Acromegaly and prolactinoma

Question 1

Why does acromegaly cause amenorrhea and galactorrhea

Answer 1

• GH stimulates prolactin R (Jak/stat)
• GH adenoma may cosecrete prolactin
• acromegalic tumor mass pushes on pit stalk and blocks dopamine

Question 2

causes of carpel tunel

Answer 2

MEDIAN TRAP
M-myxedema
edema
DM
infiltration
amyloid
neoplasms
trauma
RA
acromegaly
pregnancy

Question 3

acanthrosis nigricans

Answer 3

d/t stimulation of IGF1

Question 4

what is a normal glucose suppression test

Answer 4

must suppress GH to less then 1ng/mL

or less then /4 with ultrasensitive GH assays

Question 5

GH on meta

Answer 5

lipolysis
gluconeogenesis
lactate -> glycerol -> glucose
GH is a slow acting counter regulatory hormone like cortisol

Question 6

what syndromes are associated with acromegaly

Answer 6

MEN 1
Carney complex
MuCune-albright syndrome

Question 7

MEN1

Answer 7

parathyroid hyperplastic -> hypercalcemia

pituitary adenoma -> GH and/or pancreatic endocrine tumor -> ZE syndrome

Question 8

Carney complex

Answer 8

mutation in tumor suppressor gene for protein kinase A
GH secreting pituitary tumor
spotty skin
myxomas
testicular tumors

Question 9

associated complications with GH secreting adenoma

Answer 9

mass effects
additional hormones (PRL, TSH)
interference with other hormones (decreased ACTH, TSH)

Question 10

goals of acromegaly Tx

Answer 10

GH <.4

Question 11

increased PRL

Answer 11

decreases GNRH -> decreases LH which decreases E -> decreased sex hormone binding globulin-> increased free T -> hirsutism and acne

Question 12

endocrine causes of hyperprolactinemia

Answer 12

pituitary adenoma
hypothalamic disese
hypothyroidism
pregnanacy

Question 13

drugs which can cause hyperprolactinemia

Answer 13

CNS acting meds (hydroxyzine)
anti HTNs (verapamil)
sex hormones
certain H2 blockers
metoclopromide
protease inhibiotrs
opiates

Question 14

other causes of hyperprolactinemia

Answer 14

cirrhoiss
exercise
macroporlactinemia (IgG binding)
nipple stimulation
REM sleep
renal failure
SLE stress

Question 15

HIGH PROLACTINS

Answer 15

HTN meds
infiltrative disease
GH
hypothyroidism, H2 blockers
pregnant/postpartum, PIs, macroProlactinemia
renal failure, reglan
oral contraceptives, opiates
liver disease
adenoma of pit, empty sella
craniophayrngiomas
tranquilizers, tricclics, truama, tumor
idiopathic
nipple stimulation
stress, sleep, seizures, surgery, SSRIs, SLE, MS, sexercise

Question 16

type IV RTA

Answer 16

loss of aldosterone effect on kidney
hyperchloremic, hyperkalemic, acidosis
normal to mild elevation of anion gap

Question 17

PRL >200

Answer 17

look for prolactinoma

Question 18

what are the symptoms of prolactinomas in males

Answer 18

loss of libido
impotence
bitemporal hemianopsia

Question 19

macroprolactinemia

Answer 19

patients have PRL >200, with neg MRI and no symptoms

precipitate IgGs with polyethylene glycol, then remeasure PRL

Question 20

PPCM

Answer 20

prolactin mediated postpartum cardiomyopathy

Question 21

what order are hormones lost in pituitary insufficiency

Answer 21

GH
GN
TSH
ACTH

Question 22

GH loss

Answer 22

fine wrinkling of skin
decreased libido
hair loss

Question 23

queen annes sign

Answer 23

alopecia due to TSH loss

Question 24

loss of sex hair

Answer 24

d/t loss of ACTH

Question 25

cuases of ant pituitary failure

Answer 25

``` vindicated Vascular infection or infiltrative neoplastic disorders degenerative or deficiency states idiopathic congenital allergic or autoimmune trauma endocrine disorders ```

Question 26

vascular causes of ant pit failure

Answer 26

``` pituitary apoplexy sheehans carotid aneurysms strokes SM ```

Question 27

infectious causes of ant pit failure

Answer 27

``` syphilis TB abscess fungal parasite ```

Question 28

infiltrative causes of ant pit failure

Answer 28

``` sarcoid langerhas cell histiocytosis wegners leukemia lymphoma hemochromatosis amyloid ```

Question 29

neoplastic disorders which cause ant pit failure

Answer 29

``` adenoma mets menigioma optic glioma craniopharyngioma pineal dysgerminoma ```

Question 30

congenital causes of ant pit failure

Answer 30

kallman syndrome-GNRH stays in nose PROP 1 mutation Dax-1 mutation prader-willi

Question 31

allergic or autoimmune causes of ant pit failure

Answer 31

lymphocytic hypophysitis

Question 32

endocrine disorder causes of ant pit failure

Answer 32

hypothalamic or pit disease | MEN1

Question 33

if 2 pit hormones are low and IGF-1 is low what can you assume

Answer 33

that GH is also low

Question 34

8AM cortisol

Answer 34

should be >3ug/dl

Question 35

ACTH sitmulation

Answer 35

cortisol should be <18ug/dl in 45min

Question 36

what happens to ADH in hypopituitarism

Answer 36

low thyroixine and low coritsol -> decrease CO -> increased ADH cortisol usually inhibits ADH as well and is missing become hyponatremic, but hypotensive bc of low epi

Question 37

Uosm in SIADH

Answer 37

150-200

Question 38

how does hypothyroidism cuase hypotonic euvolemic hyponatremia

Answer 38

decreased CO and decreased ECV

Question 39

psychogenic polydipsia Uosm

Answer 39

<100

Question 40

idiopathic hyponatremia of elderly Uosm

Answer 40

<100

Question 41

how does hypopituitarism cause hypoglycemia

Answer 41

loss of hormones which counter insulin: Epi cortisol GH

Question 42

if you replace cortisol and patient develops polyuria...

Answer 42

panhypopituitarism did not realize pt had DI b/c GFR was too low d/t loss of cortisol with replacement of cortisol GFR normalizes and DI becomes apparent

Question 43

causes of polyuria

Answer 43

``` C-DRIPPED cortisol excess DI recovery from renal failure ions (hyper Ca, hypo K) Parkinsons PP enzyme- vasopressinase (autoimmune DI) Drugs ```

Question 44

serum UA

Answer 44

excreted d/t ADH binding V1 Rs | so high serum UA -> low/absent ADH

Question 45

desmopressin

Answer 45

resistant to vasopressinade | can cause serious depression and suicide