Endocrinology Made Simple : Treatment of Large Macroadenomas

Treatment of Large Macroadenomas                          

Large macroadenomas first line of treatment includes Dopamine Receptor Agonists such as Cabergoline and Bromocriptine.

With this treatment,the size of the tumor  decreases rapidly over a course of few days.

The patient”s vision also improves significantly.

After the treatment has been initiated with Dopamine receptor agonists,the patients should be closely monitored by assessing the following:

Visual fields Evaluation

Clinical symptoms

Prolactin levels

MRI of pituitary gland.

Clinical features of Macroadenoma includes:

Visual field defects due to compression of optic chiasm and visual pathways

Hypogonadism and Hypopituitarism

Computer Studies Made Simple : Metropolitan Area Network

Metropolitan Area Network

This computer network is designed to cover and maintain communication in a city.

It usually consists of one or more than one Local Area Networks

It is smaller than a Wide Area Network but larger than a Local Area Network.

A common application of Metropolitan Area Network is carrying out communications of Mobile Networks.

Endocrinology Made Simple : Cushing” Syndrome Secondary to Adrenal Etiology:

Clinical Features:

These are same as clinical features of Cushing”s Syndrome

These include

Weight gain

Lethargy

Weakness

Proximal myopathy

Hypertension

Thin extremities as compared to trunk

Increased fat distribution in the trunk region

Round face also called Moon face

Thin skin with striae

“Buffalo hump”

Biochemical Features:

Significantly Increased Urinary Free Cortisol Levels

Non-suppressible High Dose Dexamethasone suppresion Test

Undetectable ACTH Levels

Radiological Investigations

These include Imaging of the adrenal glands by MRI or CT Scan

Difference with other forms of Cushing Syndrome

In pituitary dependent Cushings Disease,Plasma ACTH levels are normal or increased.

Patients with Ectopic ACTH syndrome have high plasma ACTH levels.

Computer Studies Made Simple : Wide Area Netwrok / WAN

Wide Area Netwrok / WAN

This network covers a large area of communication such as connecting computers in different countries.

The computers in a WAN are connected by telephone lines or satellite communication.

The computers in WAN network are accessed by terminals.

The PC needs to be connected to a larger computer also called as a Host computer.

File transfer data is used to transfer the information between the personal computer or PC and the larger computer or Host computer.

Transfer of data from PC to host computer is called uploading while transfer of data from host computer to PC is called downloading.

WAN can cover greater distances than LAN and can connect computers anywhere in the world.

Data transfer speed is slower than LAN in WAN and WAN also has greater possibility of data transmission error 

Endocrinology Made Simple : Hyponatremia,Causes and Management

Hyponatremia

Hyponatremia is defined as relative excess of water in relation to sodium in the body.

Causes and Classification:

Increased water Intake:

Primary Polydipsia

Endocrine Disorders:

Adrenal Insufficiency

Hypothyroidism

Impaired water excretion

Advanced Renal Failure

Increased Anti diuretic Hormone ADH Release.

Causes Of Increased ADH Relaese:

Decreased effective circulating volume:

Volume depletion

Congestive Heart Failure

Cirrhosis

Diuretics Overuse

SIADH : Syndrome Of inappropriate ADH Secretion

Causes Of SIADH:

Central Nervous System Disorders

Cancer/Tumors : (Ususally small cell lung ca)

Medications and Drugs:

Carbamazepine

Cyclophosphamide

SSRIS : Selective Serotonin Reuptake Inhibitors

Lung Diseases

Postoperative patients.

Increased use of hypotonic fluids postoperatively

Symptoms Of hyponatremia:

These are mainly neurological and occur due to cerebral oedema caused by movement of water into the brain cells.

Earliest symptoms are nausea,malaise followed by headache.

In severe hyponatremia when serum sodium falls below 115 meq / L seizures,coma and respiratory arrest can occur.

Treatment Of Hyponatremia/Key Points

It depends upon th cause of hyponatremia,the severity of symptoms and plasma concentration of sodium.

Management of Severe Symptomatic Hyponatremia / sodium below 115 meq/L

Sodium should be corrected at rate of 1.5 – 2 meq/L / hour for the first 3 – 4 hours.

Hypertonic saline should be used in this perios eg 3 % Normal saline.

Plasma sodium levels should be monitored frequently during this initial correction.

Sodium levels should not be raised more than 12 meq/L in first 24 hours.