Test Myself Flashcards
A primary growth hormone disorder:
- Potential causes
- Lab level of GH and IGF-1
- Characteristics
- GH insensitivity at the liver
- ↑↑ GH, ↓ IGF-1
- Weight gain: ↓ fat and glycogen breakdown and protein synthesis
A secondary growth hormone disorder:
- Potential causes
- Lab level of GH and IGF-1
- Characteristics
- Pituitary tumor
- ↓GH if not making or if not responsive to GHRH/somatostatin, ↓IGF-1, ↑GHRH, ↑somatostatin
3.
A tertiary growth hormone disorder:
- Potential causes
- Lab level of GH and IGF-1
- characteristics
- ↓GH, ↓IGF-1
3.
What would diet low in protein, but adequate carb (w/insulin) due to GH?
- symptoms?
- Lab values of GH and IGF-1
- weight gain: ↑carb storage and lipogenesis
2. ↓GH, ↓IGF-1
what would you include in a differential for pituitary enlargement and a high prolactin level?
hypothyroidism
Pituitary adenoma, condition for each cell type:
- lactotrophs (prolactinoma)
- thyrotrophs
- corticotrophs
- somatotrophs
- hyperprolactinemia
- central hyperthyroidism
- cushings disease
- Acromegaly/gigantism (high GH)
General symptoms of pituitary adeoma
- headache bitemporal
- hemianopsia b/c compression of optic chiasm (lose peripheral field)
Symptoms of prolactinoma: women vs man
women:
- amenorrhea (↓GnRH/LH/FSH)
- galactorrhea
- bone fx (osteoporosis)
male:
- hypogonadotrophic hypogonadism
- decreased libido
- impotence
- infertile
If someone was hypoglycemic, but had adequate protein intake, what symptoms and lab values would that cause?
- symptoms?
- Lab values of GH and IGF-1
- how would you test this?
- shift metabolism to lipids as energy source: lipolysis, ketogenic metabolism, diabetogenic
- ↑ GH, IGF-1
- oral glucose test, would fail to suppress GH production (sensitive for acromegaly)
Potential causes for GH deficiency
- ↓GHRH (hypothalamic dys)
- ↓GH secretion
- failure to generate somatomedin (IGF-1)
- GH or somatomedin resistance (rec def)
primary cause for GH excess
GH secreting pituitary adenoma
-could lead to gigantism or acromegaly
PT presents with:
- increase bone growth
- increase extremity size
- HTN
- hyperglycemia
- organomegaly
- deep voice
- coarsening facial features with age
- excessive sweating
- insulin resistance
- What do you think the condition is?
- Cause of condition
- How would you diagnose the patient
- What lab values?
- Acromegaly
- Pituitary adenoma
- Oral glucose test w/ failure to suppress GH and pituitary mass on MRI
- ↑ IGF-1, ↑ GH
Causes of hypopituitarism
- brain damage: TBI, subarachnoid hmmm, irradiation, stroke
- pituitary tumors: adenoma
- non-pituitary tumors: carinopharyngioma
- infections: meningitis, encephalitis, hypophysitis
- infarction: Sheehan syndrome
- autoimmune disorder
Hypopituitarism-GH:
Children: short stature
Adult: no effect
Hypopituitarism-FSH/LH:
infertility
Male: decreased sperm count, hypogonadism
Female: hypogonadism, menstural irregularity
Hypopituitarism-TSH:
hypothyroidism
Hypopituitarism-ACTH:
