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what is hypopituitarism?
- Decrease secretion of adenohypophyseal hormones.
- May be congenital or may occur during life.
- The effects are related to the deficit in 1 or more of the following hormones
- -- Adrenocorticotropic hormone (ACTH): stimulates the adrenal gland to release cortiso which helps to maintain blood pressure and blood sugar
- -- Antidiuretic hormone (ADH): controls water loss by the kidneys
- -- Follicle stimulating hormone (FSH): controls sexual function and fertility in males and females
- -- Growth hormone (GH): stimulates growth of tissues and bone
- -- Luteinizing hormone (LH): controls sexual function and fertility in males and females
- -- Oxytocin: stimulates the uterus to contract during labor and the breasts to release milk
- -- Prolactin: stimulates female breast development and milk production
- -- Thyroid stimulating hormone (TSH): stimulates the thyroid gland to release hormones that affect the body's metabolism
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what happens w/ alterations in posterior pituitary function?
- variations in ADH secretion causing diabetes insipidus
- In ¼ of cases it is associated w/brain tumor requiring surgical
- treatment. If not it can be treated by insufflating (sniffing/inhaling) a small amount of synthetic vasopressin.
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what results from diabetes insipidus?
tendency to be dehydrated (due to inability to concentrate urine) & to “wash out” electrolytes from body fluids (polyuria, thirst, polydipsia)
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what is hyperthyroidism?
- thyrotoxicosis, graves' disease
- A hypermetabolic state produced by increased thyroid hormones.
- Sudden release of excessive amounts of thyroid hormones (thyroid storm) is emergency that can progress to coma.
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how does hyperthyroidism present?
manifested by hyperkinesias, emotional lability, increased appetite, but decreased weight, muscle weakness w/fine tremors, heat intolerance, warm moist skin, sweating, tachycardia, cardiac arrhythmias, exopthalmos.
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what is hypothyroidism?
- thyroid hormones deficiency
- primary hypothyroidism: result from increase in serum TSH in thyroid disease
- or
- secondary hypothyroidism: from a deficiency in TSH caused by pituitary or hypothalamic disease.
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how does hypothyroidism present?
- Adults: myxedema (muccopolysaccardies deposition in connective tissue), apathy, tiredness, dry skin & hair,dilated hrt
- Infants: mental retardation, impaired growth
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what is hypoadrenalism?
- (Addison’s disease)
- dec adrenocortical hormones: due to atrophy / TB related destruction of adrenal cortex
- dec cortisol: impaired gluconeogensis
- dec aldosterone: no retention of Na, no excretion of K
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how does hypoadrenalism present?
- due to dec in adrenocortical hormones: fatigue, anorexia, weight loss, nausea & vomiting.
- dec cortisol: altered bld glucose levels, fat & protein metabolism
- dec aldosterone: hypotension, serum decrease in Na+, Cl- HCO3 & increase in K+ (hyperkalemia)
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what is hyperadrenalism?
- (Cushing’s disease)
- associated w/abnormal amounts of cortisol.
- Increased blood glucose level is due to enhanced gluconeogenesis & if it lasts for many months it may “burn out” insulin products on cells & cause “adrenal diabetes.”
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how does hyperadrenalism present?
“moon faces,” “buffalo hump,” truncal obesity, osteoporosis, menstrual disorders, susceptibility to infection, muscle weakness
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what is hyperaldosteronism?
- (conn's disease)
- Extracellular fluid volume is increased with hypokalemia.
- Opposite of Hyperadrenalism.
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what are the different categories of renal disease?
- acute renal shutdown
- chronic renal insufficiency
- pyelonephritis
- nephrotic syndrome
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what causes acute renal shutdown?
- acute glomerulonephritis
- acute damage to the tubules and necrosis
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what is acute glomerulonephritis?
- causes acute renal shutdown
- results from an antigen-antibody reaction in which the glomeruli become inflamed (from streptococci A)
- inflammatory reaction causing total or partial blockage of large # of glomeruli & those that are not blocked develop increased permeability of glomerular membrane, allowing large amounts of protein & RBCs to leak into Glomerular Filtrate (GF).
- Acute form frequently becomes chronic.
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what causes acute damage to the tubules and necrosis?
- (common cause of acute renal shutdown)
- Poisons: carbon tetrachloride & mercuric ions have specific nephrotoxic action
- Severe Acute Renal Ischemia: usually a result of severe circulatory shock when heart fails to pump sufficient amounts of blood to body
- Transfusion reaction: where hemolysis of large amounts of RBCs releases Hg (that precipitate in the nephron) & vasoconstriction agent diminishing renal blood flow
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what is the main characteristic of chronic renal insufficiency?
decreased number of nephrons
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what are the causes of chronic renal insufficiency
- Chronic glomerulonephritis & polynephritis
- Traumatic or congenital absence of a kidney: decreases nephrons by ½
- Congenital polycystic disease: when large cycsts develop in kidneys & destroy surrounding nephrons by compression Urinary tract obstruction: caused by renal stones
- Arteriosclerosis: when small arteries supplying portions of kidneys become blocked
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what is pyelonephritis?
- an infectious and inflammatory process that usually begins in the renal prelvis and extends progressively into renal parencyma.
- invading infection results in progressive destruction of the functional renal tissue usually affecting more medulla of the kidney.
- patients have reasonably normal renal functions with inability to concentrate urine.
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what are the characteristics of nephrotic syndrome?
- loss of large quantities of plasma proteins into the urine due to increased permeability of the glomerular membrane, causing fall in colloid osmotic pressure & serious edema.
- usually associated w/renal insufficiency caused by
- -- Chronic glomerulonephritis
- -- Amyloidosis
- -- Syphilis
- -- Systemic lupus erythematosus
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