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DIABETES INSIPIDUS
SIADH
TRUE PRECOCIOUS PUBERTY
DELAYED PUBERTY
AMENORRHEA
impossibility of the kidney to concentrate urine
F:M = 1:1.
onset – sudden
Polyuria:
may be > 10 liters/day
urine is diluted, discoloured, inodorous, insipidus
Polydipsia
thirst has imperative character
ingestion of big amounts of liquid/24 hours,
It exceeds polyuria :
Trauma
Granulomatous infiltration
Post-infectious status
low level,
3. Urine density:
- very low - about 1000 (water-like).
- could be higher, but below normal values
(partial forms).
4. Seric and urinary ionogram:
hypernatremia in dehydration
hyponatremia in dilution
5. Urine and plasma osmolality -low.
a) Water deprivation test :
based on osmo-and volume-receptors
stimulation
With mild polyuria, water deprivation can begin
the night before the test.
With severe polyuria, water restriction is carried
out during the day (to allow close observation)
The extent of deprivation is limited by the
patient’s thirst, drop in BP, dehydration
urine - collected every hour (volume +density).
Results
In normal persons:
urinary volume- decreases and
urinary density and osmolality increase.
Urine density
- in normal persons – increment < 9% .
- central diabetes insipidus – increment > 20 %.
- nephrogenic diabetes insipidus- no response.
c) Endogenous ADH reserves - explored with:
nicotine
clorpropamide.
1. Diabetes mellitus:
polyuria
glycosuria
Polyuria
- thyroxine effect on renal tubes,
4. Psychogenic polydipsia:
SYNDROME OF
INAPPROPRIATE ADH
SECRETION
SIADH could be caused by:
tumors
vascular causes
local thrombosis
bronchogenic carcinoma
pancreas carcinoma
duodenum carcinoma
Clofibrate
Clorpropamide
Carbamazepine
Cyclophosphamide
ADH excess- leads to :
haemodilution
hyponatremia
hypernatriuria.
fluid restriction
Diuretics
growth
development
starts at 10 years - girls and
12 years - boys
is dominated by GH secretion
semenarche
It lasts until:
epiphyseal fusion and
wisdom tooth occur
2. Delayed puberty
• secondary sexual development
before:
8 yrs - girls
CNS disorders:
hypothyroidism:
- increase in both TRH and LH/FSH secretion.
- the onely form of true precocious puberty with
delayed bone age !!!
gonadal tumors:
in boys-leydigiomas, teratomas
in girls-luteomas,follicular cysts,tecomas
paraneoplasic secretion:
chorioepitelioma,
lung carcinoma,
hepatoblastoma
Iatrogenic (estrogens,androgens)
Premature menarche:
menstruate at an early age,
without other signs of estrogens effects;
In most subjects:
- menses stop within 1-6 months and
- normal pubertal progression occurs
thereafter.
Premature telarche:
uni-or bilateral breast enlargement
girl - 13years or
excessive exercise
chronic stress
iatrogenic
urinary gonadotropins-
decreased to
undetectable
genital infantilism:
- 17 in girls.
micromastia due to:
Clomiphene citrate :
psychological support
Amenorrhea:
Primary:
absence of first menstruation
secondary sex characters could be present / not;
Secondary
absence of menstrual cycles >6 months
secondary sex characters could be:
normal
involuated
intricated (virilisation).
Evaluation of associated disorders:
hypophyseal,adrenal,thyroid,
signs of virilisation,
malformation,
LH, FSH
Tests with GnRH, clomiphene
2. ovaries:
estrogens
cervical mucus
vaginal epithelium
endometrial biopsy
4. Hysterography
5. Hormone measurements :
PRL,
TSH, T3, T4,
cortisole,
testosterone,
17 keto-steroids
amenorrheic women
without endogenous estrogen production,
normal PRL level,
no hypothalamo-hypophyseal tumors;
may respond to pulsatile GnRH;
cause - functional.
Group II:
imperforate hymen
endometrial distruction
Group V:
hyper-PRL and
hypothalamo-hypophyseal tumors:
prolactinoma
therapy-see Prolactinoma.
Group VI:
hyper-PRL,
without hypothalamo-hypophyseal
organic lesions,
hypothalamo-hypophyseal tumors
malformation,
Intersexuality
imperforate hymen