Darrow pituitary diseases part I Flashcards Preview

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Flashcards in Darrow pituitary diseases part I Deck (44):
1

increased hat and glove size

acromegaly

2

skin tags and enlarged tongue

acromegaly

3

how can acromegaly cause abnormal menstrual cycles

can co secrete PRL
can activate PRL R
the GH adenoma can compress pituitary stalk and inhibit dopamine release

4

PRL feedback on hypothalamus

inhibits GnRH release

5

What can cause + Tinels

myxedema, edema, DM, infiltration, amyloid, neoplasms, trauma, RA, acromegaly and pregnancy

6

how does pain and stiffness in back/hips/knees relate to acromegaly

synovial thickening at the knees

7

why is snoring a component of acromegaly

increased glands

8

HA with coughing, nausea from pain?

look for brain tumor

9

what causes the acanthosis nigricans and skin tags in acromegaly

increased IGF-1

10

what cancers can cause increased hat size and skin tags

breast, thyroid, colon and renal cell cancers

11

what tests to order for suspected acromegaly with increased fasting blood sugar

glucose, PRL, BUN, AST, ALT, Ca, phosphorus
T4,TSH cortisol
Uosm/Posm
serum GH after 75 mg glucose

12

when give glucose what should the GH levels be

decreased

13

what is a + GH suppression test with glucose

if the GH is less than 1 ng/ml
or less than 0.4 in supersensitive assay

14

effects of GH on metabolism

lipolysis
gluconeogenesis
increased conversion lactate and glycerol to glucose

15

causes of acromegaly

microadenoma with somatotroph mutation
macroadenoma
Ectopic GH or GHRH production

16

what mutation causes microadenoma secreting GH

mutation of alpha subunit of GTP binding protein on Gsalpha
causes increased cAMP producing GH secretion

17

syndromes assoc with acromegaly

MEN1
carney complex
mcCune Albright syndrome

18

what causes carney complex

mutation in tumor suppressor gene for protein kinase A

19

what are signs of MuCune Albright syndrome

PFD, cafe au lait sports, endocrine hyperfunction

20

MEN1

pituitary, pancreas, PTHgland
also can have hyper Ca, peptic ulcers, hypoglycemia

21

complications with GH secreting adenoma

mass effects

22

how is a pituitary adenoma secreting GH Tx

surgery
radiation
drugs: dopamine agonists, somatostatin analogs
GH R antagonist (pegvisomat)

23

side effect of somatostatin analogs

gallstones

24

side effects pegvisomat

liver function abnormalities

25

enlarged pituitary and on surgery it is hyperplasia, no evidence of adenoma

ectopic hormone production
e.g small cell/oat cell carcinoma that produces GHRH

26

long term follow up for GH adenoma

follow GH and IGF1 levels

27

goals of Tx for GH adenoma

with suppression test to have GH level under 0.4

28

F amenorrhea, galactorrhea with dysparunia, mild hirsutism and acne
takes resperidone, verapamil, lisinopril and somtimes metoclopramide for nausea
elevated BP
BUN/Cr 10:1
high Cl
no anion gap
low HCO3
elevated PRL

Chronic renal failure renal cause from BUN:Cr
hyperchloremic non anion gap acidosis

29

how does increased PRL lead to osteoporosis and amenorrhea

decreased GnRH so decreased LH and decreased estrogen

30

how does increased PRL lead to dysparunia, hirsutism, and acne

decreased estrogen will lead to dec sex hormone binding globulin which increases free testosterone and DHEAS
leading to hirsutism and acne

31

what other conditions (not pituitary or hypothalamic) can cause increased PRL

hypothyroidism and kidney diseases

32

endocrine cuases hyper PRL

pituitary adenoma, hypothalamic disease, hypothyroidism, pregnancy

33

what drugs can cause hyperPRL

CNS acting meds, antiHTN, sex hormones, certain H2 blockers, metoclopromide, PI, opiates

34

lisinopril can do what to kidneys

type IV RTA

35

another name for hyperchloremia acidosis

hypoaldosteronism, hyporenin

36

type of RTA caused by DM

type IV hypoaldosterone hyporenin

37

if Cl is high what should HCO3 be

drop in HCO3, if not then Pt will vomit

38

prolactinoma level of PRL

>200

39

how would a men present with PRLoma

low libido
usually presents later on

40

patient has >200 PRL levels but no Sx and negative MRI

macroprolactinemia

41

what do you do if suspect macroprolactinmeia

precipitate IgGs with polyethylene glycol and then remeasure
screen for pituitary insufficiency: cortisol and T4 levels

42

Tx prolactinemia

Dopamine agonists
surgery
radiation

43

what are the side effects from dopamine agonists activating D1 R

nausea, fatigue, psychiatric Sx

44

peripartum cardiomypopathy

women secreting abnormal prolactin levels