Endocrine pathology I

Question 1

pituitary adenoma

Answer 1

benign tumor of anterio pit cells. if the tumor produces hormones, it is functional. otherwise, it is non-function

Question 2

how do nonfunctional tumors present?

Answer 2

mass effect: bitemproal hemianopsia- pressing on the optic chiasm. both eyes loose peripheral vision.
hypopituitarism: compresses normal pituitary. Sighns and symptoms of the hormones normally made by pit
headache

Question 3

How do functional tumors of the pituitary present: prolactinoma?

Answer 3

prolactinoma- most common type. signs and symptoms: galactorrhea and amenorrhea in women (nhibits GNRH synthesis and release)
in males, you see decr. libido (no GNRH) and headache. males don’t get galactorrhea- not enough breast tissue becase no lobular units

Question 4

what is the treatment of prolactinoma?

Answer 4

dopamine agonists- tumors shrink (bromocryptine0

surgery

Question 5

What do you see in terms of presentation for grhowth hormone adenoma?

Answer 5

gigantism in kids
acromegaly in adults: excess growth of bones of hands, feet, and jaw. growth of visceral organs like heart- can cause cardiac failure. large tongue
often associated with secondary diabetes- GH decr. uptake of glucose into cells

Question 6

how do you make dx of growth hormone adenoma

Answer 6

elevated GH and IGF-1

lack of suppression of GH release by glucose

Question 7

tx of growth hormone adenoma

Answer 7

octreotide: somatostatin analog that blocks the response of anterior pituitary to GHRH
GH receptor antagonists (pegvisomant)
surgery

Question 8

What is hypopituitarism

Answer 8

insufficient production of hormones of ant. pituitary

Question 9

causes of hypopituitarism

Answer 9

pituitary adenoma in aduls- compresses normal pituitary
apoplexy- bleeding into adenoma causes rapid growth
craniopharyngeoma in kids
Sheehan syndrome: during preg, there is a high hornome demand. pit doubles in size- but blood flow doesn’t. susceptible to infarction if lots of blood loss happens during delivery. they present with poor lactation and loss of pubic hair.
empty sella syndrome: trauma, or congenital defect of the sella with herniation of the arachnoid into the sella- compresses normal pituitary

Question 10

What 2 hormones are released by post pit? Where are they made? what do they do?

Answer 10

ADH and oxytocin. both made in hypothalamus and transmittted via axons.
ADH: regulates free water at distal tubules in collecting ducts
oxytocin: mediates uterine contractions and release of breast milk

Question 11

Central diabetes insipidus: causes, what is it

Answer 11

ADH deficiency- you urinate too much.

may be d/t hypothalamic or post pit pathology

Question 12

clinical features of diabetes insipidus

Answer 12

polyuria and polydipsia
hypernatremia and high serum osmolality
low urine osmolality and specific gravity

Question 13

Dx of diabetes insipidus

Answer 13

water deprivation fails to incr. urine osmolality

Question 14

Tx of diabetes insipidius

Answer 14

give ADH analog- desmopressin

Question 15

what is nephrogenic diabetes insipidus?

Answer 15

inpaired renal response to ADH
d/t inherited mutsations or drugs (lithium)
similar to centrial DI but no response to desmopressin

Question 16

What is SIADH?

Answer 16

excessive adh secretion

Question 17

clinical features of SIADH?

Answer 17

no diuresis- hold free water
hyponatremia and low serum osmolality
mental status change and seizures- can cause nerve swelling and edema

Question 18

causes of SIADH?

Answer 18

ectopic production (small cell carcinoma of the lung), CNS trauma, pulm infection, drugs like cyclophosphamide

Question 19

tx of SIADH

Answer 19

free water restriction or demeclocycline. correct serum sodium levels slowly to prevent central pontine myelinolysis