Acromegaly/Prolactinoma

Question 1

GH hormone causing amenorrhea and galactorrhea?

Answer 1

these are prolactin effects

1 GH acts on JAK STAT receptors
-same as PRL

so can cross activate

2 also - GH adenoma may release some PRL

3 and - acromegalic tumor - push on pituitary stalk - block dopamine - no PRL inhibition

Question 2

inhibition of PRL

Answer 2

dopamine

Question 3

TRH

Answer 3

stimulates PRL secretion

Question 4

PRL

Answer 4

blocks LH at ovary and testes

Question 5

positive tinel sign

Answer 5

of median nerve

-myxedema - GAG infiltrates

Question 6

bony overgrowth and synovial thickening

Answer 6

• in acromegaly

Question 7

HA worse with coughing, nausea, worse upon arising

Answer 7

marker for mass effect in brain

Question 8

acanthosis nigricans

Answer 8

and skin tags

seen in epidermis overgrowth - IGF-1 effect (acromegaly)

Question 9

increased head size

Answer 9

acromegaly

possibly cowdens

Question 10

why order calcium in GH adenoma

Answer 10

suspected MEN

-may have parathyroid involvement as well**

Question 11

serum GH 2 hours post 75g glucose

Answer 11

glucose should suppress GH level

if not - acromegaly**

inability to suppress GH to less than 1 ng/mL

Question 12

why T4, TSH, and cortisol measured in GH adenoma

Answer 12

may compress other cell types

Question 13

GH effects on glucose

Answer 13

1 produces lipolysis

• leads to increased gluconeogenesis
• increased conversion of lactate and glycerol to glucose

2 FFA block glucose uptake by muscle and fat cell

GH is slow acting counter regulatory hormone like cortisol

Question 14

microadenoma with somatotroph mutation

Answer 14

cause of acromegaly

-mutation of alpha subunit of GTP-binding protein resulting in stimulatory Gs subunit

with increased cAMP producing GH secretion

Question 15

causes of acromegaly

Answer 15

microadenoma

macroadenoma

ectopic GH - lung

Question 16

acromegaly associations

Answer 16

1 - MEN 1
2 - carney complex
3 - mucune albright syndrome

Question 17

3 Ps, hypercalcemia, peptic ulcer, hypoglycemia

Answer 17

MEN 1

Question 18

complcation of GH adenoma

Answer 18

mass effects

additional hormone production

interfere with other hormones

Question 19

dopamine agonist

Answer 19

bromocryptine

Question 20

primary tx for acromegaly

Answer 20

surgery

radiation

also -dopamine agonst - suppress somatotrophs - bromocryptine

octreotide

pegvisomant

Question 21

somatostatin

Answer 21

inhibit GH release

Question 22

octreotide

Answer 22

somatostatin analog

inhibit GH release

Question 23

pegvisomat

Answer 23

GH receptor antagonist

Question 24

acromegaly, pituitary hyperplasia, mediastinal mass

Answer 24

oat cell carcinoma of lung - secreting GHRH

Question 25

before surgery for GH adenoma

Answer 25

GHRH assay -to see if ectopic production of GHRH like oat cell carcinoma

Question 26

goals of tx for acromegaly

Answer 26

GH levels under 1ng/dL glucose suppressed GH under 0.4ng/dL

Question 27

dopamine

Answer 27

activates G-i to decrease cAMP | decreased PRL secretion

Question 28

hirsutism

Answer 28

with prolactinoma decreased estrogen - decreased sex hormone binding globulin - increased free testosterone and DHEAS** leading to hirsutism and acne

Question 29

increased PRL

Answer 29

to decreased GnRH - to decreased LH - to decreased estrogen resulting in osteoporosis and amenorrhea

Question 30

hypothyroid and PRL??

Answer 30

can lead to increased prolactin levels hypothyroid - has high TRH TRH - stimulates prolactin release from pituitary

Question 31

kidney disease and PRL

Answer 31

decreased excretion and increased blood levels

Question 32

verapamil

Answer 32

can lead to hyperprolactinemia

Question 33

metoclopromide

Answer 33

can lead to hyperprolactinemia

Question 34

type IV RTA

Answer 34

with diabetes hyporeninemic hypoaldosteronism dump sodium - retain K each 2Na - lose K and H hyperchloremic acidosis**

Question 35

Cl and HCO3

Answer 35

cancel each other out Cl elevated 15 should see bicab down 15

Question 36

normal calcium in hyperPRL

Answer 36

helps exclude MEN-1

Question 37

PRL >200

Answer 37

prolactinoma 20-100 - another cause

Question 38

male hyperPRL

Answer 38

loss of libido impotence bitemporal hemianopsia

Question 39

tx of hyperPRL

Answer 39

bromocryptine surgery radiation

Question 40

postpartum cardiomyopathy

Answer 40

mediated by cathepsin D-cleaved prolactin irreversible dysfunction in heart occurs