Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine Exam 1 > Clinical: Hypothalamus and Anterior Pituitary > Flashcards

Clinical: Hypothalamus and Anterior Pituitary Flashcards

1
Q

What are some etiologies of pituitary-hypothalamis lesions?

A
  1. Non-Functioning Pituitary Adenomas
  2. Endocrine active pituitary adenomas: Prolactinoma, Somatotropinoma, Corticotropinoma, Thyrotropinoma, Other mixed endocrine active adenomas
  3. Malignant pituitary tumors: Functional and non-functional pituitary carcinoma
  4. Metastases in the pituitary (breast, lung, stomach, kidney)
  5. Pituitary cysts: Rathke’s cleft cyst, Mucocoeles, Others
  6. Empty sella syndrome
  7. Developmental abnormalities: Craniopharyngioma (occasionally intrasellar location), Germinoma, Others
  8. Primary Tumors of the central nervous system: Perisellar meningioma, Optic glioma, Others
  9. Vascular tumors: Hemangioblastoma, Others
  10. Malignant systemic diseases: Hodgkin’s disease, Non-Hodgkin lymphoma, Leukemic infiltration, Histiocystosis X, Eosinophilic granuloma, Giant cell granuloma (tumor)
  11. Granulomatous diseases: Neurosarcoidosis, Wegner’s granulomatosis, Tuberculosis, Syphilis
  12. Vascular aneurysms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a hormonal disorder that results when the pituitary gland produces excess growth hormone after puberty?

A

Acromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who does acromegaly most often affect?

A

Middle-aged adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes acromegaly?

A

Prolonged overproduction of GH by the pituitary gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What 2 categories of tumors can cause acromegaly?

A
  1. Pituitary tumors

2. Non-pituitary tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is a random GH test useful for diagnosis of acromegaly?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is best for screening for acromegaly?

A

Insulin like growth factor 1 (IGF-1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the gold standard to confirm diagnosis of acromegaly?

A

Oral glucose GH suppression testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If acromegaly isn’t caused by a pituitary tumor, what other organs can have tumors leading to this?

A

Pancreas, lungs, and adrenal glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do pancreatic, lung, or adrenal gland tumors lead to an excess of GH?

A

Produce GH themselves, or more often, produce GHRH (stimulate pituitary to make GH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In patients with non-pituitary tumors, what can be measured in the blood?

A

Excess GHRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In over 90% of acromegaly patients, what causes the overproduction of GH?

A

A benign tumor of the pituitary gland- Adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do adenomas of the pituitary gland do?

A

Produce excess GH and can compress brain tissue like the optic nerves as they expand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Because pituitary tumors can compress the surrounding normal pituitary tissue, what can be seen in men and women due to altered production of other hormones?

A

Women: Changes in menstuation and breast discharge
Men: Impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do adenomas grow?

A

Slow or fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What 3 things are done to evaluate an incidental pituitary mass?

A
  1. Radiologic evaluation
  2. Clinical evaluation
  3. Hormonal evaluation (ALWAYS GET HORMONE LEVELS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the preferred imaging study for the pituitary?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which type of imaging gives better visualization of soft tissues and vascular structures, CT or MRI?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Does MRI result in exposure to ionizing radiation?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are images generated based upon with an MRI?

A

Magnetic properties of H atoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of MRI produce high signal intensity images of fat?

A

T1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of MRI produces high intensity signals of structures with high water content?

A

T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a T1 image good for to see?

A

Fatty marrow and orbital fat- Bright images

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a T2 image good for to see?

A

CSF and cystic lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is CT better at visualizing?

A

Bony structures and calcifications within soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is CT better at determining the diagnosis of?

A

Tumors with calicfication, like germinomas, craniopharyngiomas, and meningiomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When might CT be necessary over MRI?

A

When MRI is contraindicated

-Pacemakers or metallic implants in brain or eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are 3 disadvantages to CT?

A
  1. Less optimal soft tissue imaging compared to MRI
  2. Use of IV contrast media
  3. Exposure to radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What should all patients with macroadenomas have?

