Pituitary disorders: howell

Question 1

Anterior lobe hypopituitarism etiology

Answer 1

-nonsecreting neoplasm: gradual onset
-infection: syphillis, TB
-vascular: sudden onset
-Trauma: sudden onset

Question 2

What are 2 disorders that can cause secondary hypopituitarism

Answer 2

1. Kallman syndrome
2. Prader wili syndrrome

Question 3

Kallman syndrome

Answer 3

-secondary hypopituitarism
- no synthesis of gnRH by the hypothalamus

• X-linked recessive

Question 4

Prader Wili syndrome

Answer 4

• secondary hypopituitarism
• decreased gnRH
  -hyperphagia, obesity, hypotonia

-inherited

Question 5

Symptoms of hypopituitarism

Answer 5

-no lactation
-amenorrhea
-testicular atrophy and impotence
- no regrowth of axillary and pubic
hair
- hypothyroidism and hypoadrenalism
-waxy dispigmentation of skin
-pituitary dwarfism: normal proportion
-Achondroplastic dwarfism : lack of normal proportion

Question 6

What is associated with pituitary apoplexy

Answer 6

DM, sickle cell, HTN, acute shock

Question 7

if someone initially has a pituitary adenoma, then they will have? hyper or hypo pituitarism

Answer 7

hyperpituitarism with pituitary apoplexy due to infarction of some sort

Question 8

Symptoms of pituitary apoplexy

Answer 8

-H/A in 95% of cases : retro-orbital area
-nausea and vomiting in 70% of cases
-VF defects, diplopia, ptosis
-possible altered mental status
-severe hypoglycemia
-severe hypotension
-CNS hemorrhage- possible death

Question 9

when is sheehan syndrome see

Answer 9

after protracted labor
pituitary is enlarged in pregnancy and prone to infarction due to hypovolemia

Question 10

sheehan syndrome symptoms

Answer 10

acute: no lactation, amenorrhea and oligomenorrhea

years later: hypotension, hyponatremia, hypothyroidism (2nd)

Question 11

clinical presentation of hyperprolactinemia

Answer 11

-galactorrhea, amernorrhea, gynecomastia and impotence in men

Question 11

Etiology of hyperprolactinemia

Answer 11

• prolaction secreting tumor
• decreased dopamine synth
  -renal insufficeincy
• stress

Question 12

what is the most common cause of hyperpituitarism

Answer 12

1 is prolactinoma
#2 is GH secreting

Question 13

how to diagnois hyperprolactinemia

Answer 13

MRI of sella turcica for adenoma

Question 14

treatment for hyperprolactinemia

Answer 14

dopamine agonist

Question 15

difference between gigantism vs acromegaly

Answer 15

gigantism= Increased GH before growth plates close

acromegaly= increased GH after growth plates close

Question 16

etiology of gigantism/acromegaly

Answer 16

GH secreting pituitary adenoma

Question 17

clinical presentation of acromegaly

Answer 17

-coases facial features
-oily skin
-enlarged tongue w sleep apnea in 50%
-gluc intolerance in 50%
-impotence, irregular menses

Question 18

clinical presentation in diabetes insipidus

Answer 18

polydipsia and polyuria

Question 19

etiology of diabetes insipidus

Answer 19

central:
-due to lack of ADH
-30-50% of causes are idiopathic

Nephrogenic:
- lack of response of kidneys to ADH
-CRF, lithium toxicity

Question 20

water deprivation test

Answer 20

monitor wight, plasma and urine osm during test
- normally if you dont drink water for a while, osmo will increase by 2-4 times in 4-18 hours
-Central DI: increased urine osmo with ADH
-Neophro: no response to ADH

Question 21

SIADH pathogenesis

Answer 21

secretion of excession ADH which leads to hyponatremia

Question 22

possible complications in SIADH

Answer 22

-cerebral edema
-seizures