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Endocrine

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Question
Answer
show CRH, GHRH, GnRH, TRH, DA, SS  
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Pituitary hormones   show
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Adrenal hormones   show
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show produced by pit; neg inhib by DA (so the more DA, less prolactin)  
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Regulation of Hypothalamus   show
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show Estrogen (F); Spermatogenesis (M) [if no estrogen prod: FSH increases]  
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LH: fx   show
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TSH: fx   show
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show induces lactation  
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GH: fx   show
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show stimulates cortisol production  
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show Thyroid gland fails to make T4; TSH is HIGH; FREE T4 is LOW  
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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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show Cold intolerance; Fatigue; Heavy Menstrual Bleeding; Wt Gain; Myxedema Coma  
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show Much rarer than primary  
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show Follow TSH to adjust thyroid hormone replacement  
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Secondary hypothyroidism: poss sequela of:   show
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Secondary hypothyroidism: consider in pt with S/S of:   show
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Secondary hypothyroidism: Do not:   show
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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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show Addison Dz; adrenal gland does not respond to ACTH & not make adrenal hormones  
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show Pit does not make ACTH; adrenal is not stimulated to make cortisol  
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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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show Failure of pit to secrete ACTH; caused by the same causes of Pan-Hypopituitarism  
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show b/c secondary & tertiary adrenal insuff only involve low ACTH levels, the RAAS is still intact; Only cortisol is deficient.  
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show Hyperkalemia & Hypotension are rarely seen; hyperpigmentation is not seen  
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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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show baseline cortisol, then: 250 mcg IM Cortrosyn; cortisol s/b over 18 (if adrenal gland is working)  
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show ACTH stims adrenal to make 11-deoxycortisol (which makes cortisol); Nml pit will drive up 11-d, if 11-d goes up & ACTH goes up, then pt has nml pit-adrenal axis;  
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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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Hypogonadotropic Hypogonadism =   show
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show Hx (congenital or acquired); MRI Pituitary to assess for cause; Labs (prolactin; Iron/TIBC (Hemachromotosis); other Hormonal Work-Up; if estrogen level low, do Provera challenge); Give Hormone Replacement  
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Diabetes Insipidus definition   show
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DI: Water Deprivation Test   show
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Water Deprivation Test: purpose   show
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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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show Secondary Hypothyroidism; Hypocortisolism (secondary adrenal insuff); Amenorrhea, Menopause, Erectile Dysfunction, Infertility; Polyuria/Polydipsia  
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Management of Panhypopituitarism   show
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Hyperprolactinemia: Sx (Women)   show
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show ED; Infertility; HA; Mass Effect (eg, from tumor in head); Galactorrhea  
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show Galactorrhea  
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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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Prolactinoma: Mgmt   show
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Prolactinoma: Mgmt   show
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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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show Acromeg: pit tumor secreting GH in adulthood; Gigantism: pit tumor secreting GH during puberty before epiphyseal plate fusion; rapid linear growth, heights up to 8ft 11  
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Risks of LT exposure to GH include:   show
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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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Cushing syndrome   show
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Cushing syndrome: Sx   show
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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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show Nonpituitary Tumors secrete ACTH and do not respond to negative inhibition of high cortisol levels  
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show Small Cell Lung Ca; Carcinoid Tumors; Pheochromocytoma; Thymoma; Pancreatic Cell tumors; Medullary Ca of the Thyroid  
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Adrenal Hypercortisolism   show
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show 24 hr urine for free cortisol (if >100, prob Cushing, if >300, def Cushing; Check Cortisol at night; Suppressing Cortisol with oral dex; checking ACTH levels  
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Hypercortisolism: Dx: why suppress cortisol w/Dex   show
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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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Lack of stimulating hormone: causes   show
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Hyperfunctioning of Endocrine Gland   show
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show MRI  
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show surgery (except prolactinoma)  
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show ketoconazole  
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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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