Endo 1

Hypothalamus

What is responsible for carrying out autonomic nervous system function and pituitary regulation?

Stimulate, inhibit

Hormones are produced in the hypothalamus which ___ and ___ hormone release from the pituitary gland

Homeostasis

The pituitary gland is the regulator of ___

Anterior

Which division of the pituitary gland is growth hormone produced in?

Anterior

Which division of the pituitary gland is thyroid stimulating hormone produced in?

Anterior

Which division of the pituitary gland is adrenocorticotropic hormone produced in?

Anterior

Which division of the pituitary gland is prolactin produced in?

Anterior

Which division of the pituitary gland is luteinizing hormone produced in?

Anterior

Which division of the pituitary gland is follicle stimulating hormone produced in?

Posterior

Which division of the pituitary gland is antidiuretic hormone produced in?

Posterior

Which division of the pituitary gland is oxytocin produced in?

Feedback mechanism

What mechanisms are prominent in the endocrine system?

Negative feedback

The output of a pathway inhibits inputs to a pathway

Negative feedback

What is the most prominent feedback mechanism in endocrinology?

Positive feedback

Outputs produce inputs which enhance outputs

Unknown

Cause of hypothalamic tumor

Glial cells

In children, most tumors are composed of abnormal ___

Glial cells

What insulates neurons to enhance signal impulse?

Cancer

In adults, most hypothalamic tumors arise from ___ that has spread from another organ

Adults

Glial cell tumors in ___ tend to be more aggressive and have worse outcomes

Hypothalamic tumor

Symptoms of this include:
—Euphoric “High” Sensations

—Failure to Thrive

—Headache

—Hyperactivity

—Loss of Body Fat and Appetite

—Vision Loss (Intrusion on Optic Chiasm)

—Hydrocephaly (Blockage of CSF drainage)

—Precocious Puberty (Pituitary Function Change)

benign

Most pituitary tumors are ___

Multiple Endocrine Neoplasia I (MEN I)

The cause of pituitary tumors is unknown, however some are part of a genetic disorder called ___

Multiple Endocrine Neoplasia I (MEN I)

A familial disorder in which one, or more, endocrine glands form a tumor

Pancreas, pituitary, parathyroid

What are the 3 glands commonly involved in MEN I?

an overproduction of 1 or more hormones resulting in:
-Hyperthyroidism (TSH)

-Cushings Syndrome (ACTH)

-Giantism (GH)

-Nipple Discharge (Prolactin)

What does a pituitary tumor cause?

Pituitary Enlargement

Symptoms of this include:
—Headache

—Lethargy

—Nasal Drainage

—Nausea and Vomiting

—Olfactory Problems

—Visual Changes

-Double Vision

-Drooping Eyelids

Visual Field Loss

Hypopituitarism

A condition in which the pituitary gland does not produce normal amounts of 1 or more hormones

Hypopituitarism

Causes of this include:
-Brain Surgery 

- Brain Tumor

-Head Trauma 

- Brain Infections

- Radiation 

- Stroke

-Subarachnoid Hemorrhage

-Pituitary or Hypothalamus Tumors!

-Sheehan’s Syndrome

Sheehan’s Syndrome

Ischemic pituitary necrosis due to severe postpartum hemorrhage

Sheehan’s syndrome

Symptoms of this include:
-Headaches

-Visual Field Loss

-Hypothyroidism

-Hyponatremia

Hypopituitarism

Symptoms of this include:
—Abdominal Pain

—Decreased Appetite

—Decreased Sexual Interest (LH)

—Failure to Release Breast Milk (Oxytocin)

—Fatigue (TSH)

—Infertility in Women (FSH, LH)

—Lack of, or loss of secondary hair (FSH, LH)

—Hypotension (ADH)

—Cold Sensitivity (TSH)
—Short Height (GH)

—Delayed Sexual Maturity in Children (FSH)

—Amenorrhea (LH)

—Weakness

—Weight Loss (TSH)

-Vision Problems

Tumor

Make sure to rule out ___ when diagnosing pituitary problem

Hormone deficiency

What to test for in diagnosis of pituitary problem?

