Lecture 3 - Pathology of neurohypophysis, pituitary insufficiency

clinical manifestations diabetes insipidus

polyuria, polydipsia, nocturia → chronic fatigue syndrome, bmd decrease

hypertonic dehydration

fever, circ failure, coma

in case of water intake restriction

paracllnical dm insipidus

thirst test - if polydipsia/polyuria

urine/plasma osmolarity

nephrogenic di - forms

hereditary - mutations, in males

acquired - pyelonephritis (+ other kidney diseases), decreased aquaporin 2 (from drugs)

evolution diabetes insipidus

bladder hypertrophy → hydroureter, triphasic evolution pituitary is postop or posttrauma (hyper → hypo → hypernatremia)

treatment DI

desmopressin

adjuvant - in partial forms → carbamazepine, chlorpropamide, clofibrate, indomethacin

treatment nephrogenic di

low salt, hydrochlorothiazide

SIADH characteristics

hyponatremia, plasma hypoosmolarity, high urinary Na+

causes siadh

ectopic production by tumor (carcinomas, thymomas)

drug-induced (drugs for DI like vasopressin, chlorpropamide)

injuries baroreceptor system by lung/cns disease

treatment siadh

chronic - water restriction, correction hyponatremia slowly

hypertonic saline

tolvaptan

urea

slgt2i

osmotic demyelination syndrome occurs due to

quick correction hyponatremia in siadh

ighd causes

hereditary - hormonal deficiencies

anomalies of pituitary dev - septo optic dysplasia, pituitary hypoplasia/aplasia

tumoral - macroadenoma, germinoma, cysts

vasc - infarction pituitary (→ increase size) or sheehan’s (postpartum)

pituitary apoplexy

lethargy, anorexia, weight loss and lack of lactation are signs of

sheehan’s syndrome

clinical manifestations gh deficiency

thin smooth skin, wrinkles on face, overweight, adipose at visceral level, asthenia

clinical manifestations acth deficiency - if acute

vasc collapse + death

clinical manifestations tsh deficiency

signs of thyroxine defiiency

clinical manifestations gonadotrophs deficiency

hypogonadism, infertility, no pubic hair

paraclinicals for ighd

anemia, hypoglycemia, hyponatremia (+ no hyperkalemia), increase ldl, decreased bm density

paraclinicals for acth deficiency

measure cortisol at 8am

insulin tolerance test

acth stimulation test

paraclinicals in gonadotrope deficiency

men - basal testosterone dosage

women if amenorhea - estrogen, lh, fsh

arginine test is for

gh deficiency

treatment acute form of pituitary failure

hydrocortisone iv

levothyroxine

treatment chronic form pituitary failure

hydrocortisone, prednison, l-thyroxine

treatment women w/ gh defieincy

estradiol, progesterone

treatment men w/ gh deficiency

testosterone

lh, fsh, gnrh for fertility

treatment gh deficiency

recomb gh somatotropin (rhgh)

se somatropin

dm

__ can unmask di by increasing bp and renal flow

glucocorticoid replacement

avp defiicency vs resistance

central di - deficiency

nephrogenic - resistance

_______ has placental enzymes and associated w/ hepatic steatosis, preeclampsia and coagulopathy

gestational di

wolfram syndrome

hereditary central di, optic atrophy and deaf

etiologies central di

1. tumour

2. trauma/postop

3. infilrative - histiocytosis

4. infectious

5. vasc

6. hypophysitis