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Which hormones are made in the posterior pituitary? Correct Ans-ADH, Oxytocin - trick
question - made in hypothalamus
What's the role of ADH Correct Ans-Regulates free water at distal collecting ducts
Diagnose: An ADH deficiency with polyuria and polydipsia Correct Ans-Central diabetes
insipidus
What causes central diabetes insipidus? Correct Ans-Tumor, trauma, infection,
inflammation of anterior OR of posterior pituitary
What serum values might you expect with central diabetes insipidus? Correct Ans-
HypERnatremia (concentrate salt b/c losing free water) and High serum osmolality
(concentrated)
What urine values would you expect with central diabetes insipidus? Correct Ans-Low
osmolality and low specific gravity
How do you dx central diabetes insipidus Correct Ans-Water deprivation fails to increase
urine osmolality
How do you treat central diabetes insipidus? Correct Ans-ADH analog (desmopressin)
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What is nephrogenic diabetes insipidus? Correct Ans-Lack of renal response to ADH (d/t
hereditary cause or secondary to hypercalcemia, lithium, demeclocycline (ADH antagonist))
lithium, amethocycline cause... Correct Ans-Nephrogenic diabetes insipidus
What causes nephrogenic diabetes insipidus? Correct Ans-Inherited mutations or drugs
(lithium or amethocycline)
How do you differentiate central vs. nephrogenic diabetes insipidus? Correct Ans-
Nephrogenic has no response to desmopressin (ADH analog)
What is SIADH? Correct Ans-Too much ADH secretion
Which serum changes would one expect in SIADH? Correct Ans-HypOnatremia and LOW
serum osmolality (hold on to too much H2O)
What is the most important sequela of SIADH? Correct Ans-Hyponatremia --> Swelling of
nerves and cerebral edema --> Mental status changes and seizures
What are the 4 causes of SIADH? Correct Ans-1. Ectopic production (small cell carcinoma),
2. CNS trauma, 3. Pulmonary infection/pathology (COPD), 4. Drugs (cyclophosphamide)
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Which drug is known to cause SIADH? Correct Ans-Cyclophosphamide
What are the two treatments for SIADH? Correct Ans-Free water restriction OR
Demeclocycline (blocks action of ADH)
Dx: Anterior, midline neck mass that moves up with tongue protrusion Correct Ans-
Thyroglossal duct cyst
Dx: Base of tongue mass with dysphagia, dysphonia, or dyspnea Correct Ans-Lingual
thyroid (persistence of thyroid tissue at base of tongue)
LONG - Dx: Weight loss despite increased appetite, heat intolerance and sweating, tachycardia
with increased CO, arrythmia (a-fib) esp in elderly, tremor, anxiety, insomnia, heightened
emotions, staring gaze with lid lag, diarrhea with malabsorption, oligomenorrhea, bone
resorption with hypercalcemia (--> osteoporosis), decreased muscle mass with weakness,
hypocholesterolemia (***) hyperglycemia (Thyroid hormone causes glycogenolysis and
gluconeogenesis). Correct Ans-Hyperthyroidism
How does hyperthyroidism increase BMR? Correct Ans-increases synthesis of Na/K ATPase,
so increased O2 consumption, RR, body temp
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How does hyperthyroidism increase sympathetic nervous system activity? Correct Ans-
Expression of Beta-1 adrenergic receptor in heart (increased CO, HR, SV, contractility)
What's the most common cause of hyperthyroidism? Correct Ans-Grave's disease (IgG Ab
that stimulates TSH receptor) --> increased production and increased release
Who most commonly gets Grave's disease? Correct Ans-Women of childbearing age
Dx: Hyperthyroidism, diffuse goiter, exopthalmos and pretibial myxedema Correct Ans-
Grave's disease - (IgG stim TSH-r causes hypertrophy and hyperplasia); fibroblasts behind eye
and in front of shin have TSH-r, so they secrete excess GAGs in response. Myxedema is d/t
GAGs - dough-like appearance
What's the key histological finding in Grave's disease? Correct Ans-Scalloping of the colloid
in follicles (clear space b/n follicle and colloid)
What are the key lab findings in Grave's disease? Correct Ans-Increased total and Free T4,
DECREASED TSH (free T4 downregulates TRH-r in anterior pituitary), hypocholesterolemia,
increased serum glucose
Name the sign: Widened palpebral opening allowing the white sclera above the cornea to be
visible Correct Ans-Dalrymple's sign (a/w Grave's dz, hyperthyroidism)