SIADH What organ/tissue is involved in
Posterior Pituitary
SIADH What Hormone is involved and is it hyper or hypo
Hypersecretion ADH
SIADH What is the cause
High levels of ADH with out physiologig stimuli Pituitary Surg Infectious pulmonary diseases Psychiatric disease after drug treatment
SIADH Clinical Manifestations
Thirst, dyspnea on exertions, fatigue, dulled consciousness, progressing abdominal cramps, vomiting, confusion and seizures
What must exist for diagnosis of SIADH
Normal adrenal and thyroid function must exist Serum hypo-osmolarity and hyponatremis Urine hyperosmolarity
Diabetes Insipidus
What organ/tissue is involved
Posterior Pituitary
Diabetes Insipidus
What Hormone is involved with and is it Hyper or Hypo
Hyposecretion of ADH
Diabetes Insipidus
What is the cause
Insufficiency of ADH leading to polyuria and polydipsia
Diabetes Insipidus
Name the 3 causes
Neurogenic Nephrogenic Psychogenic
Diabetes Insipidus
What is neurogenic
Insufficient amounts of ADH a lesion on hyopthalamus or posterior pituitary interferes with ADH synthesis, transport or release
Diabetes Insipidus
What is Nephrogenic
Inadequate response to ADH insensitivity of renal tubule to ADH, Kidney not responding
Diabetes Inspipidus
What is Psychogenic
Partial resistance to ADH Cause by an extremely large volume of fluid intake
Hypopituitarism
What organ/tissue is involved
Anterior Pituitary
What Hormone is involved with and is it Hyper or Hypo
Hyposecretion Any of the hormones
Hypo pituitarism
What is the cause
Pituitary infarction Sheehan syndrome hemorrhage Shock Head trauma Infections tumors
What is panhypopituitarsim
All hormones are low
Pantypopituitarism
ACTH Target and
Effects of ACTH Deficiency
Target adrenal gland to release corisol
Cortisol deficeincy = decreased immunity
Pantypopituitarism
TSH Target and Effects of TSH Deficiency
Target Thyroid gland
Thyroid deficiency= decreased metabolism (in children this makes them short)
Pantypopituitarism
FSH and LH Target and Effects of FSH and LH Deficiency
Target Gonads Loss of secondary sex characteristics, Gonadal failure, decreased fertility levels
Growth Hormone Deficiency in children =
Normal intelligence, short stature, obesity with immature facial features and puberty is often delayed
Growth Hormone Excess what happens if it occurs in children (pre-puberty)
Giantism
Growth Hormone Excess what happens if it occurs as adult
Bones have already fused so results in Acromegaly
Acromegaly manifestations
Soft tissues grow Lowered protruding jaw Enlargement of heart teeth are splayed
Prolactinomas
What organ/tissue is involved
Anterior Pituitary
Prolactinomas
What Hormone is involved with and is it Hyper or Hypo
Hypersecreation of Prolactin
Protactimomas
What is the cause
hormonally active pituitary tumor
Prolactinomas
Female manifestations
amenorrhea (lose of mensies) galactorrhea (produce milk) hirsutism (male pattern hair growth) osteopenia (brittle bones)
Prolactinomas
Male manifestations
hypogonadism, erectile sysfunction, impaird libido, oliospermia, diminished ejaculate volume
Thyrotoxicosis (aka hyperthyroidism)
What is it
Hight than normal levels of TH
Graves disease cause
Autoimmune abnormal stimulation of thyroid glad by IgG antibodies
Graves Disease Manifestations
skinny, alway shot, irritable, fatigue, exophthalmos
Describe Thyrotoxic Crisis
death within 48 hours with out treatment symptoms hyperthermia, tachycardia, agitation, delirium, nausea, vomiting or diarrehea
Describe Primary Hypothyroidism
Loss of thryoid tissue, decreased TH, Increas TSH and goiter
What is Iatrogenic Hypothyroidism
Loss of thyroid tissue- medication causes atrophy of tissue
Its a treatment for hyperthyroidism
Manifestations of Hypothryoidism
person is heavier, sensitive to cold, lathargic
Describe congenital Hypothryoidism
common cause of preventable mental retardation appears normal at birth due to maternal TH
Results in cretinism- TH essential for normal breain development and growth
Manifestations of cretinism
dwarfism, absent axillary and scant pubic hair, poorly developed breasts, pot belly, small umbilical hernia.
