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Y3R5: Medicine I 🩺 > L8: Pituitary Disorders > Flashcards

L8: Pituitary Disorders Flashcards

(175 cards)

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1
Q

Anatomy of hypothalamus

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2
Q

Anatomy of pituitary gland

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3
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Lobes of pituitary gland

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4
Q

Types of cells in anterior Lobe

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a. Chromophobe cells “NON functioning”
b. Chromophil cells “functioning i.e. secreting”

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5
Q

Types of Chromophil cells in Pituitary Gland

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6
Q

Posterior Lobe of Pituitary Gland

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  • Act as storage for Oxytocin & Anti- Diuretic Hormone (ADH), which are synthesized in the hypothalamus in the Para-ventricular & Supra-optic nuclei
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7
Q

Control of Pituitary Gland

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8
Q

What are Releasing factors for Pituitary Gland?

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9
Q

What are Release-inhibiting Factors for Pituitary Gland?

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10
Q

Negative Pituitary Feedback (long & Short)

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11
Q

What are disorders of Pituitary gland?

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12
Q

Def of Hyperprolactenemia

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S. prolactin > 25 ng /dl.

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13
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Causes of Hyperprolactenemia

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14
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Physiologic Causes of Hyperprolactenemia

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15
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Pathological Causes of Hyperprolactenemia

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16
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Pharmacologic Causes of Hyperprolactenemia

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17
Q

idiopathic Causes of Hyperprolactenemia

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18
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CP of Hyperprolactenemia

