to oculomotor nerve palsies).
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12
Q

what is Sheehan’s postpartum pituitary necrosis?

A

Pregnancy related infarction of the pituitary gland.

  • Pituitary doubles in size during pregnancy but blood supply does not increase sufficiently.
  • Hypovolemic shock resulting from postpartum hemorrhage causes infarction of pituitary gland.
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13
Q

how does sheehan’s postpartum pituitary necrosis present?

A
  • Sudden cessation of lactation due to loss of prolactin
  • Loss of pubic hair and fatigue
  • Eventual development of panhypopituitarism.
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14
Q

what is the most common cause of hypopituitarism in children?

from where does it come from?

where can it be located?

A

Craniopharyngioma (adamantinoma)

rathke’s pouch

above the sella turcica

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15
Q

symptoms of craniopharyngioma?

A
  • Headache
  • endocrine deficiency,
  • visual disturbances
  • central diabetes insipidus
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16
Q

how does craniopharangioma look on micro and gross?

A
  • Cystic tumor filled with fluid = machinery oil
  • Shows areas of calcification
  • Stratified squamous cells, keratinized
17
Q

identify the parts of a micro photo of a craniopharyngeoma

A

upper left: calcification

lower right: keratinized squamous cells

magnification: cholesterol crystals

19
Q

what is Pituitary apoplexy?

what is Empty sella syndrome?

A

Sudden enlargement of a pituitary adenoma due to bleeding within the adenoma

Refers to abscense of the pituitary due to compression and atrophy or surgical removal.

20
Q

decreased gonadotropins in hypopituitarism will cause what effects on adult women, men, children?

and how will these changes reflect in a lab report?

A

adult woman = 2ry amenorrhea, decreased libido, diminished 2ry sex characteristics

adult men = impotence, diminished 2ry sex characteristis

children = growth and sexual maturation retardation (delayed fusion of epiphyses)

labs: low FSH and LH, low estradiol/testosterone

21
Q

growth hormone deficiency found in hypopituitarism will affect adults and children how?

A

adults = only hypoglycemia

children = pituitarism dwarf, delayed growth and sexual maturation

22
Q

TSH deficiencty found in hypopituitarism will affect individuals how?

ACTH deficiency found in hypopituitarism will affect individuals how?

Prolactin deficiency found in hypopituitarism will affect individuals how?

A
  • Secondary hypothyroidism
  • Decreased serum T4 and TSH
  • Secondary adrenal insufficiency
  • Hypoglycemia (cortisol is gluconeogenic)
  • Failure of lactation in post-partum patients
23
Q

what are the most important hormonal deficiencies to recognize in hypopituitarism?

A
  • Adrenal insufficiency
  • Hypothyrodism
24
Q

adrenal insufficiency and hypothyroidism should be treated with?

A

Glucocorticoids first (to avoid adrenal crisis) and then with Thyroid hormone

25
Q

Name a Posterior pituitary hypofunction disease

A

Diabetes insipidus

26
Q

what is Diabetes insipidus?

A

Condition that results due to Deficiency of ADH

or Failure of the kidney to respond to ADH causing

passage of large volumes of dilute urine

27
Q

what are the 2 types of diabetes insipidus?

how do we differentiate each?

A

Central diabetes insipidus: Deficiency of ADH

Nephrogenic diabetes insipidus: Failure of the kidney to respond to ADH

28
Q

what can cause central diabetes insipidus?

A
  • Transection of pituitary stalk (e.g. trauma)
  • Hypothalamic disease (e.g. histiocytosis X and sarcoidosis)
  • Posterior pituitary disease (e.g. metastasis)
  • Pituitary surgery
29
Q

what are the causes of nephrogenic diabetes insipidus?

A
  • Hypokalemia: vacuolar nephropathy of Collecting tubules
  • Drugs: Lithium, demeclocycline
  • Nephrocalcinosis: calcification of BM of collecting tubule
30
Q

Clinical features o fdiabetes insipidus are based on what?

What are the clinical features of diabetes insipidus?

A

water loss

  • Polyuria, polydipsia with risk of life threatening dehydration.
  • Hypernatremia and high serum osmolality
  • Low urine osmolality and specific gravity.
31
Q

How to Distinguish CDI from NDI?

A

Look for response to exogenous administration of ADH

Concentrated urine –> Central DI

No effect –>  Nephrogenic DI

Pathology 2 Thyroid, ParaTh, Adrenals (10 decks)

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