Endocrine
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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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Created by:
Abarnard
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