diabetes - leading cause of mortality - ANSmacrovascular disease
cerebrovascular disease - ANSdisorder resulting from a change within one or more blood
vessels of the brain
thyroid nodules - ANSgoiters can be the result of multiple goiters,
cystic nodules are not usually an underwriting concern, a solid nocule greater than 1 cm
raises concern for cancer
will appear cold (hypofunctioning) on radioactive iodine uptake scan - ANSmost thyroid
cancers
thyroxine - ANSHormone secreted from the thyroid gland that promotes growth and
development; increases metabolic rate in cells
hyperparathyroidism - ANSexcessive secretion of parathyroid hormone resulting in
abnormally high levels of calcium in the blood(hypercalcmia)
hormones - ANSpeptides that are secreted into the bloodstream and act on target tissues.
target tissues have specific receptors for hormones.
pituitary gland - ANSfound in the sella turcica above the sphenoid sinus. attached to the
brain via pituitary stalk, which is a vital link of communication between the pituitary and
hypothalamus. Colloquially called the 'master gland'.
prolactinoma - ANSbenign tumor of lactotroph cells. clinical presentation differs for men and
women and depends on size of the tumor.
prolactinoma in women - ANStumors are usually small (microadenoma, less than 10mm)
excess prolactin causes irreg menses and galactorrhea
prolactinoma in men - ANStumors are usually large (macroadenoma-greater than 10mm)
excess prolactin causes loss of libido and impotency
large tumors can cause headaches, visual disturbance
prolactinoma treatment for small tumors - ANSbromocriptine (Parlodel)
pergolide (Permax)
, carbergoline (Dostinex)
life expectancy prolactinoma - ANSmicroadenoma - normal with treatment
macroadenoma - mortality increased if hypopituitarism that develops after surgery or
radiaation is not detected or treated appropriately
hypopituitarism - ANScan result from surgical removal of prolactinoma, or other pituitary
tumors. Is of clinical and underwriting significance. patients need replacement of cortisol,
thyroid hormone, estrogen for women, testosterone for men..
diabetes insipidus - ANSthe result of lack of antidiuretic hormone (vasopressin) that is
produced in the hypothalamus and stored in, and released from the posterior pituitary. when
antidiuretic hormone is missing, free water is not absorbed and is lost into the urine.
hypernatremia - ANSexcessive amounts of sodium in the blood
desomopressin - ANSantidiuretic hormone - intranasal, IV, or oral (DDAVP), restores normal
water balance
acromegaly - ANSbenign tumor of somatotroph cells that produce and sectrete excessive of
GH (growth hormone). occurs equally in men or women. untreated = twice mortality of age.
ENLARGEMENT
T4 and T3 - ANShypothalamic-pituitary axis regulates the production of thyrosine (T4) and
tri-iodothyronine (T3) from the thyroid gland. derived by iodination of tyrosine within the
thyroid gland. 150 mcg of iodide daily is needed. plentiful in the U.S., but certain areas not
near the sea and have been covered by glaciers have some deficiency (Swiss Alps, parts of
Germany, Andes). These populations are prone to goiter formation in attempt to overcome
lack of iodide.
thyroid storm - ANSlife threatening condition of thyroid excess that results in end organ
damage and even death; can occur in untreated hyperthyroidism.
Graves disease - ANScommon cause of hyperthyroidism; occurs 20-40 years old. more
frequent in women. autoimmune stimulation of the thyroid gland. radioiodine uptake scan
shows increased uptake, which reflects increased T4 and T3.
Graves opthalmopathy - ANS-Extraocular muscles are enlarged
- Treatment is initially with steroids and management of graves disease
-Will often progress even after thyroid hormone levels are controlled
hypothyroidism - ANSinsufficient T4/T3 with symptoms and signs of decreased sympathetic
nervous system and metabolic activity. clinal: weakness, fatigue, cold intolerance, hair loss,
weight gain, hoarse voice, dry skin, loss of lateral eyebrown, slowed reflex relaxation,
impaired growth. develops gradually.
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