diseases of the posterior pituitary posterior pituitary functioning: -hyperfunction: -antidiuretic hormone effects: --\_\_\_\_\_ -examples of diseases --\_\_\_\_\_ secretion
- hypofunction
- antidiuretic hormone effects
- -_____
- examples of diseases
- -_____
- -_____
- -_____
- -_____
too much syndrome of inappropriate antidiuretic syndrome (SIADH) too little diabetes insipidus neurogenic nephrogenic dipsogenic
hyponatremia
-_____ is under Hyponatremia
SIADH
Diseases of the Posterior Pituitary
- Syndrome of inappropriate antidiuretic hormone (SIADH) secretion
- -Levels of antidiuretic hormone (ADH) are abnormally high.
- -_____ secretion of _____ is the most common cause; is also common after surgery and some cancers.
- -Water retention and dilutional hyponatremia : Action of ADH on _____ increases their permeability to _____, thus increasing _____ by the _____.
- -For diagnosis, normal renal, adrenal, and thyroid function must exist.
Ectopic ADH renal collecting ducts water water reabsorption kidneys
Clinical manifestations Lab values
- Hyponatremia: _____ mEq/L
- Hypoosmolality: _____ mOsm/kg
- Urine hyperosmolality: _____ than serum osmolality
- _____
- Weight _____
- Serum sodium levels below _____ mEq/L: Can cause severe and sometimes irreversible _____ damage
Sodium <135 <280 Higher Hypervolemia gain 110 to 115 neurologic
clinical manifestations of diseases of the posterior pit
name 5
Lethargy Hyponatremia perhaps seizure decreased plasma osmolarity concentrated urine
Diseases of the Posterior Pituitary -\_\_\_\_\_-Sodium levels are high.. Insufficiency of ADH -\_\_\_\_\_ and \_\_\_\_\_ -Partial or total inability to concentrate the \_\_\_\_\_ -Neurogenic --Insufficient amounts of \_\_\_\_\_ -Nephrogenic --Insensitivity of the \_\_\_\_\_ to ADH -Dipsogenic --Excessive \_\_\_\_\_ intake, lowering \_\_\_\_\_ to the point that it falls below the threshold for ADH secretion
Diabetes insipidus Polyuria polydipsia urine ADH renal collecting tubules fluid plasma osmolarity
diseases of the posterior pituitary
Diabetes insipidus
Is characterized by the inability of the _____ to _____ to _____.
–Excretion of large volumes of _____ urine
Increase in plasma osmolality: _____ mOsm or more, depending on adequate water intake
Urine output: _____ L/day; normal output: _____ L/day
Lab Clinical manifestations
- _____, _____, continual thirst
- Low urine-specific gravity: <1.010
- Low urine osmolality (<200 mOsml/kg)
- _____
Clinical manifestations
-Polydipsia, nocturia, _____,, _____, increased _____, large volume of dilute urine
–The basic criteria for diagnosing DI include a ______ while sodium levels are _____.
Diabetes insipidus (cont’d)
Treatment
-_____: This form of diabetes insipidus (DI) is _____ with exogenous antidiuretic hormone ADH Administration of the synthetic vasopressin analog desmopressin acetate (DDAVP)
_____: this form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate _____
kidney increase permeability water dilute 300 8 to 12 1 to 2 Polyuria nocturia Hypernatremia polyuria hypernatremia plasma osmolality low urine-specific gravity high Neurogenic treatable Nephrogenic insensitivity
diseases of the anterior pituitary
Hypopituitarism (cont’d)
-_____ - a lack of all hormones associated with the anterior pituitary is:
-Adrenocorticotropic hormone (ACTH) deficiency
–Cortisol deficiency
-Thyroid-stimulating hormone (TSH) deficiency
–Altered metabolism
-Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) deficiency
–Lack of secondary sex characteristics
-Growth hormone (GH) deficiency
–Lack of growth in children
-Treatment
–Replacement of deficient hormone(s)
Panhypopituitarism
diseases of the anterior pituitary
Hyperpituitarism
-Clinical manifestations
–Headache and fatigue
—_____-pressure of the tumor on the optic chiasm
—Hypersecretion of pituitary from _____
—Hyposecretion of neighboring _____
Visual changes
tumor
anterior pituitary hormones
If there is pressure exerted by a pituitary tumor
-If the tumor exerts sufficient _____, then _____ and _____ may occur because of lack of _____ and _____
-These result in the symptoms of _____ and _____.
pressure thyroid adrenal hypofunction thyroid-stimulating hormone (TSH) adrenocorticotropic hormone (ACTH) hypothyroidism hypocortisolism
Visual disturbances are a result of a pituitary adenoma
-Due to the pressure of the _____ on the _____!!!!
tumor
optic chiasm
Diseases of the AnteriorPituitary
Hypersecretion of GH
-Giantism
–_____ in children and adolescents because the the _____ have not yet closed.
