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Lecture 45 April 4th-Endocrine

Lecture 45 April 4th-Endocrine

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Published by: api-26938624 on Oct 19, 2008
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1DDX: LECTURE 45 \u2013 APRIL 4TH, 2007
Endocrine (1), Hypothalamus and Pituitary
Page 1
GH stimulates prolactin, TRH stimulates Prolactin, GnRH stimulates prolactin. Somatostatin and Dopamine are inhibitory.

Distinct areas in Hypothalamus
Optic chiasm right next to pituitary. CN III, IV, VI.
Posterior pituitary only stores hormones.
PRL will be seen in pituitary adenoma

Page 2
Anterior pituitary hormones may have more dramatic impact when FSH and LH are low.
GH: glucagons-like effects.
GH: Acutely, GH has insulin-like activity to counter the glucagon released in hypoglycaemia.
Interfereing factors: argentine, insulin and glucagon are in large amounts.
Prolactin:
See nipple discharge

TSH:
Lesion at thyroid and TSH gets no response.
Thyrotoxicosis is a type hyperthyroidism

FSH and LH:
Most pituitary hormones have diurnal variation. Spike in early morning: this is why we do 24 hour urine sample.
PCOS = polycystic ovarian syndrome
Hematuria: interferes with 24 hour urine test.

Page 3

Emesis happens in sympathetic state. Body produces ADH in sympathetic state.
Trying to keep fluid in the system.
DM: different is that one is nephrogenic: lesion at level of KI or neurogenic, lesion is at level of brain.
SIADH: syndrome of inappropriate ADH.

Headaches: anything over 10mm (macro) starts pressing on structure
*Signs and symptoms of a mass lesion, such as headaches, visual field defects are the biggest clue to pituitary tumour.
If 1 hormone: it is at level of gland.
Bilateral hemianopia: loss of vision on outer halves of visual field

Sclerosis: change in skin texture (thickening/hardening)
Chronically high ACTH in Addison\u2019s, Cushings.
Myxedema: hypothyroid
Hypothalamus mediates primitive functions. Endorphins and enkephalins are hypothalamus-mediated.
Page 4
Generalized Adult Hypopituitarism

Rare for pituitary lesion to only effect ECTH.
\u201cpituitary dwarfism\u201d is from birth
Loss of muscle mass and strength in isolated GH deficiency.

Panhypopituitarism normally results from Sheehan\u2019s syndrome. Low anterior pituitary hormones across the board.
Pituitary apoplexy normally not panhypopituitary
Empty sella syndrome: visual problems are insidious.
Headache: chronic and increasingly severe
DDX LECTURE 45, APRIL 4TH, 2007 \u2013 PAGE 1

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