Endocrine
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| Hypothalamus hormones | show 🗑
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| Pituitary hormones | show 🗑
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| show | Epinephrine; Cortisol; Aldosterone
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| show | produced by pit; neg inhib by DA (so the more DA, less prolactin)
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| show | Upper cortical inputs (CNS); Autonomic NS; environmental cues (light & temp); Peripheral endocrine FB
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| FSH: fx | show 🗑
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| show | regulates ovulation; stimulates testosterone in men [if no testosterone prod: LH increases]
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| TSH: fx | show 🗑
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| show | induces lactation
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| show | controls acral growth
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| show | stimulates cortisol production
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| Primary hypothyroidism | show 🗑
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| show | Pituitary gland fails to make TSH; TSH is inappropriately LOW; FREE T4 is LOW; Other Pit Hormone Deficiencies; cannot follow TSH (must also follow Free T4)
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| Hypothyroid S/S | show 🗑
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| show | Much rarer than primary
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| Secondary hypothyroidism: you cannot: | show 🗑
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| Secondary hypothyroidism: poss sequela of: | show 🗑
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| show | hypothyroidism & low normal TSH, low normal t4
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| show | replete thyroid hormone before repleting cortisol; if pt adrenal/ cortisol deficient, & replete TH first, revs up metab, can lead to adrenal crisis (wont have enough cortisol to support metabm)
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| show | Sx of Hypothyroidism; Low TSH; Low T4; Other Sx to suggest Pan-Hypopituitarism
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| show | Cortisol Deficiency
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| Primary Adrenal Insuff = | show 🗑
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| Secondary Adrenal Insuff = | show 🗑
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| Tertiary Adrenal Insuff = | show 🗑
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| Primary Adrenal Insuff: Sx | show 🗑
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| show | Low morning cortisol <5
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| Secondary Adrenal Insuff: due to: | show 🗑
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| Secondary AI & RAAS | show 🗑
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| Secondary AI: Sx | show 🗑
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| show | Low morning cortisol <5; Low ACTH in setting of low cortisol; No Response to synthetic ACTH (cortrosyn) stim test; Insulin Tolerance Test; Metyrapone Test
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| Secondary AI: synthetic ACTH (cortrosyn) stim test | show 🗑
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| ACTH & 11-deoxycortisol | show 🗑
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| show | Give metyrapone: blocks cortisol prodn, cortisol goes down, FB to hypo-pit, if pit working, more ACTH to inc cortisol
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| show | F: Amenorrhea/Infertility; M: Erectile Dysfunction/ Infertility; Inappropriately Low FSH/LH for low estrogen or testosterone
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| Hypogonadotropic Hypogonadism: Eval | show 🗑
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| show | ADH insufficency: cannot concentrate urine.
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| show | Follow every 1-2 hrs: Na; UOP, Urine Osmo; Wt; BP & HR (Lying / Standing); Once serum osmo >300 & urine osmo has not increased, give 10 ug of vasopressin and follow urine osmo
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| show | distinguish btw central and (nephrogenic) DI. Nephrogenic: give AVP, kidney will not respond, urine remains dilute; Central: give AVP, later serum osmo changes?
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| Diabetes Insipidus: DDx | show 🗑
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| show | Panhypopituitarism (often have intact ADH secretion with deficient ant pit hormones); Sarcoidosis/ Infiltrative Dz; Tumor; Trauma; Image Pituitary to Dx
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| Sx of Hypopituitarism | show 🗑
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| show | Investigate / Tx Underlying Cause (MRI pit); Replace Hormones (unless CI); Cortisol First; Thyroid Hormone; Sex Steroids: Estrogen (unless postmenopause); Testosterone
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| show | Galactorrhea; Amenorrhea; Infertility
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| show | ED; Infertility; HA; Mass Effect (eg, from tumor in head); Galactorrhea
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| Pathognomonic for hyperprolactinemia in men: | show 🗑
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| show | Hyperprolactinemia; Pit Adenoma; Renal Fail; PG
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| show | Hyperprolactinemia; Pit Adenoma; Renal Fail; PG; Drugs; Other Pit Tumors; Hypothal Tumors; Chest Wall Stimulation
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| Drugs that cause Hyperprolactinemia | show 🗑
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| show | dopamine agonist (bromocriptine) often replaces need for surgery.
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| show | Dopaminergic Drugs if: Macroadenoma; Mass Effect; Visual Field Deficit; Fertilty Desired
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| Prolactinoma: Mgmt: Hormone Replacement if: | show 🗑
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| show | Tx w/ Dopaminergic Drugs; DA inhib fx on prolactin; shrink tumor; Cabergoline / Bromocriptine; AE: nausea, hypotension
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| Acromegaly vs Gigantism | show 🗑
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| show | Arthropathy, neuropathy, CVD; HTN; resp dz; malig; CHO intol/DM
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| show | MEN-1 / other FH; Prominent Brow; Enlarged soft tissue of hands / ft; Teeth Splaying; DM; HTN/ LVH; Can be Subtle
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| show | Elevated insulin-like growth factor I (IGF-1). Glucose suppression test: GH Fails to suppress <2 ng/mL after 75 g CHO load
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| show | Surgical; Somatostatin Analogs: Sandostatin; XRT
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| show | Too much Cortisol Prodn; Exogenous (Use of synthetic Glucocorticoids); Endogenous = Cushing Dz
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| show | DM; HTN; Osteoporosis; Psychosis; Easy Bruising; Truncal Obesity; Hyponatremia; Moon Facies; Buffalo Hump; Mx Wasting; Hirsutism; Purple Striae; Supraclavicular Fat; Infections
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| show | Pit ACTH overprodn; Ectopic ACTH Prodn; or Pit/Adrenal Adenoma producing cortisol; 75-80 % of cases with endogenous cortisol excess; elevated cortisol levels do not suppress hypothalamic & ant pit secretion of CRH & ACTH
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| Ectopic ACTH production = | show 🗑
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| Ectopic ACTH production poss d/t: | show 🗑
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| show | ACTH & CRH are suppressed; Caused by: Adrenal Adenomas; Adrenal Ca; Micronodular or Macronodular Hyperplasia
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| Hypercortisolism: Dx | show 🗑
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| show | if suppress to <2, then do not have Cushing (dex provided enough glucocorticoid to pit, signals need not prod cortisol); if ACTH >2, prob has tumor that does not respond to dex
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| show | Do not do radiographic studies prior to lab studies (poss Incidental Tumors, False Negative Scans)
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| Hypofunction of endocrine gland d/t: | show 🗑
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| show | Pituitary (PanHypopituitarism); Hypothalamus (Stress, Tumor)
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| show | Autonomous Fn of Primary Gland (Thyroid Toxic Adenoma); Autonomous Fn of Gland making Stim Hormone (Cushing Dz: ACTH); Ab’s that Stim Hor Receptor (Graves / TSI); Ectopic Prod Stim Hormone (Ectopic ACTH)
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| show | MRI
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| Tx of choice for all pituitary tumors | show 🗑
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| Tx for surgically untreatable cases of Cushing dz | show 🗑
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| show | Neurogenic: 2/2 autoimmune destruction of ADH (AVP) secreting cells.
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| SIADH sxs | show 🗑
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| Diabetes insipidus clinical findings | show 🗑
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| show | Less common than central DI. Vasopressin insensitivity 2/2 kidney dz (abnormal receptors). Sickle cell dz, Lithium tx
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Created by:
Abarnard
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