loss of pigmentation and hypoadrenalism
Hypopituitarism-ADH:
diabetes inspidus
PTH:
- Stimulus:
- Action on:
- Bone:
- Kidney
- GI: - Overall effect on:
- Serum Ca:
- Serum P:
- ↓ serum Ca
- organs
- Bone: ↑ resorption
- Kidney: ↑Ca reabsorp, ↓P reabsorption (↑urine cAMP)
- GI: + Vit D to ↑ Ca reabsorption - ↑ Ca, ↓P
Vitamin D:
- Stimulus:
- Action on:
- Bone:
- Kidney
- GI: - Overall effect on:
- Serum Ca:
- Serum P:
- ↑ PTH, ↓P and Ca
- Bone: ↑ resorption
- Kidney: ↑Ca reabsorp, ↑P reabsorption (↑urine cAMP)
- GI: ↑ Ca and P reabsorption
- ↑ Ca and P
Calcitonin:
- Stimulus:
- Action on:
- Bone:
- Kidney
- GI: - Overall effect on:
- Serum Ca:
- Serum P:
- ↑ serum Ca
- ↓ resorption
- ↓ Ca
Primary hyperparathyroidism
- Cause
- Lab levels for:
- PTH:
- Calcitriol:
- Bone:
- Urine:
- Serum Ca:
- Serum P:
- Parathyroid adenoma
- PTH: ↑
- Calcitriol: ↑ (PTH + 1a-hydroxylase)
- Bone: ↑ resorption
- Urine: ↑ cAMP, P, Ca
- Serum Ca: ↑
- Serum P: ↓
Humoral hypercalcemia of malignancy
- Cause
- Lab levels for:
- PTH:
- Calcitriol:
- Bone:
- Urine:
- Serum Ca:
- Serum P:
- PTH-related peptide (PTH-rp)
- PTH: ↓
- Calcitriol: -
- Bone: ↑ resorption
- Urine: ↑ P
- Serum Ca: ↑
- Serum P: ↓
Surgical Hypoparathyroidism
- Cause
- Lab levels for:
- PTH:
- Calcitriol:
- Bone:
- Urine:
- Serum Ca:
- Serum P:
- thyroidectomy
- PTH: ↓
- Calcitriol: ↓
- Bone: ↓ resorption
- Urine: ↓ P excretion, ↓ cAMP
- Serum Ca: ↓
- Serum P: ↑
Pseudohypoparathyroidism type 1a
- Cause
- Lab levels for:
- PTH:
- Calcitriol:
- Bone:
- Urine:
- Serum Ca:
- Serum P:
- PTH: ↑
- Calcitriol: ↓
- Bone: ↓ (defect Gs)
- Urine: ↓P and cAMP
- Serum Ca: ↓
- Serum P: ↑
Chronic Renal Failure
- Lab levels for:
- PTH:
- Calcitriol:
- Bone:
- Urine:
- Serum Ca:
- Serum P:
- PTH: ↑ (secondary)
- Calcitriol: ↓ (caused from RF)
- Bone: osteomalacia (↓ D3), ↑ resorption (↑PTH)
- Urine: ↓P excretion (due ↓ GFR)
- Serum Ca: ↓ (due to ↓ D3)
- Serum P: ↑ (↓ P excretion)
Osteoporosis causes:
-Age: bone resorption rate>deposition
Hypocalcemia symptoms
- hyperflexia
- spontaneous twitch
- muscle cramp
- tingle, weakness
Chvostek sign: twitch facial muscles from tapping on facial n
Trousseau sign: carpopedal (hand) spasm on BP inflation
Hypercalcemia signs
- decrease QT
- constipation
- lack of appetite
- polyuria
- polydyspia
- muscle weakness
- hyporeflexia
- lethargy
- coma
effect of chronic hypercalcemia on PTH
↓storage and synthesis
↑b/d of stored PTH and inactive PTH release
effect of chronic hypocalcemia on PTH
↑storage and synthesis = hyperplasia of parathyroid gland (secondary hyperpara-)
Patient presents with hypocalcemia and severe hypomagnesemia, what is the physiological basis? What condition is this commonly seen in?
Mg acts like Ca+ normally in stimulating PTH when levels are low, but in severely low levels- some Mg+2 is needed for normal functioning of the CaS-Rec
-Abnormal function = surpasses PTH release
Alcoholism
Primary hyperparathyroidism
Overactive gland