A

Formal visual field testing

30
Q

Besides radiographic and hormonal evaluation, what else should patients be asked and examined for (with a macroadenoma)?

A

Pituitary hyerfunction or hypofunction

31
Q

What 2 types of hormonal evaluation should be done?

A

Basal hormone measurement and dynamic stimulation testing

32
Q

All pituitary masses should have screening basal hormone measurements… what are they?

A
  1. Prolactin
  2. TSH, FT4
  3. ACTH, AM cortisol, midnight salivary cortisol
  4. LH, FSH, estradiol or testosterone
  5. Insulin-like growth factor-1 (IGF-1)
33
Q

What might be useful in select cases to further evaluate pituitary reserve and/or for pituitary hyperfunction?

A

Dynamic stimulation/suppression testing

34
Q

What are some examples of dynamic stimulation/suppression testing?

A
  1. Dexamethasone suppression testing
  2. Oral glucose GH suppression test
  3. GHRH, L-dopa, arginine
  4. CRH stimulation
  5. Metyrapone
  6. TRH stimulation
  7. GnRH stimulation
  8. Insulin-induced hypoglycemia
35
Q

There are a lot of symptoms for acromegaly… list as many as you can…

A
  1. swelling of the hands and feet
  2. facial features become coarse as bones grow
  3. body hair becomes coarse as the skin thickens and/or darkens
  4. increased perspiration accompanied with body odor
  5. protruding jaw
  6. voice deepening
  7. enlarged lip, nose, and tongue
  8. degenerative arthritis
  9. thickened ribs (creating a barrel chest)
  10. joint pain
  11. enlarged heart
  12. enlargement of other organs
  13. impotence in men
  14. strange sensations and weakness in arms and 15. legs
  15. snoring*** SLEEP APNEA
  16. fatigue and weakness
  17. headaches
  18. loss of vision
  19. irregular menstrual cycles in women
  20. breast milk production in women
  21. Abnormal glucose tolerance test (glucosuria/polyuria)
36
Q

What 3 things can be done to help diagnose acromegaly?

A
  1. Serial photos over years to observe physical changes in patient
  2. XR to detect bone thickening
  3. Blood tests to check GH level
37
Q

Are the changes seen with acromegaly subtle or quick?

A

SUBTLE…over many years

38
Q

What is the gold standard for treatment of GH-secreting tumors because of its aggressive nature?

A

Surgical therapy- Must be done as the primary choice in all patients who are otherwise acceptable surgical risks

39
Q

What are the 2 surgical modalities?

A
  1. Transsphenoidal (better option)

2. Craniotomy

40
Q

What size limit is there for operation of pituitary tumors?

A

No larger than 10mm in diametert

41
Q

What are 3 drugs that can be given for pituitary tumors?

A
  1. Dopaminergic analogues: Bromocriptime
  2. Somatostatin analogues: Octreotide
  3. Pegvisomant: Directly blocks effects of GH
42
Q

If untreated, acromegaly can lead to what 2 things?

A
  1. DM

2. HTN

43
Q

What can acromegaly also increase a patient’s risk for?

A
  1. CV disease

2. Colon polyps- Lead to CA

44
Q

What is due to excess cortisol from pituitary, adrenal, or other sources (exogenous glucocorticoids, ectopic ACTH, ect.)

A

Cushing’s Syndrome

45
Q

What is hypercortisolism due to ecess pituitary secretion of ACTH

A

Cushing’s Disease

46
Q

What accounts for about 70% of cases of endogenous Cushing’s syndrome?

A

Cushing’s Disease

47
Q

What are 4 prominent feature of Cushing’s Syndrome?

A

Proximal muscle wasting, progressive/central obesity, striae (“stretch marks”), Buffalo Hump

48
Q

Lots of symptoms for Cushing’s Syndrome… name as many as you can…

A
  1. Moon facies
  2. Facial plethora
  3. Supraclavicular fat pads
  4. Buffalo hump
  5. Truncal obesity
  6. Weight gain
  7. Purple striae
  8. Proximal muscle weakness
  9. Easy bruising
  10. Hirsutism
  11. Hypertension
  12. Osteopenia
  13. Diabetes mellitus/IGT
  14. Impaired immune function/poor wound healing
49
Q

What 4 things can help diagnose Cushing’s Syndrome?

