Sandbox:Vindhya
Disease |
Causes | Symptoms | Diagnosis and treatment |
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SIADH | SIADH is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload. | symptoms are variable. Ranging from nausea/vomiting,cramps,depressed mood,irritability,confusion and hallucinations. In severe cases seizures ,stupor or coma may result. | Hyponatremia <135 mmol/l
Decreased effective serum osmolality<275mosm Urine sodium concentration>40mmol/litre Plasma uric acid <200;FeUrate>12% Absence of edematous disease like cardiac failure, liver cirrhosis, nephrotic syndrome. normal adrenal and thyroid function |
Cerebral salt wasting | Cerebral salt wasting is defined as the renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. | polyuria,polydipsia,lightheadedness, muscle cramps,orthostatic hypotension,headaches | The patient is hypovolemic and hyponatremic.
Treatment is with adequate hydration and sodium replacement. |
Adrenal insufficiency | Adrenal insufficiency ranges from mild nonspecific symptoms to life-threatening shock condition. An important distinction in these patients is the presence of mineralocorticoid deficiency. Those with secondary or tertiary adrenal insufficiency will typically have preserved mineralocorticoid function due to the separate feedback systems.
Adrenal insufficency can be primary, secondary or tertiary. Common causes of primary adrenal insufficiency:
Secondary adrenal insufficiency refers to decreased adrenocorticotropic hormone (ACTH) stimulation of the adrenal cortex and therefore does not affect aldosterone levels. Traumatic brain injury (TBI) and panhypopituitarism are common causes. Tertiary adrenal insufficiency refers to decreased hypothalamic stimulation of the pituitary to secrete ACTH. Exogenous steroid administration is the most common cause of tertiary adrenal insufficiency. |
Chronic disease is characterized by weight loss,sparse axillary hair,hyperpigmentation of the skin,orthostatic hypotension. Acute addisonian crisis is characterized by fever and hypotension. A low sodium with a high potassium level and mild acidosis are also present. |
The diagnosis of Addison disease is made through rapid ACTH administration and measurement of cortisol.Lab findings include white blood cell count with moderate neutropenia,lymphocytosis,and eosinophilia;elevated serum potassium and urea nitrogen;low sodium;low blood glucose;and morning low plasma cortisol.
The definitive diagnosis is the cosyntropin or ACTH stimulation test. A cortisol level is obtained before and after administering ACTH. A normal person should show a brisk rise in cortisol level after ACTH administration. "Management": The management of Addison disease involves glucocorticoid,mineralocorticoid,and sodium chloride replacement. Adrenal crisis: In adrenal crisis,get a cortsol level,then rapidly administer fluids and hydrocortisone. Adrenal crisis may occur in: previously undiagnosed patient with adrenal insufficiency who has undergone surgery,has a serious infection,or any major stressful conditions. Bilateral adrenal infarction or hemorrhage, Patient who is abruptly withdrawn from chronic glucocorticoid therapy |
Hypopituitarism: | Hypopituitarism is defined as the partial or complete loss of anterior pituitary function that can result from acquired or congenital causes.
Etiology is as follows:
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Signs and symptoms of hypopituitarism vary, depending on the deficient hormone and severity of the disorder,some of the symptoms may be as follows:
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Hypothyroidism | Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to autoimmune causes described below:
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Psychogenic polydipsia | Also called as primary polydipsia is characterized by polyuria and polydipsia. Causes could be:
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polyuria,polydipsia,confusion,lethargy,psychosis,seizures and sometimes, even death. [1] |