-_____- Hypersecretion of growth hormone
–Hypersecretion of GH during _____
–Slowly progressive _____
—Co-morbid conditions: _____; _____; _____; _____, leading to _____
—Other malignancies: Common
GH hypersecretion Epiphyseal plates Acromegaly adulthood pituitary adenoma Cardiac hypertrophy hypertension atherosclerosis type 2 diabetes mellitus coronary artery disease
diseases of the anterior pituitary
Hypersecretion of prolactin
-Caused by _____
–Most common _____ active pituitary tumor
–In women: _____, _____, _____, and _____
In men: _____, _____
Treatment
Bromocriptine, cabergoline, and pergolide (dopaminergic agonists): Rapid reduction in the size of the tumor and a reversal of the gonadal effects
Resistant or intolerant to medication: Transsphenoidal surgery, endonasal endoscopic surgery, and radiotherapy
prolactinomas hormonally Amenorrhea halactorrhea hirsutism osteoporosis Hypogonadism erectile dysfunction
alterations of thyroid function
- _____: Hypersecretion of thyroid hormone- _____
- -Cause is an _____; develops autoantibodies. _____ immunoglobulin that causes overproduction of thyroid hormones.
- Clinical manifestations
- -Ophthalmopathy
- –Exophthalmos: Increased secretion of hyaluronic acid, orbital fat accumulation, inflammation, and edema of the orbital contents
- –Diplopia: Double vision
- -Pretibial myxedema (Graves dermopathy): Leg swelling
- Treatment
- -Antithyroid drugs, radioactive iodine, or surgery
- -Does not reverse infiltrative ophthalmopathy or pretibial myxedema
Hyperthyroid condition
Graves disease
autoimmune disease
Thyroid-stimulating
graves disease
- The level of _____ (_____) in individuals with Graves disease is usually _____.
- Palpation of the _____ of a person diagnosed with Graves disease would detect a _____ that is diffusely _____.
thyroid-stimulating hormone (TSH) low neck thyroid enlarged
Alterations of ThyroidFunction
thyrotoxic crisis (thyroid storm)
-Clinical manifestations
–_____; _____, especially atrial _____; _____-output heart failure; agitation or delirium; and _____, vomiting, or _____
Hyperthermia tachycardia tachydysrhythmias high nausea diarrhea
alterations of thyroid function
- Primary hypothyroidism
- -A deficiency of chemical: _____ deficiency (_____): Most common worldwide
Iodine
endemic goiter
alterations of thyroid function
Hypothyroidism (cont’d)
-Thyroid carcinoma
–Most common endocrine malignancy from ionizing radiation
–Changes in voice and swallowing and difficulty in breathing, related to a tumor growth impinging the trachea or esophagus
–Some may have normal T3 and T4 levels
–Diagnosis is with _____
fine- need aspiration biopsy
alterations of thyroid function
Hypothyroidism (cont’d)
-Clinical manifestations
–Low _____ , decreased _____, _____ intolerance, _____, _____, _____, and slightly lowered _____; also possible _____ hypertension
–_____- Hyposecretion of thyroid hormone
—Nonpitting, boggy edema, especially around the eyes, hands, and feet; thickening of the tongue
–Myxedema coma
—Medical emergency, diminished level of consciousness; hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, lactic acidosis, and coma
basal metabolic rate heart rate cold constipation lethargy tiredness basal body temperature diastolic Myxedema
Alterations of Parathyroid Function hyperparathyroidism -Secondary hyperparathyroidism --Increase in \_\_\_\_\_, secondary to a \_\_\_\_\_ ----\_\_\_\_\_
PTH
chronic disease
Chronic renal failure
alterations of parathyroid function
hypoparathyroidism
-Usual cause-Most common cause is _____ in _____
Parathyroid damage
thyroid surgery
alterations of parathyroid function
- hypoparathryoidism
- -clinical manifestations:
- –Hypocalcemia
- –Lowering of the threshold for nerve and muscle excitation
- —-_____; ______; tonic-clonic _____; _____ spasms; death from _____ and _____
Muscle spasms hyperreflexia seizures laryngeal asphyxiation Chvostek Trousseau signs
Type 1 Diabetes Mellitus
- Clinical manifestations
- -Long preclinical period with gradual beta cell destruction, leading to insulin deficiency and hyperglycemia
- –An 80% to 90% loss of function of the insulin-secreting beta cells in the islet of Langerhans occurs before hyperglycemia develops
- -Polydipsia, _____, polyphagia, weight loss, and fatigue
polyuria
Why polyuria in Diabetes??
-_____ accumulates in the blood and appears in the _____ as the renal threshold for glucose is exceeded, producing an _____ and the symptoms of _____ and _____.
Glucose urine osmotic diuresis polyuria thirst
