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Terms in this set (44)
2(Na) + BUN/2.8 + Blood Glucose/18
What are the six anterior pituitary hormones?
1) growth hormone
2) luteinzing hormone
3) follicular stimulating hormone
6) adenocorticotropic hormone
What stimulates and inhibits ACTH?
stim: CRH and stress
inhib: high cortisol levels
What stimulates and inhibits GH?
stim: GHRH; hypoglycemia
inhib: somatostatin; hyperglycemia
What stimulates and inhibits LH/FSH?
inhib: inhibin only inhibits FSH
What stimulates and inhibits prolactin?
stim: absence of dopamine
inhib: tonic by hypothalamic dopamine
What stimulates and inhibits TSH?
inhib: somatostatin; high thyroid hormone levels
What are mass effect symptoms of a pituitary tumor?
headache, diplopia, bitemporal hemianopsia
What are symptoms of a pituitary adenoma?
low libido, weight loss, anorexia, weakness, amenorrhea
What is workup for <1cm pituitary adenoma?
prolactin, IGF-1, TSH/fT4, LH/FSH, cortisol excess (24hr urine, low dose dexameth, or midnight salivary cortisol)
What is the workup for >1cm pituitary adenoma?
all labs of <1cm AND visual field test; ACTH stim for cortisol def.; LH/FSH (post-menopausal) and testosterone (men); normal menses r/o gonadotropin deficiencey
What is imaging follow-up for a nonfunctional pituitary adenoma?
<1cm: 1 year then every 1-2 yrs for 3 years
>1cm: 6 mos then yearly
What are surgical indications for surgery of a pituitary tumor?
visual defects; apoplexy; hypersecretion of ACTH, TSH, or GH
What is the treatment of empty sella syndrome?
none if no hormone deficiencies
What are nonprolactinoma causes of hyperprolactinemia?
dopamine antagonists (antipsychotics), metoclopramide
sarcoidosis or trauma of hypothalamus or stalk
chest wall injury
chronic kidney disease
What are the results of hyperprolactinemia?
decreased LH/FSH; hypogonadism, ED, amenorrhea/galactorrhea
What are indications for treatment of prolactinomas?
>1cm; hypogonadism sx; galactorrhea affecting quality of life; infertility
What is the medical treatment of a prolactinoma?
cabergoline; contraindicated in cardiac or lung disease
What are signs and symptoms of acromegaly?
deepening of voice, carpal tunnel, acanthosis nigrans, excessive sweating
What are associated problems with acromegaly?
HTN; ischemic heart disease; OSA; insulin resistance, colorectal cancer
What is diagnostic test and treatment of acromegaly?
IGF-1; confirm with OGTT and failure to suppress GH; all tx is surgical removal
What tumors most commonly metastasize to the pituitary?
breast and lung; may present as isolated DI
What is Sheehan syndrome?
What are causes of central DI?
cancer; trauma; infiltrative disease (eos. granuloma, sarcoid)
What are causes of nephrogenic DI?
Li, chronic pyelonephritis, myeloma, sickle cell.
*also hyperCa++ or hypoK+
What is the treatment for central DI?
Desmopressin (ADH analog)
What is the treatment for nephrogenic DI?
Amiloride or HCTZ; low sodium diet (1st)
What cancer is associated with SIADH?
small cell lung
What are urine osm, urine Na+, serum Na+ in SIADH?
high urine osm and Na+; low serum Na+; treat with fluid restriction
What conditions have increased uptake on RAIU?
Graves*, hot nodule, TSH-secreting tumor, iodine def., tumor, hCG-secreting tumor
What conditions have decrease uptake on RAIU?
thyroiditis, exogenous T3/T4, iodine excess, factitious
What are indications for thyroid U/S?
solid vs. cystic, localize for FNA, follow nodule size or #
What are lab finding in hypothyroidism?
hypoNa+, macrocytic anemia, hyperlipid., pericardial effusion, increased prolactin
What drugs interfere with thyroxine absorption?
Fe, Ca, Al, bile acid sequestrants, estrogens
What are the 2 thyroid emergencies?
myxedema coma and thyroid storm
What is Schmidt's syndrome?
Autoimmune thyroiditis with Addison's disease (adrenal insuff.) and in some cases DM1 (polyendocrine autoimmunity)
What is the presentation of myxedema coma?
decreased mentation, hypothermia, bradycardia, progressive hypothyroid sx, hypoglycemia, pericardial effusion, seizures
What is the treatment of myxedema coma?
T3 and T4, stress-dose steroids, passive rewarming
What are causes of hyperthyroidism?
Graves disease, or autoimmune stimulation of TSH receptors; toxic multinodular goiter; toxic adenoma; thyroiditis; amiodarone
What are lab findings in hyperthyroidism?
1. Low TSH (if primary)
2. High free or total T3 and T4
3. Hypocholesterolemia (due to increased LDL receptor expression)
4. normochromic, normocytic anemia
5. dilated cardiomyopathy
What are physical findings of Graves disease?
1. diffuse, soft goiter
2. bruit on thyroid
4. pretibial myxedema; peau d'orange
5. pernicious anemia, ITP
What are treatments of Graves disease?
MMI, PTU (more toxic), radioactive I, surgery
med toxicity: liver, agranulocytosis
What are symptoms of pituitary apoplexy?
severe headache, N/V, visual defects, and/or altered mental status
What is treatment of pituitary apoplexy?
neurosurgical emergency if severe sx; mild sx may only require corticosteroids
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