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Endocrine > Lec 3 Pituitary Tumors > Flashcards

Lec 3 Pituitary Tumors Flashcards

1
Q

What are the 3 major types of functional pituitary tumors?

A
  • prolactin secreting
  • GH secreting
  • ACTH secreting
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2
Q

What is MIB-1 index?

A

proliferation index –> predicts aggressive behavior if MIB1 >3%

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3
Q

What are 4 signs of hyperprolactinemia?

A
  • galactorrhea
  • menstrual abnormalities
  • infertility
  • decreased libido
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4
Q

What is usual presentation of prolactinoma in females?

A

small + present earlier in females b/c of abnormal menses

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5
Q

What is relationship level of serum prolactin and prolactinoma tumor size?

A

well corrleated

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6
Q

What levels of prolactin associated wtih macroprolactinoma?

A

> 150 ng/ml

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7
Q

What should you think if large pituitary tumor but only modest elevation in prolactin?

A

may be secondary to stalk compression from non-secretory tumor = lack of dopamine coming down stalk causes increase in prolactin

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8
Q

What is medical therapy for prolactinoma?

A

dopamine agonist

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9
Q

What are 6 potential causes of hyperprolactinemia?

A
  • prolactinoma
  • non-secretory macroadenoma w/ stalk compression
  • hypothalamic lesion
  • hypothyroid [high TRH stimulates prolactin]
  • medication [DA antagonists = psychiatrics]
  • pregnancy/nursing
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10
Q

What do you see histologically in pituitary adenoma

A

highly monomorphic cells

absence of small clusters and sinusoids

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11
Q

What 3 tests should you order if signs of hyperprolactinemia?

A
  • prolactin
  • TSH
  • pregnancy test
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12
Q

What is treatment for microprolactinoma?

A

first line is medical = dopamine agonist

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13
Q

What is treatmetn for macroprolactinoma?

A

surgical probably

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14
Q

What is effect of high GH in kids vs adults?

A

kids –> gigantism

adults –> acromegaly

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15
Q

What is presentation of kid with GH secreting tmor?

A

gigantism

- tall height

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16
Q

What are signs of acromegaly?

A
  • large tongue with deep furrows
  • deep voice
  • large hands and feet
  • coarse facial feat.
  • insulin resistance [imparied glucose tolerance]
  • space between teeth
17
Q

What are metabolic consequences of high GH?

A
  • insuline resistance
  • hyperinsulinemia
  • glucose intolerance
18
Q

What is major cause of mortality in patients with acromegaly?

A

cardiovascular disease

19
Q

What type of tumor primarily secretes GH?

A

macroadenoma

20
Q

What is typical etiology of GH secreting tumors?

A

activation point mutation in alpha subunit of Gs protein which is coupled to GHRH receptor –> persistent activation of adenylate cyclase

get cellular proliferation and increased GH secretion

21
Q

What is action of somatostatin?

A

inhibits GH secretion

22
Q

What is action of GHRH?

A

induces GH secretion

23
Q

What is best lab test for acromegaly?

A

IGF1 level –> represents GH secretion over 24 hours

24
Q

What is problem with random GH level as screening test?

A

not specific –> protein ingestion increases GH; glucose suppresses GH; diurnal variation

25
Q

What do you see in glucose tolerance test w/ GH secreting tumor?

A

glucose is supposed to suppress GH but in GH secreting tumor –> have paradoxical increase in GH with glucose

26
Q

What are 3 long term sequelae of acromegaly?

A
  • mortality due to cardiovascular risk
  • increased risk colonic polyps + colon cancer
  • sleep apnea
27
Q

What is treatment for acromegaly?

A

pituitary adenoma resection

treat with octreotide = somatostatin analog or pegvisomant = GH receptor antagonist

28
Q

What do you see in TSH producing tumor?

A

hyperthyroidism with non-suppressed TSH [but not necessarily elevated]

29
Q

What is typical manifestation of gonadotropin tumors?

A

usually are clinically silent b/c do not generally secrete biologically active LH/FSH

present with hypogonadism

30
Q

Can you treat gonadotropin tumors medically?

A

nope! need surgery

31
Q

How do you differentiate pituitary from ectopic cushings [non-pituitary source of ACTH]?

A

measure ratio of central [next to pituitary] and peripheral ACTH before and after CRH

if pituitary cushings –> higher ACTH centrally than peripherally; gradient increases after CRH

Endocrine (21 decks)

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