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2012-05-19 16:04:43
clinical medicine endocrine

clinical medicine endocrine
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  1. 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
  2. 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.
  3. 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)
  4. 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.
  5. 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.
  6. 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.
  7. how does hypothyroidism present?
    • Adults: myxedema (muccopolysaccardies deposition in connective tissue), apathy, tiredness, dry skin & hair,dilated hrt
    • Infants: mental retardation, impaired growth
  8. 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
  9. 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)
  10. 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.”
  11. how does hyperadrenalism present?
    “moon faces,” “buffalo hump,” truncal obesity, osteoporosis, menstrual disorders, susceptibility to infection, muscle weakness
  12. what is hyperaldosteronism?
    • (conn's disease)
    • Extracellular fluid volume is increased with hypokalemia.
    • Opposite of Hyperadrenalism.
  13. what are the different categories of renal disease?
    • acute renal shutdown
    • chronic renal insufficiency
    • pyelonephritis
    • nephrotic syndrome
  14. what causes acute renal shutdown?
    • acute glomerulonephritis
    • acute damage to the tubules and necrosis
  15. 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.
  16. 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
  17. what is the main characteristic of chronic renal insufficiency?
    decreased number of nephrons
  18. 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
  19. 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.
  20. 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