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Clin Med II Liza > Pituitary Disorders > Flashcards

Pituitary Disorders Flashcards

0
Q

Pit Adenomas can be part of which hereditary ds

A

Multiple Endocrine Neoplasia - MEN I : 3 Ps: pit ad, parathyroid hyperplasia, pancreatic

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1
Q

Most pituitary adenomas are what type

A

Microadenomas < 1 cm

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2
Q

Which is the most common type of Pit Ad secretory or non secretory?

A

Secretory

Prolactinomas are most common

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3
Q

High prolactin level can be due to

A

!Pit stalk (infindibulum) compression
!Physiologic stiumuli: suckling, chest wall trauma
! Hormonal : pregs, estrogen therapy, hypothyroidism
! Drugs: psych meds, cimetidine, verapamil, opiates
! Renal or liver failure

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4
Q

Renal or liver failure can cause

A

high prolactin

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5
Q

Posterior pituitary secretes which Hs

A

ADH (vasopressin)
Oxytosin
Both are MADE by Hypothalamus!
PP does not PRODUCE any hormones, just secretes it

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6
Q

what are the sx of nonsecretory adenomas?

A

asx usually

Dx by accident on imaging

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7
Q

Pit adenomas

A

asx = common
Sx: pit H dysfx
Mass effect sx:
HA, Nausea, lethargy, altered mind, cranial nerve palsies, visual field defects, compression - part or complete hypopituitarism

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8
Q

what visual defect is common in pit adenomas?

A

no peripheral vision = “temporal hemianopsia”?

refer to optomology and endo

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9
Q

Med therapy for Pit Adenomas

A

Dopamine agonists = supress Prolactin release:
bromocriptine and cabergoline
tx excess hormone secretion
reduce tumor size

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10
Q

Do Surgery for pit adenomas if

A
  • secretory: GH (growth h), ACTH, TSH
  • large, non fx’l tumors: mass effect, visual compromise
  • potl complications (of surgery?): D Insipidus, Hupopituitarism
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11
Q

what tx after surgery if tumor remains?

A

radiotherapy

potl complication: hypopituitarism

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12
Q

Excess GH

A

GH secreting pit adenoma

results in gigantism or acromegaly

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13
Q

Gigantism

A

kids, prior to closure of epiphysis
excess growth of long bones
very rare

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14
Q

Acromegaly

A

enlargement/thickening and elongation of hand, feet, jaw, internal organs
does NOT affect long bones (vs gigantism does)
onset in 30s
dx’d in 50s

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15
Q

etiology of acromegaly

A

Macroadenoma is most common >1 cm

often ass with prolactin (PRL) secretion

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16
Q

risks of acromegaly

A

DM, HTN, CAD !!!
OVERT HF !!! at Dx in 10%
increased mortality due to CVD if untreated

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17
Q

Sx

A

CVD, CAD, DM
deep boice
acne

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18
Q

radiographic findings in acromegaly

A

skull: enlarged sella, thickened skull

hands/feet: tufting (unreveling) of terminal phalanges

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19
Q

Dx studies for GH excess

A

!! Random GH not accurate as levels fluctuate (pulsatile in acrom)
1) Random serum IGF-1 (hepatic):
if normal for age, rules out acromegaly
if elevated 5x, likely GH secreting adenoma (not truly Diagnostic)
2) 75 gm 1 hr glucose tolerance test (GTT)
shows failure of GH to suppress
3) PRL prolactin
GH-secreting tumors often co-secrete PRL
4) MRI - imaging test of choice BUT must do biochem studies BEFORE doing imagins

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20
Q

Which is the imaging test of choice for GH excess?

A

MRI but

must do biochem studies before do imaging!

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21
Q

Tx of GH excess

A 
combo surg, meds, radio
transsphenoidal microsurgery, Dopamin to decr PRL bromocriptine,mcabergolide, GH rec antag expensive
SOMATOSTATIN analogs: (decrease GH)
octreotide/lanreotide
decrease GH sectons, 
injections
- radiation
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22
Q

Tx of excess GH

A 
Dopamine agonist:
bromocriptine
cabergolide
GH receptor antagonist
Pegvisomant injection
blocks hepatic IGF-1 production

Radiation

23
Q

GH deficiency in kids

A

pit dwarfism:
fail to grow
Causes: congenital, tumor (craniopharyngioma), severe brain injury
Often co-occurs with deficiences of other pit hormones

24
Q

look at the pit dwarfism ss

A

slide 37

25
Q

Pit dwarfism dx tests

A

PE + hand x-ray to determine BONE AGE ????????
!!! IGF-1 below nl for age and gender supports dx
!!! GH stimulation test: insulin-induced hypoglycemia ASK??????????
measure other hormones
MRI of head
GH is pulsatile, not helpful for Dx

26
Q

GH deficiency in adults sx

A 
reduced E
depressed mood
emotional lability
diminished libido
decrease muscle mass, strength
increased abdominal adiposity
decreased exercise capacity
27
Q

Tx for GH deficiency

A

SC injection
SE:
HA, fluid retention, m and joint aches, slipped capital femoral epiphysis (peds)

28
Q

Diabietes Insipidus (DI)

A

Insipid = tastless

polydipsia, polyuria and DILUTE URINE (vs hunger in DM)

29
Q

DI has a problem with which hormone?

