Endocrine: Pituitary Disorders

Question 1

Anterior pituitary synthesizes what hormones? (6)

Answer 1

ACTH, GH, TSH, FSH, LH, Prolactin

Question 2

The intermediate pituitary produces ____ which has what effect?

Answer 2

MSH, skin pigmentation

Question 3

The posterior pituitary stores which homrones?

Answer 3

oxytocin, ADH

Question 4

Which hormone of the posterior pituitary?

stimulate water reabsorption

conc. Urine

Released in response to hypertonicity

Answer 4

ADH

Question 5

Which posterior pituitary hormone has the following characteristics?

↑ uterine contractions

Lactation: contracts milk ducts

Positive feedback mechanism

Answer 5

prolactin

Question 6

The following S/S should be immediately concerning for…

bitemporal hemianopsia
Visual Impairment
Diplopia
HA

Answer 6

sellar masses (adenoma)

Question 7

Sellar masses are often identified how?

Answer 7

incidental MRI finding

Question 8

What is the size cutoff between a micro or macroadenoma?

Answer 8

1cm

Question 9

60% of pituitary adenomas are…

Answer 9

prolactinomas

Question 10

pituitary adenoma of gonadotrophs would have what effect on them?

Answer 10

non-functioning

Question 11

pituitary adenoma of thyrotrophs would have what effect on them?

Answer 11

↑ TSH

Question 12

pituitary adenoma of corticotrophs would have what effect on them?

Answer 12

↑ ACTH

Question 13

Prolactinomas have what effect on lactotrophs?

Answer 13

↑ prolactin → hypogonadism

Question 14

pituitary adenoma of somatotroph would have what effect on them?

Answer 14

↑ GH → acromegaly

Question 15

How is sellar mass/adenoma diagnosed?

Answer 15

MRI or hormonal hypersecretion

Question 16

what lab tests can be ordered to assess a sellar mass/adenoma?

Answer 16

serum prolactin
IGF-1 (GH assessment)
T3/T4/TSH
24 hour urine cortisol (ACTH)

Question 17

Male patient presents w.

↓ libido
impotence
infertility
gynecomastia
\+/- galactorrhea

Answer 17

Prolactinoma

Question 18

How is prolactinoma diagnosed in men?

Answer 18

serum prolactin > 20

MRI

Question 19

A pre-menopausal woman presents w.

infertility
oligomenorrhea/amenorrhea
Galactorrhea

Answer 19

prolactinoma

Question 20

How is prolactinoma diagnosed in pre-menopausal women?

Answer 20

serum prolactin > 30

MRI

Question 21

A post-menopausal woman presents w.

HA
impaired vision
+/- galactorrhea

Answer 21

Prolactinoma

Question 22

How is prolactinoma diagnosed in post-menopausal women?

Answer 22

Serum Prolactin > 20

MRI

Question 23

Medical tx for prolactinoma…

Answer 23

Cabergoline (prolactin antagonist)

bromocriptine (DA agonist)

Question 24

surgical tx for prolactinoma

Answer 24

transsphenoidal resection, +/- radiotherapy

Question 25

What is the most common cause of GH excess

Answer 25

benign pituitary macroadenoma

Question 26

the below are less common causes of... ectopic tumor, MEN Type I, Neurofibromatosis

Answer 26

GH excess

Question 27

GH excess is more or less common in children or adults?

Answer 27

adults

Question 28

What manifestation of GH excess occurs in adults?

Answer 28

Acromegaly (Hands/Feet/Jaw)

Question 29

acromegaly confers increased risk for...

Answer 29

DM/HTN/CAD Risk

Question 30

GH excess manifests as ____ in children, resulting in excessive long bone growth

Answer 30

gigantism

Question 31

Increased GH corresponds with increased ______ from the liver

Answer 31

IGF-1

Question 32

A patient presents with... 30s DM/HTN/CAD +/- HF w. LV dilation

Answer 32

acromegaly

Question 33

why is random serum GH not an accurate lab test for GH excess?

Answer 33

Pulsatile GH Release Thruout Day

Question 34

What is the 1st test for GH excess?

Answer 34

serum IGF-1

Question 35

The below is the gold standard dx for... 2-hour OGTT showing failure of GH decrease to < 2mcg/L

Answer 35

GH excess | hyperglycemia should inhibit gonadotrophs

Question 36

What imaging can aid in dx of GH excess?

Answer 36

MRI showing pituitary tumor (95%)

Question 37

Surgical tx for GH excess...

Answer 37

Transsphenoidal Microsurgery

Question 38

Medical tx for GH excess

Answer 38

Octreotide/Lanreotide | Somatostatin Analogs

Question 39

In GH excess Transsphenoidal Microsurgery is indicated when?

Answer 39

GH < 50 ng/mL, tumor ≤ 2cm

Question 40

What must be monitored and when after Transsphenoidal Microsurgery for GH excess?

Answer 40

IGF-1 q 3-6 mo | directly linked to morbidity and mortality

Question 41

These GH excess drugs are inhibitory, may decrease tumor size...

Answer 41

Octreotide/Lanreotide | Somatostatin Analogs

Question 42

MC cause of GH deficiency?

Answer 42

pituitary adenoma

Question 43

rare but serious cause of GH deficiency?

Answer 43

Sheehan syndrome

Question 44

With GH deficiency, the following are increased or decreased? Lean Body Mass Bone Density QOL

Answer 44

decreased

Question 45

With GH deficiency, the following are increased or decreased? Fat Mass Fx risk CVD Mortality

Answer 45

Increased

Question 46

Diagnosis for GH deficiency relies of ID of pituitary adenoma via..