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19
Q

Mass effects of Pituitary Hyperprolactenemia

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20
Q

Work up of Patient with Hyperprolactinemia

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21
Q

Investigations for Pituitary Hyperprolactinemia

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22
Q

TTT of Pituitary Hyperprolactinemia

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23
Q

Medical TTT of Pituitary Hyperprolactinemia

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24
Q

Duration of Medical TTT of Pituitary Hyperprolactinemia

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25
Bromocriptine in Medical TTT of **Pituitary Hyperprolactinemia**
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cabergoline in Medical TTT of **Pituitary Hyperprolactinemia**
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Surgical TTT of **Pituitary Hyperprolactinemia**
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Indications of Surgical TTT of **Pituitary Hyperprolactinemia**
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Complications of Surgical TTT of **Pituitary Hyperprolactinemia**
Hypopituitarism, CSF rhinorrhea, Meningitis, Optic nerve damage.
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Radiotherapy in **Pituitary Hyperprolactinemia**
31
Function of **GH**
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What stimulates **GH**?
33
What Inhibits **GH**?
34
Def of **Acromegaly**
It is the clinical syndrome that results from persistent hypersecretion of growth hormone (GH) & hence IGF-1 in adults
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Causes of **Acromegaly**
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CP of **Acromegaly**
Refer to Summary
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Changes in appearence - CP of **Acromegaly**
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Acromegalic Facies - CP of **Acromegaly**
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Hands & feet - CP of **Acromegaly**
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Bones & Joints - CP of **Acromegaly**
Kyphosis & Osteoarthrosis
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Organomegaly - CP of **Acromegaly**
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Metabolism & Electrolytes - CP of **Acromegaly**
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Neurological Manifestations - CP of **Acromegaly**
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Endocrinal Manifestations - CP of **Acromegaly**
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Major causes of death in untreated acromegaly
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Indicators of disease activity in acromegaly
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Investigations for **Acromegaly**
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Lab Investigations for **Acromegaly**
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OGTT for **Acromegaly**
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Rad Investigations for **Acromegaly**
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X-Ray in **Acromegaly**
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CT & MRI in **Acromegaly**
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Abdominal & Chest Imaging in **Acromegaly**
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Hand & Spine X-Ray in **Acromegaly**
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Other Investigations for **Acromegaly**
 Visual field examination  ECG & ECHO  Colonoscopy & Investigations of DM & HTN
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TTT of **Acromegaly**
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Surgical TTT in **Acromegaly**
Trans-sphenoidal (most common) or Tans- frontal
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Pituitary Irradiation in **Acromegaly**
If surgery is refused or contraindicated BUT with tumors with NO supra-sellar extension
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Medical TTT of **Acromegaly**
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Approach for Dx of **Acromegaly**
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Def of **Gigantism**
Growth hormone ( GH and IGF-1 ) excess that occurs before fusion of the epiphyseal growth plates ---> rapid, excessive linear growth & extremely tall stature
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Causes of **Gigantism**
- Pituitary GH-secreting Hyperplasia (Commonest) OR adenoma - Hypothalamic GH-releasing hormone excess - Ectopic GH or GHRH secretion [rare].
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CP of **Gigantism**
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DDx of Rapid Linear Growth
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Investigations & TTT of **Gigantism**
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Hormones of posterior pituitary
- ADH - Oxytocin
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what is another name of ADH?
Vasopressin
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Function of ADH
- Stimulate water reabsorption by renal tubules water retention - Vasoconstriction
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Functions of Oxytoxin
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Hypothalamic posterior pituitary control
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Control of ADH
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Def of **Diabetes Insipidus**
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Classification of **Diabetes Insipidus**
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Causes of **Pituitary “Cranial – Central” diabetes insipidus**
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Causes of Nephrogenic “Peripheral” DI
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CP of **Diabetes Insipidus**
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DDx of **Diabetes Insipidus**
Other Causes of Polyuria
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Dx of **Diabetes Insipidus**
Lab & Rad
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Lab Dx of **Diabetes Insipidus**
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Urine Osmolarity **Dx of Diabetes Insipidus**
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Plasma Osmolarity Lab Dx of **DI**
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Significance of Fluid Deprivation Test
Test differentiates patients with DI from patients with primary polydipsia.
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Physiologic Principle of Fluid Deprivation Test
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Dose in **Desmopressin challenge [DDAVP]**
The patient is then given 4 µg IV or SC desmopressin or 10 µg nasal with urine volume and urine & serum osmolality measured over the next 4h (/30 min).
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Significance of **Desmopressin challenge [DDAVP]**
Test differentiates central DI from nephrogenic DI.
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Physiologic Principle of **Desmopressin challenge [DDAVP]**
Physiologic principle: DDAVP causes urine concentration. - Patients with central DI will concentrate urine after receiving DDAVP; patients with nephrogenic DI will not.
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Rad Dx of DI
CT, MRI of Sella tursica to exclude pituitary tumor.
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TTT of DI
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TTT of Central DI
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Drug of Choice in Central DI
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SE of Pitressin tannate in oil
pallor, angina, bronchospasm, uterine contraction.
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TTT of **Nephrogenic DI**
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Drugs used in **Nephrogenic DI**
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Def of **SIADH**
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When should **SIADH** be suspected?
- SIADH should be suspected in any patient with euvolemeic hyponatremia, hyposmolality & urine osmolality > 100 mosmol/kg
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Pathophysiology of **SIADH**
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Etiology of **SIADH**
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what are CNS Problems that cause **SIADH**?
Stroke, Hge, infection, trauma & psychosis ----> enhance ADH release.
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Pulmonary Causes of **SIADH**
pneumonia (legionella), T.B.
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Tumors causing **SIADH**
- Ectopic production of ADH by small cell carcinoma of the lung (most common). - Less common H & N cancer, olfactory neuroblastoma, lymphoma, leukemia.
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Drugs Causing **SIADH**
( Increase ADH release or effect) - Chlorpropamide, Carbamazepine, high-dose IV Cyclophosphamide & SSRIs.
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Surgery & **SIADH**
Hyponatremia is a common late complication of trans-sphenoidal pituitary surgery.
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Diagnostic Criteria of **SIADH**
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Investigations for **SIADH**