Life threatening

In severe cases of hypopituitarism, when a person requires extra corticosteroid treatment, failure to take them can be ___

Neoplasm, infection, hemorrhage

Hypopituitarism is caused by factors that decrease, or stop hormone release… look for ___

Diabetes Insipidus

What is indicated with excessive thirst and passage of large quantities of dilute urine

< 1.006

Specific gravity of urine in diabetes insipidus

Deficiency or resistance

Diabetes insipidus is caused by a vasopressin (ADH) ___

Vasopressin

Increases water absorption in the collecting ducts of the nephron

Water retention

Vasopressin regulates this

Arterial blood pressure

Vasopressin increases peripheral vascular resistance, thus increasing this

Homeostasis

Vasopressin promotes ___ by regulating salt, glucose, and water in the blood

Angiotensin II

What stimulates the release of vasopressin in response to decreased fluid volume?

Primary

Type of central DI that is idiopathic, possibly due to an autoimmunity to hypothalamic arginine vasopressin

Stalk thickening

With primary central DI, there are no identifiable lesions on MRI, but there is usually ___ present

Autoimmunity or genetics

What to consider with primary central DI?

Wolfram Syndrome

Primary DI can also occur with ___

Wolfram Syndrome

Rare, autosomal recessive disorder that is usually present in childhood and associated with DIDMOAD

Diabetes Insipidus, Diabetes Mellitus type 1, optic atrophy, deafness

What does DIDMOAD stand for?

Secondary

Which central DI is caused by damage to the hypothalamus or pituitary stalk?

Secondary DI

Causes of this include:
—Tumor

—Hypophysitis

—Anoxic encephalopathy

—Surgical, or accidental trauma

—Sarcoidosis

—Multifocal Langerhans Cell (Eosinophilic) Granolomatosis

Multifocal Langerhans Cell Granulomatosis (LCH)

An overproliferation of Langerhan cells, which capture and process microbial antigens in skin infections, can metastasize to the skin, bone, and almost any organ

33-50%

What percent of LCH cases, which is seen mostly in children, involve the pituitary stalk and leads to DI?

Multifocal Langerhans cell granulomatosis

What condition is characterized by fever, bone lesions, and eruptions (mostly on the scalp and ear canals)?

Hand Schuller Christian triad

A triad of diabetes insipidus, bone lesions, and exophthalmos

Third, puerperium

Vasopressinase-induced DI may be present in the ___ trimester of pregnancy and in the ___

Puerperium

Approx 6 week period between childbirth and the return of the uterus to normal size

Vasopressinase-induced DI

In which condition does a circulating enzyme destroy native vasopressin?

Nephrogenic DI

What condition is caused by a defect in the kidney tubules which interferes with water reabsorption?

Normal

Patients with Nephrogenic DI have ___ vasopressin levels

Congenital nephrogenic

What type of DI has a defective vasopressin V2 receptor and high uric acid levels in adults?

Demeclocycline

What is the only tetracycline known to cause DI?

Increases

Does corticosteroid use increase or decrease free water clearance?

Ice water

Sign of DI includes intense thirst, especially for ___

Hypernatremia

A symptom of DI usually when patients cannot get enough water intake

Oligohydramnios, preeclampsia, hepatic dysfunction

Signs and symptoms of vasopressin-induced DI

<200

Diabetes Insipidus has a ___ urine osmolality level

Normal

Glucose is ___ in DI

High

Sodium is ___ in DI

Low

Potassium is ___ in DI

High

Blood urea nitrogen may be ___ in nephrogenic DI

High

Calcium may be ___ in DI

Malignancy

What should you consider with hypercalcemia?

Low

Serum vasopressin is ___ in central and vasopressin induced DI

Normal to high

Serum vasopressin is ___ in nephrogenic DI

Central or Vasopressin-induced

Which DI is the likely culprit if polyuria and polydipsia improve when vasopressin is given?

Pituitary surgery

Central DI after ___ usually remits in days to weeks, but may be permanent if the upper stalk is cut

Thiazide Diuretics

Treatment for nephrogenic DI

Hydrochlorothiazide (HCTZ), Amiloride, Indomethacin

Treatment for central and nephrogenic DI

Vasopressin-Induced DI

This form of DI is generally self limited and resolves by the end of the puerperium

Desmopressin Acetate

Treatment for central and vasopressin induced DI

Depression and hyponatremia

Desmopressin can cause ___

Central DI

This DI is an inconvenience, not a life threatening issue as long as hydration is adequate

Nephrogenic DI

This DI has the same prognosis of the underlying disorder