Prolactinoma
Comp?
COMP:
- Impingement of optic chiasm -> Bitemporal Hemianopia
NONFUNCTIONAL Pituitary Adenomas
Potential Pres (3)?
POTENTIAL PRES:
- Hypopituitarism (due to compression of normal pituitary tis)
- Bitemporal Hemianopsia (due to compression of optic chiasm)
- Headache
Pituitary Adenomas
2 Variations, Comp?
- Functional: Hormone-producing
- Nonfunctional: Silent. Often produce mass effect.
COMP:
- Islet Cell tumor
Empty Sella Sx
Def’n, Mech (3 steps), Pres (Epi), Imaging?
Congenital defect of Sella Turcica.
MECH:
Defective Sella Turcica ->
Herniation of arachnoid + CSF into it ->
Compression / destruction / atrophy of Pituitary.
PRES: Obese Women
IMAGING: Pituitary ABSENT on imaging
Hypopituitarism
Causes (5)?
CAUSES:
- Pituitary Adenoma / Craniopharyngioma
- Empty Sella Sx
- Sheehan Sx
- Brain injury / hem
- Radiation
Sheehan’s Sx
Def’n, Mech (2 steps), Pres (3)?
Postpartum Bleeding -> Hem / Ischemic INFARCT of Pituitary.
MECH:
- Pituitary doubles in size during pregnancy, however its bl supply does NOT increase significantly.
- Bl loss during labor -> Pituitary infarct
PRES:
- Cold Intolerance + Fatigue
- Absent menses
- Failure to lactate
Diabetes Insipidus
Mech, Assoc,
Pres (2), Labs (Bl, Urine)?
MECH = Lack of ADH (Central) / Lack of response to ADH (Nephrogenic).
Loss of Free H2O
ASSOC:
- Hand-Schuller Christian Dz
PRES:
- Intense thirst + Polyuria
- Inability to concentrate urine
LABS:
- HIGH Serum Osm > 290
- LOW Urine Osm / Specific Gravity
Central DI
Mech, Causes (4), RX?
MECH = LACK of ADH.
CAUSES:
- Surgery
- Trauma
- Histiocytosis X
- Pituitary tumor
RX: Intranasal Desmopressin (ADH analog)
SIADH
Mech (3 steps), Causes (4), Pres / Labs, RX (2)?
MECH:
Excessive ADH secretion ->
Retention of Free H2O ->
↓Aldosterone (body’s response to maintain near-normal volume status).
CAUSES:
- Small Cell Carcinoma of Lung (ectopic ADH)
- Pulmonary dz
- CNS disorders / trauma
- Cyclophosphamide
PRES: Excessive water retention
- Hyponatremia (due to↓Aldosterone)
- > Low Serum Osm
- > Neuronal swelling + Cerebral Edema
RX:
- Water restriction
- Demeclocycline
Nephrogenic DI
Mech, Causes (4), RX (3)?
MECH = Lack of renal RESPONSE to ADH.
CAUSES:
- Hereditary
- Hypercalcemia
- Demeclocycline use (ADH antagonist)
- Lithium use
RX:
- Amiloride
- Hydrochlorothiazide
- Indomethacin
Neuroblastoma
Location, RF (Genetic), Pres, Urine?
Can occur anywhere along sympathetic chain.
RF:
- Overexpression of N-myc oncogene (assoc with rapid tumor prog)
PRES: LESS likely to devel Htn compared to Pheochromocytoma
URINE:
-↑HVA (b/d product of dopamine)
Pheochromocytoma
Seen In (4), Pres?
SEEN IN:
- MEN 2
- All Neurocutaneous Disorders EXCEPT Tuberous Sclerosis*
- Sturge-Weber Sx
- Neurofibromatosis Type 1
- Von Hippel-Lindau Dz
PRES: Symptoms occur in spells- relapse and remit. Are result of catecholamine secretion by tumors.
- Episodic Htn
- Tachycardia + Palpitations
- Sweating
- Headache
21-hydroxylase Deficiency
Pres (2)?
PRES:
- CONGENITAL adrenal hyperplasia
- Hypotension
1ry Hyperaldosteronism
Pres (2), Labs (3)?
