7. Diagnosis of PD by PH stimulation test Peak value >5 mu/ml TRH 500 ng TSH Doubling of baseline TRH 100-500 metoclopramide Prl Serum GH > 10ng/ml at any time I H test 0.1 uint L-dopa 250-500 Arginine 0.5 gm Clonidine test Glucagon test G H N response Test agent Hormone
8. Pituitary stimulation test 2 Peak serum cortisol >20 ng/dl Serum 11-deoxycortisol level >8 ng/dl I H TEST (short ACTH stimulation test cosyntropin test) Metyrapone test 2-3 gm po ACTH Doubling of the base line LH@FSH GnRH 100mmg IV LH @FSH N response Test agent hormone
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15. Interpretation of WDT low Normal or high low Plasma ADH increase No change increase Urine osmol after vasopressin Increase >750 No change <300 No change <300 Urine osmol after wdt psychogenic NDI CDI
26. CALCIUM HOMEOSTASIS DIETARY CALCIUM INTESTINAL ABSORPTION ORGAN PHYSIOLOGY ENDOCRINE PHYSIOLOGY DIETARY HABITS, SUPPLEMENTS BLOOD CALCIUM BONE KIDNEYS URINE THE ONLY “IN” THE PRINCIPLE “OUT” ORGAN PHYS. ENDOCRINE PHYS. ORGAN, ENDOCRINE
27. VITAMIN D SYNTHESIS SKIN LIVER KIDNEY 7- DEHYDROCHOLESTEROL VITAMIN D 3 VITAMIN D 3 25(OH)VITAMIN D h 25-HYDROXYLASE 25(OH)VITAMIN D 1,25(OH) 2 VITAMIN D ( ACTIVE METABOLITE ) 1 -HYDROXYLASE TISSUE-SPECIFIC VITAMIN D RESPONSES
28. CALCIUM, PTH, AND VITAMIN D FEEDBACK LOOPS NORMAL BLOOD Ca RISING BLOOD Ca FALLING BLOOD Ca SUPPRESS PTH STIMULATE PTH BONE RESORPTION URINARY LOSS 1,25(OH) 2 D PRODUCTION BONE RESORPTION URINARY LOSS 1,25(OH) 2 D PRODUCTION
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