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Ant Pituitary H's

TSH; FSH/LH; hGH; ACTH; LTH

Tx goals

Treat cause
Manage S/s
Monitor

Hyperthyroid AI syndrome

Grave's Dz

Grave's Mechanism

ABs that mimic TSH bind to TSH receptors, srtimulate T3/T4 release

Grave's Lab findings

TSH v LOW
T4/T3 v HIGH

Grave's S/s; gender split

Women 10X men
OI THE PAWN:
OLIGOMENORRHEA
Irritable
TREMOR, palpitations, TACHY
HEAT INTOLERANCE
Emotionally labile
Proximal muscle weakness
Anxiety
WEIGHT LOSS w/ hyperphagia
Nervous

Thyroid Storm

Off the chart T4; fever, tachy, ALOC

Hypothyroid AI syndrome

Hashimoto's Dz (Myxedema)

Hashimoto's mechanism & gender split

Women more freq
ABs bind to TSH receptors and BLOCK T4/T3 production

Thyroid panel values

T4: 0.8-2.4;
T3: 260-480;
TSH: 0.2-5.4

Mxyedema S/s

OI THE KING
In other words, opposite of the PAWN:
Fatigue, Hypermenorrhea, Cold sensitivity, Depression, Edema

Myxedema coma S/s

Prolonged hypothyroidism;
Brady --> CHF
Hypoventilation-->Acidosis
Paralytic Ileum

Myxedema Lab Findings

TSH HIGH
T3/T4 LOW

Hypothyroidism in neonates

Cretinism-> Retardation, hypotonic muscles, failure to thrive

hGH Over-production syndromes

Gigantism before epiphyseal plates close
Acromegaly after plates colse

Acromegaly causes & gender

Most common: Pituitary adenoma;
Males 40-45

Acromegaly S/s

Lantern jaw'
Kyphosis
Arthralgias/arthritis
INSULIN ANTAGONIST->DM S/s

hGH underproduction

pituitary dwarfism

FSH in females, males

Females: Stimulates development of follicle & Estrogen production
Males: Stimulates spermatogenesis

LH in females; males

Females: Stimulates Progesterone production by corpus luteum
Males: Stimulates production of Testosterone

Testosterone delivery & Lab Tests

Bound to Sex-Hormone Binding Globulin (SHBG);
Tests: Free & Total

Causes of hypertestosteronism

CHAD
Congenital Adrenal Hyperplasia
Hyperthecosis
ADrenal cortical tumors;

Causes of hypotestosteronism

KIST
Kleinfelters
Primary Hypogonadism
Secondary Hypogonadism
Testes D/o's

ACTH fx

Stimulates release of Adrenal Cortical Hormones, esp:
Cortisol
Aldosterone

ACTH deficiency

Secondary Addison's

Addison's S/s

SHAPE
Sodium excretion (hyponatremia)
Hyper-pigmentation, hTN
Autoimmune
Potassium & Hydrogen retention
End result: Hypotension/fatigue/Ix

ACTH excess & gender

Cushing's syndrome;
5X more in females

Ranked causes of Cushing's

Secondary (pituitary adenoma);
Ectopic secretions (Small cell CA/other tumors;
Iatrogenic (Esp steroids/prednisone)
Primary (adrenal tumors)

Cushing's S/s

MMM O HEAD
Moon face
Menstrual D/o
Metabolic Syndrome
Osteoporosis
Hypertension/hirsutism
Easy bruising
Acne
Depression

Cortisol Lab values

AM: 5-23 ug/dL
PM: 3-16 ug/dL

Cortisol suppression test

Dexamethasone ( DST, a cortisol analog) will SUPPRESS AM cortisol to <5 ug

Cortisol stimulation test

Cortrosyn. ELEVATE AM cortisol by @ least 10 ug/dL

Hyperaldosteronism S/s & Cause

CHAMPS:
Cut renin
HTN
Acidosis
Mg decreased
Potassium decreased
Sodium increased

Possible causes of decreased Cortisol

HA-HA-HA
Hypothyroidism; Adrenal Hyperplasia; Hepatitis/cirrhosis; Addison's; Hyposecretion at Ant pituitary

Possible causes of increased Cortisol

COAT:
Carcinoma/Cushing's;
Obesity
Adrenal adenoma
Tumor secreting ACTH

Phaeochromocytoma Description

Catecholamine secreting tumor of adrenal medulla (EPI, NOREPI, DOPAMINE)

Phaeo S/s & Dx

HA, Sweating, Tachy;
Dx: 24-hr urine catecholamine

Post Pit hormones

ADH (vasopressin / arginine vasopressin), Oxytocin

SIADH

Syndrome of Inappropriate ADH--
Excess ADH secretion leads to hypervolemia. Assoc'd w/ small cell, brain tumors

Diabetes insipidus

Deficient ADH--> High volume of dilute urine. Specific Gravity stays low at all levels of hydration, polyuria

Oxytocin

Uterine contractions & milk letdown

PTH

Main calcium regulator. Increased PTH-> Lincrased Ca by bone resorption & GI absorption

Calcium/Phosphat relationship

Inverse ( As Ca2+ increases, PO4 decreases)

PTH test normal & renal failure

Measure C-terminal in normal pts;
Measure N-terminal in Renal pts

Four uses of Testosterone test

PHIC
Pituitary fx, Hypogonadism, Impotence & Cryptorchidism

PSA

Prostate-Specific Antigen: SCREEN for prostate CA, monitor recurrence after surgery

PAP; when elevated?

Prostatic Acid Phosphatase: Dx of metastatic CA of the prostate. Elevated in CA beyond the capsule.

DM stats

No 4 cause of death;
90-95% DM2

Distinguishing DM1 & DM2

DM1: IMMUNE MEDIATED, Insulin DEFICIENT, Young, thin, recent wt loss, Kussmaul resp, Acetone breath;
DM2: Insulin RESISTANT, Obesity, FamHx, Non-Caucasian, HTN, HDL<35/TriG>250. Hx of gestational DM/Hx impaired glucose tolerance

DM2 Risk Factors

HARD BBioii
Habitual inactivity
Age >45;
Race
Dyslipidemia
BMI>25
Birth wt >9 lb

DM acute & chronic effects

Acute: Ketoacidosis (DM1), Hyperosmolar non-ketotic coma(DM2);
Chronic: Ulcer/neuropathy @ extremities, Renal failure (microalbumin check!), CHF

DM Dx

Fasting glu: >126, 2X;
3-hr glu tolerance: >200 TWO HOURS after glu load, 2X;
Fasting or 2-hr post-prandial >200 JUST 1X;

Must-do test every 3 mo for DM pts

HbA1c, monitors [GLU] and compliance, as Hb circulates for 120 days

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