Pituitary

Question 1

Sellar mass typical neuro sxs?

Answer 1

HA

CSF rhinorrhea

Question 2

Sellar mass typical visual sxs?

Answer 2

(most common sxs of mass)
bitemporal hemianopsis
diplopia

Question 3

Sellar mass typical hormone sxs?

Answer 3

↓ LH/FSH
↑ prolactin
↑ ACTH
↑ TSH

Question 4

Hormone hypersecretion labs?

Answer 4

Prolactin (lactotroph adenoma)

IGF1, GH (somatotroph adenoma)

TSH (thyrotropin adenoma)

ACTH, Cortisol, 24 hr urine cortisol (corticotroph adenoma)

Question 5

Hormone hyposecretion labs?

Answer 5

Same as hyper and:

LH/FSH
Free/Total Testost
Free/Total Estradiol
Vasopressin

Question 6

Pituitary mass imaging?

Answer 6

MRI w/ and w/o gadolinium

CT for craniopharyngioma or meningioma (calcification more visible)

Question 7

Prolactin actions? (4)

Answer 7

Stim lactation
Provides sexual gratification
Stim oligodendrocytes (myelin)
Fetal lung surfactant

Question 8

Prolactin levels highest when?

Answer 8

REM sleep and early a.m.

Also rise w/ exercise, food, sex, surgery

Question 9

Prolactinoma signs/sxs?

Answer 9

(Excess prolactin)

All: Visual, HA, thyroid dysfxn

Men: ↓ libido, impotence, infert, boobs/milk

Premeno W: infert, cycle dysfxn, milk

Question 10

Prolactinoma diagnositcs: clinical?

Answer 10

Check for:
Rx interference
Pregnancy
Renal dz

Question 11

Prolactinoma diagnositcs: labs?

Answer 11

Prolactin levels:
hyperprolactinema = prolactin > 20
adenoma = prolactin > 200

Question 12

Prolactinoma diagnositcs: imaging?

Answer 12

MRI w/ gadolinium

Question 13

Prolactinoma tx:

Meds?

Surgery?

Radiation?

Answer 13

Dopamine agonists (Bromocriptine):
↓ size and S/E

Transphenoidal resection:
S/E possible vasopressin dysfxn (SIADH)

Radiation:
for large/refractory tumors

Question 14

GH synth’d where?

Action?

Highest levels when?

Answer 14

anter pituitary

Stim growth
Stim IGF-1 prdxn

1 hr into sleep

Question 15

GH release stim’d by? (5)

Answer 15

GHRH
Sleep
Exercise
Protein diet
Estradiol

Question 16

GH release inhibited by? (4)

Answer 16

Neg feedback of GH/IGF1
Somatostatin
Carb diet
Glucocorticoids

Question 17

GH excess caused by? (3)

Answer 17

1) Somatotroph pituitary adenoma
2) GHRH hypothal tumor
3) Small cell lung CA

Question 18

GH excess most common when?

Answer 18

40-45 yo

Question 19

GH excess signs/sxs?

Answer 19

Visual
↑ sweat, oil
Sleep apnea
HTN, LVH
Organomegaly
HA, peripheral paresthesia
Arthralgia, OA, kyphosis
Fatigue, cold intolerance, DM

Question 20

GH excess labs?

Imaging?

Answer 20

(Best marker for somat adenoma is IGF1, not GH)

Full hormone
CBC, CMP, UA, rheum panel

MRI

Question 21

GH labs results that EXCLUDE Acromegaly?

Answer 21

GH < 0.4 and normal IGF1

Or

2hr glucose tolerance:
GH levels suppress to < 1 mcg

Question 22

Acromegaly ↑ risk of what? (5)

Answer 22

Early death
Insulin resistance
LVH/CHF
Colon CA
Musculoskeletal issues

Question 23

Acromegaly tx: Rx?

Answer 23

Somatostatin analogues:
suppress receptors on tumor ->
↓ IGF1

GH receptor agonists

Question 24

Acromegaly tx:

Surgery?

Radiology?

Answer 24

Most effective for rapid reduction
Best for micro tumors

Gamma Knife:
Not primary therapy
S/E hypopituit

Question 25

GH deficiency etiology? (5)

Answer 25

``` Normal w/ aging Pituitary dysfxn Hypothal dysfxn Radiation/surgery Uncontrolled DM ```

Question 26

GH deficiency signs/sxs?

Answer 26

Rare to have GH deficiency by itself -> (U) present w/ signs/sxs of other pituitary issues

Question 27

GH deficiency labs? Imaging?

Answer 27

Full hormone CBC, CMP, insulin, lipids DEXA (bone scan)

Question 28

GH deficiency: Next step if initial labs are abnormal?

Answer 28

Confirm dx with: Arginine-growth hormone-releasing hormone test

Question 29

GH deficiency tx?

Answer 29

DO NOT treat w/o confirmation of deficiency Recombinant GH

Question 30

Hypopituitarism from infiltrate/inflamm caused by?

Answer 30

Sarcoidosis Amylodosis Hemochromatosis Lymphatic hypophysitis

Question 31

Hypopituitarism from infiltrate/inflamm results in?

Answer 31

↓ GH, GnRH, AVP

Question 32

Hypopituitarism from infection typically caused by?

Answer 32

TB Fungus HIV Syphilis

Question 33

Hypopituitarism from infection results in?

Answer 33

↓ in some or all pituitary hormones

Question 34

Hypopituitarism from vascular disorders caused by?

Answer 34

Pituit Apoplexy: acute infarct/hemorr/shock damaging gland Sheehan's Synd: Apoplexy from severe blood loss during childbirth

Question 35

Central Diabetes Insipidus is what type of pituitary disorder?

Answer 35

``` POSTERIOR Insuff AVP (ADH) prdxn ```

Question 36

Central DI signs/sxs?

Answer 36

Dilute urine High plasma osmolarity Dehydration

Question 37

Central DI tx?

Answer 37

Desmopressin

Question 38

SIADH is what type of pituitary disorder?

Answer 38

POSTERIOR | Excess ADH prdxn

Question 39

SIADH signs/sxs? Tx?

Answer 39

Concentrated urine HypoNa+ surgical

Question 40

Panhypopituitarism is?

Answer 40

↓ in majority of pituitary hormones TSH, ACTH, GH, FSH, LH, prolactin

Question 41

Panhypopituitarism workup?

Answer 41

Full hormone MRI w/ w/o gadolinium Stim tests to r/o other dz

Question 42

Panhypopituitarism tx?

Answer 42

Replace deficient hormones | Ca2+/Vit D bone protection

Question 43

Hormonal HYPOsecretion is NOT caused by?

Answer 43

Adenoma Cause is either hypothal or pituitary lesion of some other kind, just not adenoma