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TTT of **SIADH**
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Vasopressin antagonist in TTT of **SIADH**
**Tolvaptan** - Competitive vasopressin receptor 2 antagonist - Used for resistant hyponatremia
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Hypertonic saline in TTT of **SIADH**
In emergency (slowly I.V. infusion) - Rapid normalization (> 0.5mmol/h) of Na+ may be ass. With Central Pontine Mylenosis & other CNS damage.
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Def of **Polyuria**
Urine volume > 2000 cc/day
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Causes of **Polyuria**
- Physiological (functional) - Psychological (hysterical) - Pathological
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Physiological Causes of **Polyuria**
- High water intake : ↓ ADH secretion - Winter time : ↓ sweating - Alcoholic beverages, coffee, tea, beer
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Psychological Causes of **Polyuria**
**Compulsive water drinking** - Low plasma osmolality < 290 mosmol/kg - Water deprivation: ↓ urine volume & ↑ urine osmolality - No improvement after ADH - Treatment is by sedative & hypnotic
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Pathological Causes of **Polyuria**
- Renal - Endocrinal - Drugs - Miscellaneous
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Renal causes of **Polyuria**
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Endocrinal Causes of **Polyuria**
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Drugs Causing **Polyuria**
Drugs causing nephrogenic DI : lithium, Demeclocycline
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Miscellenoues Causes of Transient **Polyuria**
Migraine, Epilepsy, Paroxysmal tachycardia, Bronchial asthma
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Def of **Pituitary Dwarfism**
1ry deficiency of GH in childhood.
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Causes of **Pituitary Dwarfism**
 Deficiency of GH-RH from hypothalamus  Deficiency of GH from pituitary  End organ unresponsiveness (Levi-Laron syndrome)
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CP of **Pituitary Dwarfism**
 Proportionate dwarfism.  Pseudo-super-intelligence.  Protein induced hypoglycemia
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Investigations for **Pituitary Dwarfism**
1) Fasting level of GH: low (+ low IGF-1) 2) Growth hormone stimulation test: negative 3) Insulin induced hypoglycemia: normally ↓ blood sugar to 50 mg →↑ GH level.
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TTT of **Pituitary Dwarfism**
Recombinant GH.
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Causes of **Froehlich's Syndrome**
Hypothalamo-pituitary tumor (as craniopharyngioma).
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CP of **Froehlich's Syndrome**
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Characters of Samboxa shape obesity
fat is deposited in the face, shoulder, trunk, hips but sparing the extremities
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Def of **Laurence-Moon-Biedel Syndrome**
Rare congenital AR disease
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CP of **Laurence-Moon-Biedel Syndrome**
- Features of Froehlich's syndrome - Polydactyly - Skull deformations, mental retardation - Retinitis pigmentosa
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TTT of **Laurence-Moon-Biedel Syndrome**
Recombinant GH.
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DDx of hypopituitarism in children
- Dwarfism. - Infantilism = Short stature & hypogonadism
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Def of **Short Stature**
- Child whose height is 2 standard deviations (SD) or more below the mean for children of that sex and chronologic age (and ideally of the same racial-ethnic group). - This corresponds to a height that is below the 3rd percentile of normal people for their own sex & age.
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Causes of **Short Stature**
- Endocrinal causes - Chronic severe-illness during childhood - Skeletal causes - Genetic disordes
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endocrinal causes of **Short Stature**
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Chronic Severe Illness & **Short Stature**
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Skeletal causes of **Short Stature**
- Congenital - Acquired
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Congenital Skletal Causes of **Short Stature**
- Achondroplasia - Osteochondrodystrophy - Osteogenesis imperfecta
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Achondroplasia
**disproportionate dwarfism** - Height > Span & Upper segment > Lower segment - Big skull & depressed nose
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Osteochondrodystrophy
limbs & trunk are short and deformed
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Osteogenesis imperfecta
- Fragile bone leading to pathological fracture + malfusion + dwarfism + joint dislocation. - Blue sclera. - Deafness due to otosclerosis.
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Acquired Skeletal Causes of **Short Stature**
- Rickets - Pott’s disease of spine - Paget’s disease of bone
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Genetic Disordres & **Short Stature**
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Algorithm of **Short Stature**
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what is the most common cause of disproportionate **Short Stature**?
Achondroplasia
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Algorithm to short stature
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Familial Vs Constitutional short stature
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Approach to short stature **Notes**
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How to do **Comparison with Child’s Own Genetic Potential**?
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Bone Age
- Bone age assessment should be done in all children with short stature. - Bone age is delayed compared to CA in almost all causes of pathological short stature.
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Investigations for short stature
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Managment of short stature
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Types of hypopituitrism in adults
- Isolated & Pan
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Causes of Isolated Hypopituitrism
 ↓ TSH: 2ry hypothyroidism  ↓ ACTH: 2ry hypocorticism  ↓ Gonadotrophins: (2ry hypogonadism)
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Def of Kallman's Syndrome
Kallmann syndrome (anosmia - midline fascial deformities - renal abnormalities & color blindness)
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Causes of Panhypopituitrism (Simmon's Disease)
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CP of Panhypopituitrism (Simmon's Disease)
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Manifestations of hormones deficiency in pamhypopituitrism
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Difference between 1ry & 2ry Decreases in ACTH
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First presentatation in Panhypopiyuitrism
2ry hypogonadism
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GH in Panhypopiyuitrism
late & minimal - Atrophy of viscera & skin wrinkling & weakness & wasting. - Hypoglycemia, premature CVS disease, reduce muscular mass.
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What Causes Coma in Panhypopiyuitrism?
due to :  Hypoglycemia  Hypothermia  Pressure by tumor on brain stem reticular formation
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DDx of Panhypopiyuitrism
154
Investigations for Panhypopiyuitrism
155
TTT of Panhypopiyuitrism
A. TTT of cause if possible. B. Replacement therapy
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Replacment of Panhypopiyuitrism
157
Gonadal hormones replacment in Panhypopiyuitrism
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Thyroxin replacment in Panhypopiyuitrism
159
Drugs for pituitary Crisis
 Hydrocortisone.  Volume expansion  Hypertonic saline
160
Classification of pituitary tumors
161
Benign pituitary tumors
162
Malignant pituitary tumors
Primary (germ cell tumors and lymphoma) or secondary to breast cancer and lung cancer.
162
CP of pituitary tumors
163
Dx of pituitary tumors
164
Lab Dx of Malignant pituitary tumors
165
Rad Dx of Malignant pituitary tumors
MRI brain (better than CT scan in evaluating pituitary tumors): lesions < 1 cm in diameter (microadenoma) while lesions > 1 cm (macroadenoma).
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DDx in Malignant pituitary tumors
from other causes of sellar masses: - Pituitary hyperplasia: Lactotroph hyperplasia during pregnancy. - Cysts: Rathke's cleft. - Hypophysitis: lymphocytic hypophysitis. - Infiltration: sarcoidosis, and Langerhans cell histiocytosis.
167
Managment of Malignant pituitary tumors
according to type, size of the tumor & pituitary hormonal status. 1. Surgery: trans-sphenoidal or sub frontal approach. 2. Radiotherapy: conventional or gamma knife technique. 3. Medical: somatostatin analogues and/or dopamine agonists.
168
Done
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Y3R5: Medicine I 🩺 (47 decks)

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