What causes goiter
low TH excessive TSH
Myxedema is a manafestation of ______
What is Myzedema
Manifestations-
Hypothyroidism
nonpitting mucous edema
eye and facial puffiness Enlarged tongue
Acute Thyroiditis cause
Due to a bacterial infection
Subacute Thyroiditis cause
Due to viral infection
Autoimmune thyroiditis is also know as
Hashimoto disease
Hasimoto disease
antibodies attack the TH
Painless thyroiditis
a combo of sub acute and Hashimoto- Can have auto antibodies that are triggered by a virus
Postpartum thyroiditis
occurs up to 6 months after delivery
Myxedema coma
manifestations
is a medical emergency
hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, and lactic acidosis
What is secondary Hypothyroidism
failure to synthesize adequate TSH
Hyperparathyroidism is an increase of what hormone
PTH
Primary hyperparathyroidism is
excess secreation of PTH from one or more parathyroid gland
Secondary hyperparathyroidsim is
increase in PTH secondary to a chronic disease example renal failure
Why is there a connection between renal failure and secondary hyperparathyroidsim
Function of parathyroid hormone is incease blood calcium.
The organ that makes the decision about how much calcium we need is the Kidney
If the kidney is in renal failure it constantly is thinking we need more calcium, sending a message to the PTH to release more calcium
Clinical manifestations of Hyperparathyroidism
Hypercalcemia Bone resorption cause increased susceptibility to fracture Calcium stones
Hypoparathyroidsim is
abnormally low PTH levels
Hypoparathyroidism is usually caused by
parathyroid damang in thyroid surgery
Clinical manifestations of hypoparathyroidsim
Hypocalcemia lowered nerve and muscle excitation spasms, hyper reflexia and clonic tonic convulsions
Bone deformities
Diabetes Mellitus is a dysfuncation of
the pancreas
To get the Dx of Diabetes Mellitus you must have
More than one eleveated fasting plasma glucose level
Elevation plasma glucose levels in resposne to oral glucose tolerance test
classic symptoms of plydipsia, poly phagia and polyuria
Glycosylated hemoglobin (a lot of sugar in blood- glucose binds with hemoglobin)
Type 1 diabetes Mellitus is
Insulin Dependent Diabetes
lack of insulin and relative excess of glucagon
Epidemiology of Type 1 diabetes
most commonly diagnosed in those younger than 18
Eitiology of Type 1 Diabetes
beta cells destroyed due to autoantibodies
Manifestations of Type 1 Diabetes
polydipsia and polyuria resulting from osmotic diuresis (glucose is attracting water to it) weight loss and polyphagia.
Ketoacidosis due to increase matabolism of fats and proteins
TYpe II diabetes is
Insuling dependent or non-insulin dependent?
Non-Insulin Dependent
They do make insulin just done have the receptors to use it
Epidemiology of Type II Diabets
Native Americans, Hispanics, black and alaskan natives
Most are over 40 and many are obese
Etiology of Type II diabetes
3 main reasons why Type II Impaired Beta Cell Function Peripheral Insulin Resistance Increased Hepatic Glucose Production
Type II Diabetes
Describe Impaired Beta Cell Funcation
Pancreas is making some insulin but is not making enough
Type II diabetes
Describe Peripheral Insulin Resistance
Insulin can't bind;glucose can't go into cell stays in blood stream
Most common reason for Type II
Type II Diabetes
Describe Increased Hepatic Glucose Production
liver doesn't know when to stop releasing glucagon released suger you don't need
Type II Diabetes Manifestations
Puritus, recurrent infections, visual changes, and parethesias
also plydipsia
Gestational Diabetes mellitus
Why?
because excess stress on pancreas and growing a baby increased sugar
Epidemology of Gestational Diabetes
family history of diabetes, high-risk ethnic group, advances maternal age, prior hx of GDM, overweight
Acute Complications of Diabetes
Hypoglycemis (insulin shock) Diabetic Ketoacidosis HHNK Somogyi Effect Dawn Phenomenon
Acute Complication of Diabetes
Hypoglycemia (insulin shock)
Type I or Type II
What is the blood glucose
Manifestations
Treatment
90% are Type I
blood glucose of 46-60
pallor, tremor,anxiety, tachycardia, palpitations, diaphoresis(sweating), HA, Dizziness, fatiue, confusion, seizures, coma
Nervous system- Brain needs glucose for energy
Treatment- juice, fruit, candy bar
Acute Complication of Diabetes Diabetic Ketoacidosis
What is it and is it type I or Type II
Type I High sugar low insulin not enough insulin makes body release glucose more
Acute COmplication of Diabetes
Diabetic Ketoacidosis Manifestations
Slow onset metabolic acidosis producing ketone bodies Thirsty, confusion, fatigue
Alot of urine
Acute Complications of Diabetes
Hyperosmolar Hyperglycemic Nonketotic Syndrome HHNK
Is it type I or Type II
Type II
Acute Complications of DiabetesHyperosmolar Hyperglycemic Nonketotic Syndrome HHNK
Glucose level and why it's a problem
Treatment
Who doesn't in commonly effect
Slow onset High mortality due to high serum glucose (More than 500) leading to sever dehydration
Treatment: manage fluid/electrolytes and glucose control
Older adults who binge on sweet and didn't adjust meds
Acute Complications of Diabetes
Somogyi effect
what is it
combination of hypoglycemia follwed by rebound hyperglycemia
Startes with Hypo but body kicks in a raises glucose/stress hormone ends up in hyper
Acute Complications of Diabetes
Dawn phenomenon
What is it
early morning rise in blood glucose with no hypoglycemia during the night due to nocturnal elevation of GH
GH increases blood sugar in the night= high morning blood sugar
Chronic Complications of Diabetes
Microvasular disease due to
due to capillary basement membrane thickening, ischemia hypoxia
Chronic Complications of Diabetes
Retinopahty due to
blood vessel changes and RBC aggregation
Increase sugar= retina vessels rupture= blindness
More likely in Tpe II as a result of Hyperglycemia
Chronic Complications of Diabetes
Nephropathy most common cause of
end stage renal disease
Chronic Complications of Diabetes.
