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Endo II > Acromegaly and prolactinoma > Flashcards

Acromegaly and prolactinoma Flashcards

1
Q

Why does acromegaly cause amenorrhea and galactorrhea

A
  • GH stimulates prolactin R (Jak/stat)
  • GH adenoma may cosecrete prolactin
  • acromegalic tumor mass pushes on pit stalk and blocks dopamine
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2
Q

causes of carpel tunel

A 
MEDIAN TRAP
M-myxedema
edema
DM
infiltration
amyloid
neoplasms
trauma
RA
acromegaly
pregnancy
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3
Q

acanthrosis nigricans

A

d/t stimulation of IGF1

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4
Q

what is a normal glucose suppression test

A

must suppress GH to less then 1ng/mL

or less then /4 with ultrasensitive GH assays

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5
Q

GH on meta

A

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

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6
Q

what syndromes are associated with acromegaly

A

MEN 1
Carney complex
MuCune-albright syndrome

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7
Q

MEN1

A

parathyroid hyperplastic -> hypercalcemia

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

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8
Q

Carney complex

A 
mutation in tumor suppressor gene for protein kinase A
GH secreting pituitary tumor
spotty skin
myxomas
testicular tumors
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9
Q

associated complications with GH secreting adenoma

A 
mass effects
additional hormones (PRL, TSH)
interference with other hormones (decreased ACTH, TSH)
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10
Q

goals of acromegaly Tx

A

GH <.4

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11
Q

increased PRL

A

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

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12
Q

endocrine causes of hyperprolactinemia

A

pituitary adenoma
hypothalamic disese
hypothyroidism
pregnanacy

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13
Q

drugs which can cause hyperprolactinemia

A 
CNS acting meds (hydroxyzine)
anti HTNs (verapamil)
sex hormones
certain H2 blockers
metoclopromide
protease inhibiotrs
opiates
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14
Q

other causes of hyperprolactinemia

A 
cirrhoiss
exercise
macroporlactinemia (IgG binding)
nipple stimulation
REM sleep
renal failure
SLE stress
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15
Q

HIGH PROLACTINS

A 
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
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16
Q

type IV RTA

A

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

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17
Q

PRL >200

A

look for prolactinoma

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18
Q

what are the symptoms of prolactinomas in males

A

loss of libido
impotence
bitemporal hemianopsia

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19
Q

macroprolactinemia

A

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

precipitate IgGs with polyethylene glycol, then remeasure PRL

20
Q

PPCM

A

prolactin mediated postpartum cardiomyopathy

21
Q

what order are hormones lost in pituitary insufficiency

A

GH
GN
TSH
ACTH

22
Q

GH loss

A

fine wrinkling of skin
decreased libido
hair loss

23
Q

queen annes sign

A

alopecia due to TSH loss

24
Q

loss of sex hair

A

d/t loss of ACTH

25
Q

cuases of ant pituitary failure

A 
vindicated
Vascular
infection or infiltrative
neoplastic disorders
degenerative or deficiency states
idiopathic
congenital
allergic or autoimmune
trauma
endocrine disorders
26
Q

vascular causes of ant pit failure

A 
pituitary apoplexy
sheehans
carotid aneurysms
strokes
SM
27
Q

infectious causes of ant pit failure

A 
syphilis
TB
abscess
fungal
parasite
28
Q

infiltrative causes of ant pit failure

A 
sarcoid
langerhas cell histiocytosis
wegners
leukemia
lymphoma
hemochromatosis
amyloid
29
Q

neoplastic disorders which cause ant pit failure

A 
adenoma
mets
menigioma
optic glioma
craniopharyngioma
pineal dysgerminoma
30
Q

congenital causes of ant pit failure

A

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

31
Q

allergic or autoimmune causes of ant pit failure

A

lymphocytic hypophysitis

32
Q

endocrine disorder causes of ant pit failure

A

hypothalamic or pit disease

MEN1

33
Q

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

A

that GH is also low

34
Q

8AM cortisol

A

should be >3ug/dl

35
Q

ACTH sitmulation

A

cortisol should be <18ug/dl in 45min

36
Q

what happens to ADH in hypopituitarism

A

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

37
Q

Uosm in SIADH

A

150-200

38
Q

how does hypothyroidism cuase hypotonic euvolemic hyponatremia

A

decreased CO and decreased ECV

39
Q

psychogenic polydipsia Uosm

A

<100

40
Q

idiopathic hyponatremia of elderly Uosm

A

<100

41
Q

how does hypopituitarism cause hypoglycemia

A

loss of hormones which counter insulin:
Epi
cortisol
GH

42
Q

if you replace cortisol and patient develops polyuria…

A

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

43
Q

causes of polyuria

A 
C-DRIPPED
cortisol excess
DI
recovery from renal failure
ions (hyper Ca, hypo K)
Parkinsons
PP
enzyme- vasopressinase (autoimmune DI)
Drugs
44
Q

serum UA

A

excreted d/t ADH binding V1 Rs

so high serum UA -> low/absent ADH

45
Q

desmopressin

A

resistant to vasopressinade

can cause serious depression and suicide

Endo II (15 decks)

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