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Cote- Diabetes Insipidus, Anterior Pituitary Disease
Terms in this set (15)
What are the causes of diabetes insipidus? What is the workup?
urine output over 50mL/kg/day and urine osmolarity less than serum
fluid deprivation test used to make diagnosis- test start in morning and body weight, plasma osmolarity, serum sodium, and urine volume should be measured hourly
What is the difference between central diabetes insipidus and nephrogenic diabetes insipidus?
central DI- loss of ADH
nephrogenic- resistance to ADH
What are the diseases that can result in SIADH?
What are the drugs that can result in SIADH?
What is the treatment of hyponatremia?
What is the treatment of hypernatremia?
if central DI: desmopression (dDAVP) intranasally
if neprhogenic DI: sodium restriction with thiazide diuretic
if hypovolemic as well, give normal saline, then when stable switch to hypotonic fluid
What are the tests of pituitary sufficiency?
What can cause hypopituitarism?
pitutiary tumor, craniopharyngioma, sarcoidosis, Sheehan's syndrome
inflammation (like TB, fungal infections with AIDS)
How do you treat hypopituitarism?
What are the hormonal evaluations for craniopharyngioma?
basal prolactin level, IGF-1, 24 hour urine free cortisol (and possibly dexamethasone suppression test), FSH and LH, TSH
What is the role of IGF-1 in assessing pituitary function?
may be used to detect excess GH and help diagnose and monitor treatment of acromegaly and gigantism
What are the features of GH deficiency in adults, cause, diagnosis, treatment?
clinical features: changes in lipid metabolism, quality of life, CV dysfunction
diagnosis: insulin-induced hypoglycemia (normal GH goes up) or IV arginine then draw GH level
tx: GH to titrate to maintain IGF-1 levels at mid-range
What is the most concerning symptom of acromegaly?
CV symtpoms: coronary artery disease, cardiomyopathy with arrhythmia, LVH, diastolic dysfunction, and hypertension
Treatment of acromegaly?
most is surgery due to pitutiary adenoma
octreotide (somatostatin analog) may be used
if can't do surgery; radiation or gamma knife plus medical therapy
What are the various etiologies, clinical presentation, diagnosis and treatment of hyperprolactinemia?
high prolactin (lack of dompamine inhibition) over 200ug/L
men: loss of libido, gynecomastia, weight gain
women: amenorrhae, galactoria, infertility, weight gain
diagnosis: fasting prolactin level (should be below 200) check TSH and T4 levels too (may have hypothyroidism)
treatment: dopagmine agonists (cabergoline and bromocriptine0
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