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Central nervous system disorders associated with SIADH? - answer;-encephalitis, meningitis, intracranial
hemorrhage, tumors and trauma
In regards to the kidneys, what mutations cause SIADH? - answer;-Mutations in arginine vasopressin
(AVP) genes lead to chronic activation of tubular V2 receptor and results in excessive free water
reabsorption.
Any surgery can result in post-op fluid volume shifts and transient _______________for as long as 5-7
days post op. - answer;-SIADH
What factors cause post-op transient SIADH during surgery? - answer;-Fluid and volume changes, IV
fluids (amount and tyupe), and narcotic analgesics.
Decreased hypothalamic function/anterior pituitary
SEE diagram - answer;-
Transient SIADH is especially common after what type of surgery? - answer;-pituitary
What other medication can cause SIADH, especially in older adults? - answer;-antidepressants,
antipsychotics, narcotics, anesthetics, chemo agents, NSAIDs, quinolone antibiotics, and synthetic ADH
analogs.
,Pathophysiologic affects of SIADH. - answer;-Result in enhanced renal water retention. Water retention
results from the action of ADH on renal collecting ducts where permeability to water is increased,
increasing water reabsorption by the kidneys.
Symptoms of SIADH - answer;-Hypotonic (dilution) hyponatremia and hypervolemia and weight gain.
Thirst, impaired taste, anorexia, dyspnea, fatigue and NA that decreased from 140 to 130 rapidly.
Hypoosmolarity.
Urine is ________________in SIADH - answer;-concentrated
Diagnosis of SIADH includes what? - answer;-Serum hypoosmolality <280mOsm/kg, and hyponatremia
<135 mEq/L
In SIADH osmolality is higher in urine than in plasma, that is why urine is ___________________. -
answer;-concentrated
What solution (IV) corrects low sodium? - answer;-Hypertonic saline, and fluid restriction
Diabetes Insipidus is an insufficiency of what? - answer;-ADH, leading to polyuria, and polydipsia
(frequent urination and frequent drinking)
What are the three types of Diabetes Insipidus? - answer;-Neurogenic (hypothalamic), nephrogenic
(renal), and polydipsic (polydipsia-polyuria syndrome)
What causes neurogenic DI? - answer;-Brain tumors (primary or secondary), aneurysms, thrombosis,
infection and immunologic disorders
Nephrogenic DI is caused by? - answer;-Insensitivity of the renal collecting tubules to ADH.
Diseases of the Anterior Pituitary include? - answer;-Hypopituitarism, Hyperpituitarism (primary
adenoma), Acromegaly (Hypersecretion of GH), hypersecretion of prolactin.
, Most common of the hormonally active pituitary tumors are called what? - answer;-prolactinomas
(hormones that secrete prolactin) they are either microprolactinomas (<1cm) or macroprolactinomas
(>1cm).
Which of the two types of pituitary tumors (prolactinomas), micro or macro, are most invasive? -
answer;-Macroprolactinomas commonly expand into the optic chasm and invade local structures.
What are the physiological actions of prolactin? - answer;-breast development during pregnancy,
postpartum milk production, and suppression of ovarian function in nursing women.
Describe Acromegaly. - answer;-Excessive levels of GH and concomitant elevation of IGF-1.
Giantism? - answer;-In children and adolescent whose epiphyseal plates have not yet closed, the effets
of increased GH level on long bone growth is termed giantism.
Hypopituitarism? - answer;-failure or absence of all pituitary hormone function.
What are some causes of hypopituitarism? - answer;-Shock, aneurysms, sickle cell, pregnancy can cause
pituitary infarction. Also tumors or lesions
Pituitary gland relies on blood flow from where? - answer;-Portal blood flow from hypothalamus.
What hormone stimulates secretion of prolactin? - answer;-TRH (thyroid releasing hormone)
Medications that block the effect of dopamine at the pituitary can increase _____________level. -
answer;-Prolactin
What medications can affect dopamine levels? - answer;-Antipsychotics (risperidone), chlorpromazine,
metoclopramide, tricyclics, methyldopa and estrogens.
Hyperthyroid is also called? - answer;-Thyrotoxicosis