Answer 46

MRI

Question 47

What labs can be helpful in identifying GH deficiency? (5)

Answer 47

``` CBC CMP Lipid Panel Fasting insulin IGF-1 ```

Question 48

In addition to MRI, what imaging modality is helpful for GH deficiency?

Answer 48

DEXA scan

Question 49

Who should be evaluated for GH deficiency?

Answer 49

Known hypothalamic/pituitary disease hx of GH deficiency in childhood

Question 50

What is the tx for GH deficiency?

Answer 50

If Childhood Onset | GH SC QD

Question 51

The below are SFx of... peripheral edema arthralgia paresthesia worsening glucose tolerance

Answer 51

GH therapy

Question 52

What type of male hypogonadism? ↓ T ↑ FSH/LH (hypergonadotrophic hypogonadism)

Answer 52

primary

Question 53

What type of male hypogonadism? ↓ T, FSH, LH (hypogonadotrophic hypogonadism)

Answer 53

secondary

Question 54

What causes primary male hypogonadism? | hypergonadotrophic hypogonadism

Answer 54

failure of testis

Question 55

What causes secondary male hypogonadism? | hypogonadotrophic hypogonadism

Answer 55

defects in HPT axis

Question 56

A patient presents w. ED hot flash gynecomastia infertility ↓ energy, libido, muscle mass, body hair

Answer 56

Male hypogonadism | sxs of estrogen excess

Question 57

What 4 labs help diagnose male hypogonadism? What information do these labs give you about etiology?

Answer 57

Free & Total Serum Testosterone, LH, FSH determines primary vs secondary

Question 58

what f/u tests should be ordered if you determine secondary male hypogonadism?

Answer 58

Serum Prolactin, TSH, CBC, CMP, semen analysis, MRI

Question 59

What tx regimen is recommended to treat male hypogonadism?

Answer 59

Testosterone IM q 2 weeks, transdermal Testosterone QD THEN SC Testosterone Pellets Q 3 mo

Question 60

What 2 screenings should be done before initiating testosterone therapy, and what is contraindicated?

Answer 60

DRE & PSA (annual if T therapy initiated) Prostate CA C/I

Question 61

the below tests should be used for monitoring before or during T therapy? Free & Total T CBC (erythrocytosis) Free Estradiol DRE/PSA

Answer 61

during

Question 62

what should always be considered with a traumatic birth?

Answer 62

Sheehan's syndrome/Pan-hypopituitarism

Question 63

This disease is postpartum pituitary necrosis after hypovolemia during/after childbirth

Answer 63

sheehan's syndrome/pan-hypopituitarism

Question 64

What is the initial sx of sheehan's syndrome/pan-hypopituitarism?

Answer 64

agalactorrhea/difficulty lactating

Question 65

What does the workup for pan-hypopituitarism/sheehan's look like? (4)

Answer 65

H&P full hormone workup brain MRI stimulation tests to exclude primary disease

Question 66

What is the tx for pan-hypopituitarism/sheehan's?

Answer 66

Extensive hormone replacement 1500 mg Ca2+ + 800 IU Vit. D. QD

Question 67

What hormones should be administered with sheehan's as part of extensive hormone replacement?

Answer 67

Levothyroxine dexamethasone T (for males)/Estrogen-Progestin (for females) GH

Question 68

Presentation: Dilute Urine Polyuria Polydipsia, Nocturnia/Enuresis

Answer 68

central DI

Question 69

What is a late stage finding in central DI?

Answer 69

hypernatremia

Question 70

Central DI is most commonly by...

Answer 70

idiopathic ↓ ADH Release

Question 71

The below is the workup for... 24 hr Urine Collection Urine SG Serum/Urine Osmolality ``` Serum Lytes Serum Glucose (r/o DM) ``` Desmopressin Testing MRI

Answer 71

Central DI

Question 72

The following test results indicate... 24 Hr. Urine Collection: > 3L/day (elevated) Urine Osmolality: < 250 mOsm/kg (low) Serum Osmolality: Normal to High Serum Sodium: Normal to High

Answer 72

Central DI

Question 73

What is 1st line tx for central DI?

Answer 73

Desmopressin, IN, PO, SC/IV

Question 74

The below drugs can be used after 1st line drugs to treat... Chlorpropamide carbamazepine thiazides NSAIDs

Answer 74

Central DI

Question 75

↑ ADH Release Caused by: Trauma, CNS Disorders, Malignancy

Answer 75

SIADH

Question 76

4 hallmark S/S for SIADH?

Answer 76

Concentrated Urine ↓ Urine Volume High Urine Osm. Hyponatremia

Question 77

The below is the workup for... 24 hr Urine Collection Urine Sodium Serum/Urine Osm. Serum Lytes CT/MRI Head CXR ( r/o paraneoplastic syndrome)

Answer 77

SIADH

Question 78

The below lab results indicate... 24 Hr. Urine Collection: < 2000 mL/Day (Low) Urine Osmolality: > 1200 mOsm/Kg (High) Serum Osmolality: Low Serum Sodium: Low Urine Sodium: > 40 mmol/L

Answer 78

SIADH

Question 79

What is the 1st line tx for SIADH and with what goal?

Answer 79

Fluid Restriction (< 800 mL/Day) correcting hyponatremia

Question 80

In addition to fluid restriction, what can be added to tx SIADH?

Answer 80

PO Salt Vasopressin receptor agonists IV Hypertonic Saline (if severe/resistant)

Question 81

What role does prolactin have in males?

Answer 81

work with T for increased repro