PRES: Uni- or bilateral
- Htn (↑bl Na + H20 ->↑plasma volume)
- Metabolic Alkalosis (↑H + K secretion)
LABS:
- Renin↓(high B.P downregulates renin)
- Aldosterone↑
- Na + H2O↑
- H + K ↓
2ry Hyperaldosteronism
Causes (3), Labs (2)?
CAUSES:
- CHF
- Renovascular Htn (Nephrotic Sx, Renal art Stenosis, Chronic RF)
- Cirrhosis
LABS:
- Renin↑
- Aldosterone↑
Conn Sx
Pres (2)?
PRES:
- Htn
- Metabolic Alkalosis (-> Hypokalemia)
Cushing’s Sx
Pres (7), Labs (2), DX (2)?
PRES:
- “Moon facies, Truncal obesity, Buffalo hump”
(↑glucose -> ↑insulin -> ↑fat storage)
- Weight gain
- Htn
- Amenorrhea
- Immune suppression
- Skin thinning + striae (impaired collagen syn)
- Osteoporosis, thin extremities + muscle weakness (Cortisol b/d muscle for gluconeogenesis)
LABS:
- Hyperglycemia
- Eosinopenia
DX:
- 24h Urine:↑Cortisol levels
- Dexamethasone Suppression Test
Addison Disease
Mech, Causes (3), Pres (4: CLUE + 3), Labs (4)?
MECH:↑ACTH + MSH production
CAUSES:
- Autoimmune dz MC in West
- TB MC in developing world
- Metastasis (from lung)
PRES: Deficiency of Aldosterone + Cortisol
- Hypotension (hyponatremic vol contraction)
- Acidosis (Aldosterone def ->↑H)
- Fatigue, Vomiting + Diarrhea
- “Skin hyperpigmentation” (Cortisol def ->↑ACTH -> ↑MSH)
LABS:
- Aldosterone↓
- Cortisol↓
- Na↓
- H + K↑
Waterhouse-Friderichsen Sx
Causes / Assoc (3)?
CAUSES / ASSOC:
- Neisseria meningitidis septicemia (young children)
- Endotoxic Shock and Hypotension
- DIC
Hyperthyroidism
Mech (2), Causes (2)?
MECH:
- ↑BMR (due to↑syn of Na/K ATPase)
- ↑SNS activity (due to↑expression of b1-receptors)
CAUSES:
- Struma Ovarii
- Choriocarcinoma (male + female)
Graves Dz
Pres (Epi + Envir + 3), Labs, Histo (2), Comp?
PRES: MC in women 20-40
- Times of stress (ie childbirth)
- Exophthalmos, Proptosis, Eyelid retraction / Sclera visible
- Pretibial Myxedema
- Diffuse Goiter (thyroid hyperplasia + hypertrophy)
LABS:
- ALP↑(due to↑bone turnover)
HISTO:
- Irregular thyroid follicles
- Chronic infl
COMP:
- Thyroid Storm
Thyroid Storm
Def’n, Pres (4)?
Stress-induced CATECHOLAMINE surge leading to death by arrhythmia.
PRES:
- Arrhythmia
- Hyperthermia
- Hypovolemic Shock
- Vomiting
Multinodular Goiter
Mech (4 steps), Causes (2), Comp?
- Goiters usually non-toxic
- Hot nodules rarely malignant
MECH: Mutation in TSH receptor -> Patches of HYPERfunctioning follicular cells working INDEP of TSH -> ↑release of T3 + T4 -> Hyperthyroidism.
CAUSES:
- Iodine def
- Mutation in TSH receptor
COMP:
- Jod-Basedow Phenomenon: THYROTOXICOSIS if patient with Iodine-def-goiter made Iodine-replete.
Hashimoto’s Thyroiditis
HLA, Ab, Pres (2), Clinical Course, Micro Findings (2), Comp?
HLA-DR5.
Antimicrosomal Antithyroglobulin antibodies.
PRES:
- Moderately enlarged NONTENDER thyroid
- Myxedema
HYPERthyroidism early in course (thyrotoxicosis during follicular rupture) -> Progression to HYPOthyroidism.
FINDINGS:
- Hurthle cells
- Chronic infl / lymphocytic infiltrate with germinal centers
COMP:
- NHL