A
  1. ACTH, AM cortisol
  2. 24 hour urine cortisol
  3. Dexamathasone suppression testing
  4. Midnight salivary control
50
Q

What do circadian studies of serum cortisol levels show?

A

High cortisol all the time in Cushing’s disease and Ectopic ACTH syndrome

-In normal people, the levels peak in the AM and slowly decrease thoughout the day

51
Q

What can women present with with hyperprolactinemia/prolactinoma?

A

Oligomenorrhea, amenorrhea, galactorrhea, or infertility

52
Q

What can men present with with hyperprolactinemia/prolactinoma?

A

Less symptoms than women and diagnosed later, but sexual dysfunction, visual problems, or headache

53
Q

In both sexes, what can cause visual-field defects or headache due to hyperprolactinemia/prolactinoma?

A

Tumor mass effects

54
Q

What are 4 causes of hyperprolactinemia?

A
  1. Hypothalamic dopamine deficiency
  2. Defective transport mechanisms
  3. Lactotroph insensitivity to dopamine
  4. Stimulation of lactotrophs
55
Q

What 2 things can lead to hypothalamic dopamine deficiency?

A
  1. Disease of hypothalamus (tumors, AV malfornations, inflammation)
  2. Drugs (alpha-methyldopa and reserpine)
56
Q

What can cause defective transport mechanisms?

A

Pituitary or stalk tumors- section of the pituitary stalk (ALL GOES BACK TO THIS)

57
Q

What type of drugs can cause lactotroph insensitivity to dopamine?

A

Dopamine-receptor-blocking agents: phenothiazines (e.g. chlorpromazine), butyrophenones (haloperidol), and benzamides (metoclopramide, sulpiride, and domperidone)

58
Q

What 3 things can cause stimulation of lactotrophs?

A
  1. HYPOthyroidism: Increased TRH production
  2. Estrogens
  3. Chest wall injury
59
Q

How does chest wall injury lead to stimulation of lactotrophs?

A

abnormal stimulation of the reflex associated with the rise in prolactin that is seen normally in lactating women during suckling- Nerves not growing back as fast as they should post rib-fx or injury

60
Q

True or False: Not all hyperprolactinemia is due to a prolactinoma?

A

TRUE

61
Q

What are some other things that can cause hyperprolactinemia?

A

Pregnancy, stress, drugs, other pituitary and hypothalamic disease

62
Q

What must be ruled out in females when working up a patients for hyperprolactinemia?

A

PREGNANCY

63
Q

What blood test should be ordered to evaluate hyperprolactinemia?

A

TSH- Hypothyroidism can cause high prolactin

64
Q

What part of the history is super important for evaluating hyperprolactinemia?

A

DRUGS- Medications can cause this

65
Q

What are some other common causes of hyperprolactimeia that have to be ruled out?

A
  1. Nonfasting sample
  2. Nipple stimulation or sex
  3. Excessive exercise
  4. History of chest wall surgery or trauma
  5. Renal failure
  6. Cirrhosis
66
Q

If no cause is determined or a tumor is expected and the prolactin is high (over 100ng/mL) what should be considered?

A

MRI

67
Q

What are 3 options for treatment for a prolatin-secreting tumor?

A
  1. Pharmacotherapy
  2. Surgical resection
  3. Radiotherapy
68
Q

What surgical approach is used for 95% of pituitary tumors?

A

Transsphenoidal

69
Q

What are other surgical approaches for pituitary tumors?

A
  1. Endonasal submucosal transseptal approach
  2. Septal Pushover/Direct Sphenoidotomy
  3. Endoscopic approach
70
Q

What class of drugs is the treatment of choice for most prolactinomas?

A

Dopamine agonists

71
Q

What are some examples of dopamine agonists used for prolactinomas?

A

Bromocriptine, pergolide, cabergoline

72
Q

What are some SE of dopamine agonists?

A

Postural hypotension, dizziness, nasal stuffiness, GI SE

Endocrine Exam 1 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions