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Flashcards in Anterior Pituitary Deck (36):
1

Dx acromegaly

elevate IGF-1

 

oral glucose tolerance test - normally glucose suppresses GH levels within 2 hours, glucose will no decrease below 1ng/ml in acromegaly

1

General causes of panhypopoituitaryism / hypopituitarism

Mass lesion

treatment of sellar, parasellar, hypothalamic diseases (surgy)

infiltrative disease (autoimmune, sarcoidosis, hemochromatosis

trauma

Vascular (Sheehans syndrome, pituitary tumor apoplexy

Medications

Infectious

Genetic

Developmental

2

Rx for Acromegaly

Octreotide+ Lanreotide (Somatostatin receptor ligands)

Cabergoline (DA agonist, limited effectiveness)

Pegvisomant (GH receptor blockade in liver)

2

normal potassium and no hyperpigmentation seen in ___ adrenal insufficiency

secondary

4

hormones of posterior pituitary

ADH

Oxytocin

4

DA agonists used for hyperprolactinemia, prolactin secreting adenomas, acromegaly, parkinsons

Bromocriptine

Cabergoline

5

clinical signs of GH def in neonate

 

 

in child

Neonate: jaundice

hypoglycemia

microphallus

traumatic delivery

Child: hypoglycemia

increased fat

high pitched voice

absent/late puberty

physical defects of skull, craniofacial abnls

6

GH receptor antagonist used for acromegaly

Pegvisomant

7

Testing procedures for ACTH

Cortisol 8am fasting

inuslin tolerance test (30, 60min) (insuf if cortisol repsonse

 

8

non-Rx treatment of Prolactinemas

Transsphenoidal ressection in patients not tolerating DA agonists

 

asymtpomatic require no treatment

 

Radiation for hihg surgical risk

8

Acromegaly etiology

typically GH-secreting pituitary tumor

9

Rx for GH def

 

side effects

recombinent humone growth hormones rGH

(SubQ nightly)

 

side effects: slipped femoral epiphysis

scoliosis

psuedotumor cerbri

snoring/sleep apnea from tonsil growth

9

somatostatin analogs used to treat acromgelly

Octreotide

lanreotide

11

contents of cavernous sinus

Internal carotids

CN III IV V1, V2, VI 

(3+4+5.1+5.2+6)

12

clinical presentation ACTH deficiency (as in hypopituitarism)

weight loss

weakness, fatigue

nausea/vomiting/anorexia

abdl pain

arthralgias + myalgias

orthostatic hypotension

hyponatremia + glycemia

13

mechanism underlying decrease in male libido and decrease in menses in women seen in hyperprolactinemia

inhibition of pituitary gonadotropins FSH and LH

14

dx of hyperprolactinemia

serum prolactin above reference range

14

Endocrine/metabolic changes in Acromegaly

menstrual abnls+male hypogonadism - (PRL production by tumor or compression of gonadotrophs)

galactorrhea - PRL production or GH stimulation of PRL binding sites in breasts

DM2 +impaired glucose tolerance - anti-insulin effects of GH

15

hormones secreted from posterior pituitary originate in 

paraventricular nuclei of hypothalamus

(transport via supraopticohypophyseal tract)

17

80% of IGF-1 circulates bound to 

IGFBP-3

18

regulation of GH

GHRH and somatostatin (both from hypothalamus)

 

IGF-1 inhibits (negative feedback)

20

metabolic actions of GH

antagonizes insulin action

> increase lipolysis, Free FA porduction

increase protein synthesis

21

GH testing procedures

Basal IGF

GHRH arginine stimulation test

glucagon stimulation test

22

hormones of anterior pituitary

Prolactin

GH

ACTH

FSH

LH

TSH

 

23

clincila presentation of GH deficiency in adult

increased visceral fat, reduced lean body mass

reduced eneryg, social isolation, emotional lability+depression

reduced bone mineralization

elevated LDL and TG, low HDL

25

mild-moderate hyperprolactinemia most likely

infudibular stalk compression by a tumor, inhibition dopamine trasnport to lactotroph

26

systemic causes of hyperprolactinemia

neurogenic - chest trauma, surgery, herpes zoster

chronic renal failure due to decreased breakdown of PRL

Cirrhosis

Primayr hypothyroidism

Polycystic ovaran disease

27

physiological causes of hyperprolactinemia

pregnancy

lactation

exercice

sleep

stress

29

Rx hyperprolactinemia

DA agonists bromocrptine (esp in fertility induction) 

cabergoline (preferred)

29

TSH or thyroid hormones is replaced with ___

ACTH or cortisol is replaced with ___

TSH or thyroid with levothyroxine or T4

ACTH or cortisol with hydrocortisone or prednisone

31

testing procedures for FSH LH

males - 8am fasting T (if below normal range or low with inappropriately normal LH+FSH)

females - basal serum estradiol

32

GH stimulates rlease of 

IGF-1

33

clinical presentation of TSH deficiency or secondary hypothyroidism

weight gain

weakness, fatigue, lethary

cold intolerance

arthralgias+myalgias

Dry skin and hair

Constipation

diffuse edema, periorbital edema

bradycardia

34

drugs causing hyperprolactinemia

metoclopramide

risperidone

(both DA antagonists)

35

control of prolactin synthesis and secretion

tonic inhibition via Dopamine from hypothalamus

 

stimulation  via thyrotropin releasing hormone

estrogen

vasopressin

VIP

oxytocin

EGF

(Thy Expression Varies Very Oddly, Ed

36

Acromegaly non-Rx treatment

must treat both the tumor an GH IGF-1 levels

  1. Transsphenodal surgery
  2. radiation therapy (10-15 years to see full effect)
  3. (Rx)