A

ADH

secreted in response to osmoreceptors and baroreceptors in the carotids, atria and aorta

30
Q

cental DI is

A

deficincy of ADH , can’t secrete

31
Q

nephrologic DI

A

resistance of kidney to ADH, can’t bind ADH

often due to lithium use

32
Q

which med often contributes to nephro DI

A

lithium

33
Q

What is the serium osmolality in DI?

A

It is normal (285-295)

34
Q

What is the urine osmolality and spesific gravity SG in DI?

A

Urine OSM < 300 (low)
Plasma OSM >287 (high but normal)
Urine Spec Gravity <1.005

35
Q

urine volume, osm, etc in DI vs normal

A

Normal urine volume: 800-2000 ml.day DI: >3 L /day
Serum OSM: 285-295 DI: >287
thirst at 290 mOsm no thirst mech in DI
Urins Osm 50-1200 normal DI: < 300
Urine SG: 1.010-1.030 DI: <1.005

36
Q

Is ADH high or low in central DI

A

ADH is low bc unable to produce.secrete ADH

37
Q

Is ADH high or low in nephro DI?

A

ADH is high bc brain can produce it but kid can’t respond to it

38
Q

When does central DI happen most

A

after head trauma or neurosurgery
in adulthood
responds to desmopressin (DDAVP)

39
Q

When is nephro DI most commone

A 
Lithium!!!
Childhood
Chronic renal fail
hypercalcemia, hypokalemia
No response to DDAVP (desmopressin)
40
Q

DI SS

A 
???????? intense thirst
fluid intake up to 20L per day
Ice water craving
Large volume polyuria
Enuresis (bed wetting)
HyperNa why ??????????, dehydration possible
41
Q

See slide 47 for DI pic

A

ok

42
Q

Dx studies for DI

A

?????? 24 hour urine to measure volume
serum electrolytes and glucose to ro osmotic diureces??
!!! SIMULTANEOUS URINE and serum OSMOLALITY!!!
must do SIMULTANEOUSLY - call lab
urine osm - low 287 (normal but high)
-urine SG <1.005

43
Q

DI dx

A

?????? water deprivation and vasopressin challenge?
?if central - double urine osmolality
? if nephro - little or no elevation in urine osm

MRI of pituitary

44
Q

DI tx

A 
???????Mild: adequate hydration
Central DI: Desmopressin acetate (DDAVP)
Nephro DI:
Indomethacin, with or without
HCTZ (thiazide?)
DDAVP or 
Amiloride (k sparing but causes hypothyroid?) use with Lithium
45
Q

Panhypopituitarism

A

deficient in GH (HYPOGLYCEMIA, short), ADH (polyuria -> polydipsia, hyperNa, dehydration, lethargy), LH/FSH: low estrogen, delayed puberty, amenorrhea,. TSH (Low T4: fatigue, constipation, cold intolerance bradycardia), ACTH (low cortisol: HYPOglycemia, vomiting, malaise)

46
Q

how to dx panhypopit

A

S S, provocative tests, MRI last

47
Q

ACTH deficiecy in panhypopit

A

1) ACTH stimulation test can be neg or pos:
if adrenal gland is functional -> positive test
if not _> negative
2) tx with Hydrocortisone or Prednisone
3) GIVE above before Thyroid hormone to lower risk of cortisol insufficientcy due to increased metabolism with thyroid meds

48
Q

Which type of pit adenomas have to be removed surgically

A

1) secretory : GH, ACTH, TSH (goiter)
2) Large non-fx’al tumors that have mass effect and/or visual compromise
3) complications of surgery are: DI, hypopituitarism

49
Q

if you don’t want to surgically remove pit adenoma, what medical tx to use

A

Dopamine agonists: bromocriptine and cabergoline ( to tx excess hormone secretion and reduce tumor size)

50
Q

when to use radiation to tx pit adenomas

A

following surgery if residual tumor remains

51
Q

ACTHn def in pan pt should carry what?

A

hydrocortisone vial and syringe

med alert tag

52
Q

Pan tx:

A

if TSH def: Levothyroxine
if Gonadotropin def: estrogen, progest, OCP, test
if ADH def: DDAVP (intranasal, oral or sublingual)

53
Q

GH def in PAn

A

tx with GH

54
Q

Tx of high prolactin in PAN

A

Stalk effect: compression of pit stalk decreases dopamine

Dopamine inhibits prolactin - so give dopamin?

Clin Med II Liza (6 decks)

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