Term
| ___ ___thyroidism can cause galactorrhea. This is b/c the low ___ causes ___ to be high which stimulates release of prolactin. |
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Definition
- Secondary hypothyroidism
- low TSH causes TRH to be high |
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Term
| Medications that cause hyperprolactinemia: |
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Definition
- verapamil
- estrogen antiandrogens
- H2 blockers (cimetidine, zantac) |
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Term
| Hyperprolactinemia causes: |
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Definition
Idopathich
Hypothyroidism
Cushings disease
Acrometaly
Hypopituitarism
Medications: dopain antagonists-phenothiazines, risperidone, metoclompramide, dopamine depleteing agents- methyldopoam, and reserpine, isoniadiz, TCAs, verapamil, estrogen antiandrogens, cocaine, H2 blockers (cemetidine, zantac)
Prolactinoma |
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Term
Labs:
TSH
Prolactin level (fasting b/c prolactin gets secreted in a certain pattern, exercise sex etc can increase prolactin levels so don’t want it random)
Pregnancy test (urine hCG)
Glucose (CMP b/c also want renal/hepatic function as well: BUN, creatinine, LFTs)
Electrolytes
FSH and LH and estradiol
MRI of brain or pituitary if suspicious (generally wait until get labs back b/c expensive) |
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Definition
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Term
If prolactin is around 200 or higher, its almost always a prolactinoma. With drugs your levels usually stay less than 100. So when its this high its time to do an MRI. If less than 40 don’t have to treat just monitor.
MRI shows 12 mm adenoma= macroadenoma. 10 is the cut off b/c micro and macro |
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Definition
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Term
| Prolactinoma is most common pituitary tumor. 30% of pit tumors are prolactinomas. 30% of time have pt with high prolactin it will be due to a prolactinoma |
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Definition
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Term
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Definition
- Dopamine agonists: Bromocriptine (Parlodel) or Cabergoline (Dostinex)
- can also try OCPs |
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Term
Prolactin levels normal ranges:
men: 2-18
Female: 3-30 |
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Definition
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Term
Dopamine is responsible for sexual arousal but the prolactin is counteractin the dopamine so sexual dysfunction occurs
Prolaction inhibitisnt GnRH> less fsh and LH> less testosterone produced |
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Definition
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Term
| Possible causes of Diabetes Insipidus: |
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Definition
Lithium
Sjogrens
Chronic renal insufficiency
Hypokalemia
Hypercalcemia/hyperparathyroidism
Pituirary tumor, other brain tumor, head trauma surgery
(first 5 above cause nephrogenic DI, last one would cause central DI) |
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Term
2 types of DI:
central: starts in brain, not producing ADH
Nephrogenic: not responding to the ADH, pit still making same amount kidneys just don’t respond to it |
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Definition
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Term
| What happens to urine concentration and serum concentration with a water deprivation test if a patient has central DI? With this test you deprive pt of water for a while, and then give them desmopressin. |
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Definition
You give them ADH they did not have, so they hold onto the fluid:
- urine concentration increases
- serum concentration decreases (diluting sodium and potassium) |
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Term
| What happens when you administer a water deprivation test to a patient with nephrogenic DI? |
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Definition
| nothing changes b/c they already had ADH they are just unresponsive to it |
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Term
| What happens to a normal pt with a water deprivation test? |
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Definition
| - water deprivation alone concentrates urine, add desmopressin> concentrates it even more |
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Term
| With central DI before treatment, the urine is very ___ and the serum has a very __ ___. |
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Definition
- dilute
- high concentration
central DI aren't making ADH, so they are peeing out tons of water> dilute urine, leaving all the concentration in the blood. |
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Term
| If urine concentration increases with administration of desmopressin, what does this patient have? |
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Definition
| Central Diabetes Insipidus |
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Term
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Definition
| Desmopressin (DDAVP) po or nasally. Monitor them for fluid retention. Recheck the sodium and urine specific gravity within next couple of days. Monitor 24 hour urine volume. |
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Term
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Definition
Chlropropamide (SU not used for DM)- enhances renal response to ADH
Thiazide diurectics (HCTZ): get a mild volume depletion, decrease flow to distal nephron and simulatanelously the proximal tubule registers that and increases fluid reabsorption. Ultimately enhances renal reabsorption of fluid> greater fluid volume and less polyuria
NSAIDS: inhibit prostaglandins and prostaglandins decrease fluid reabsorption so NSAIDs increase fluid reabsorption. |
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Term
| Polyuria and polydypsia make sure you include DI in DDx. Check UA and glucose in the office. If urine dilute w/o glucose and finger stick shows normal resuults> persue work up for DI: 24 hour urine, etc. Based on those results then consider water deprivation test. |
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Definition
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