nephropathy death from renal failure more commin in Type ____ as a result of ____
Type I
proteinuria
Chronic Complications of Diabetes
Macrovasular Complications
Coronary Artery Disease (most common cause for death in Type II)
Stroke (2x as common with diabetics)
Peripheral Vascular Disease (PVD) due to occlusions of small vessels (may result in gangrene in lower extremities)
Chronic Complications of Diabetes
Infections- why?
increased risk due to senses impairment (don't know you have a cut)
WBC can't function right when there is too much sugar
poor circulation
microbes love sugar so they increase in number
Cushing disease is a disorder of what organ/tissue
Adrenal cortex
Cushings Syndrome cause
Excessive level of cortisol
Cushings Disease cause
excessive anterior pituitary secreation of ACTH
Cushings manifestations
Altered fat metabolism -Moon face and buffalo hump Muscle weakness due to protein breakdown deranged glucose metabolism susceptibility to infection
Conn disease, primary aldosteronism
manifestations
hypertension, renal potassium wasting, hypokalemia, and neuromuscular manifestations
Primary adrenal insufficiency is termed
addison's disease
Addison disease is caused by
____________________
and is more common in ______
Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women.
Addisons manifestaions
Feminizations- boys become girl like
Virilization- girls become boy like
Uncommon disease cause by continuously high GH Levels
Acromegaly
Most common cause of hyperthyroidism
graves disease
high concentration of blood glucose with severe dehydration
HHNKS
Ketosis prone insuline dependent glucose intolerance syndrome
Type I Diabetes mellitus
non insulin dependent glucose intolerance syndrome, typically adult onset
Type II diabetes
disorder of the posterior pituitary involving high levels of ADH
SIADH
early morning rise in blood glucose concentration with no hypoglycemia durning the night
Dawn Phenomenon
Hypopituitarism in an adult male likely includes all of the following except:
A. dwarfism
B. muscular mass decrease
C. impotence
D. skin pallor
A. dwarfism
Excessive secretion of GH in an adult may cause:
acromegaly
A manifestation shared by both diabetes mellitus and diabetes insipidus is:
a. elevated blood and uring glucose levels
b. inability to produce ADH
c. Inability to produce insulin
d. polyuria
e. elevated blood uring and keton body levels
d. polyuria
The manifestations of hyperthyrodism include all of the following except:
A. weight losse. wakefulness
B. constipation
C. heat intolerance
D. diarrhea
B. constipation
Hypothyroidism ciris is:
A. addison disease
B. graves disease
C. cretinism
D. myxedema coma
E. cushing disease
D. myxedema coma
Graves Disease is:
A. hyperthyroidism
B. associated with autoimmunity
C. manifested by ophthamopathy
D. all of the above
D. all of the above
Inadequate levels of thyroid hormones at birth may cause:
a mental retardation
b. immediate death
c. thyroid ciris
d. myxedema
e. dwarfism
a. mental retardation
Hyperparathyroidism causes:
A. decreased plasma calcium
B. hypocalcemia
C. increased osteoclastic activity
D. increased phosphorus absorption form GI
C. increased ostoclastic activity
A manifestation of hypocalcemia is:
A. myopathy
B. lethargy
C. hypertension
D. bone cysts
E. tetany
E. tetany
What is the most common cause of acromegaly
A. Overproduction of TSH
B. over producation of ACTH
C. pituitary atrophy
D. anterior pituitary adenoma
D. anterior pituitary adenoma
If a 19 yr old woman were suffering from shortness of breath, weight loss, excessive sweating, exophthalmos, and irritability which hormone would you expect to find elecatied in her serum?
A. acth
B. cortisol
C. thyroxine
d 17 ketosteroid
C. thyroxine
A 24 year old femail with a history of juvenile onset diabetes is found in a stuporous state.She is hypotensice and has cold, clammy skin. What is the likely etiology of her condition?
A. peripheral neuropathy
B. hyperglycemia
C. renal failure
D. insulin shock
D. insulin shock
A 10 year old male was brought into the emergency room comatose, suffering from metabolic acidosis with a blood glucose level of 800. The most probable disease causeing his condition is
A. IGT
B. cretinism
C. type I diabetes
D. Type II diabetes
E GDM
C. type I diabetes