Pituitary

Question 1

What is the cause and clinical presentation of acromegaly?

Answer 1

GH excess after puberty. Acral/facial changes, headache, hyperhidrosis, oligo/amenorrhea, obstructive sleep apnea, HTN, dyslipidemia, carpal tunnel syndrome, DM.

Question 2

What is the cause and clinical presentation of gigantism?

Answer 2

GH excess before puberty. Excessive linear growth.

Question 3

What is the clinical presentation of AoGHD?

Answer 3

More fat less muscle and bone. Hypercholesterolemia, increased inflammatory and pro-thrombotic markers, impaired energy and mood, impaired quality of life.

Question 4

What is the clinical presentation of hyperprolactinemia?

Answer 4

Glactorrhoea, menstrual irregularity, infertility, headache, impotence, visual field abnormalities. Female predominance. Different presentation in M and F.

Question 5

What is the clinical presentation of prolactin deficiency?

Answer 5

In F, failed lactation post-partum. No presentation in M.

Question 6

What is the clinical presentation of hypercortisolism/Cushing Syndrome?

Answer 6

Changes in carbohydrate, protein, and fat metabolism, changes in sex hormones, salt and water retention, impaired immunity, neurocognitive changes. Violaceous striae.

Question 7

What is the clinical presentation of central adrenal insufficiency (AI)?

Answer 7

Fatigue, anorexia, nausea/vomiting, and weight loss. Generalized malaise/aches. Scant axillary/pubic hair, hyponatremia and hypoglycemia.

Question 8

What is the clinical presentation of hypogonadism in females?

Answer 8

Anovulatory cycles, oligo/amenorrhea, infertility, vaginal dryness, dyspareunia, hot flashes, decreased libido, breast atrophy, reduced bone mineral density (BMD)

Question 9

What is the definition of hypopituitarism?

Answer 9

Deficiency of 1 or more pituitary hormones

Question 10

What is apoplexy?

Answer 10

Headache, vision changes, ophthalmoplegia, and altered mental status caused by the sudden hemorrhage or infarction of the pituitary gland.

Question 11

What is the definition and clinical presentation of SIADH?

Answer 11

Syndrome of inappropriate ADH release/action. Most common cause of hyponatremia. Presentation depends on severity of hyponatremia. Neuro symptoms from osmotic shifts and brain edema.

Question 12

What is diabetes insipidus (DI)?

Answer 12

Syndrome of hypotonic polyuria as a result of either inadequate ADH secretion or inadequate renal response to ADH.

Question 13

What are the 5 cell types of the anterior pituitary?

Answer 13

Somatropes, lactotropes, corticotropes, gonadotropes, and thyrotropes

Question 14

What do somatotropes secrete and where does it act?

Answer 14

GH; liver to make IGF-1

Question 15

What do lactotropes secrete and where does it act?

Answer 15

Prolactin; breast for lactation

Question 16

What do corticotropes secrete and where does it act?

Answer 16

ACTH; adrenal gland to make cortisol

Question 17

What do gonadotropes secrete and where does it act?

Answer 17

FSH, LH; gonads to make sex steroids

Question 18

What do thyrotropes secrete and where does it act?

Answer 18

TSH; thyroid to make T4 and T3

Question 19

What stimulates and what inhibits somatotropes?

Answer 19

Stimulated by GHRH and inhibited by SRIF (somatostatin)

Question 20

What stimulates and what inhibits corticotropes?

Answer 20

Stimulated by CRF, no inhibition

Question 21

What stimulates and what inhibits lactotropes?

Answer 21

Stimulated by TRH and inhibited by DA

Question 22

What stimulates and what inhibits gonadotropes?

Answer 22

Stimulated by GnRH, no inhibition

Question 23

What stimulates and what inhibits thyrotropes?

Answer 23

Stimulated by TRH and inhibited by SRIF (somatostatin)

Question 24

What are the physiological causes of hyperprolactinemia?

Answer 24

Pregnancy, suckling, sleep, stress

Question 25

What are the pharmacological causes of hyperprolactinemia?

Answer 25

Estrogens, antipsychotics, antidepressants, antiemetics, opiates

Question 26

What are the pathological causes of hyperprolactinemia?

Answer 26

Pituitary stalk interruption, hypothyroidism, chronic renal/liver failure, seizure, prolactinoma

Question 27

What is the most common functional pituitary adenoma?

Answer 27

Prolactinoma

Question 28

What are the functions of cortisol?

Answer 28

Gluconeogenesis, breakdown of fat and protein for glucose production, control inflammatory reactions.

Question 29

What is the most common cause of Cushing's?

Answer 29

Exogenous steroids

Question 30

What is the most common cause of AI?

Answer 30

Exogenous steroids

Question 31

What is the clinical presentation of hypogonadism in males?

Answer 31

Reduced libido, ED, oligospermia or azospermia, infertility, decreased muscle mass, testicular atrophy, decreased BMD, hot flashes with acute and severe onset of hypogonadism.

Question 32

What are some causes of hypogonadism?

Answer 32

Macroadenomas, prolactinomas, XRT, hemochromatosis, starvation, opiates, glucocorticoids

Question 33

Which is more common, primary or secondary thyrotropin elevation?

Answer 33

Primary

Question 34

Describe the triphasic response to post-op/trauma-related DI.

Answer 34

Primary phase: DI-polyuric phase due to axonal shock/decreased AVP relsease (days 1-5) Secondary phase: SIADH from degenerating neurons/excessive AVP release (days 6-11) Tertiary phase: Permanent DI after depleted ADH stores and if >80% AVP neuronal cell death - very uncommon

Question 35

What is the most common tumor of the pituitary?

Answer 35

Pituitary adenoma

Question 36

Does size correlate with aggressiveness of a pituitary adenoma?

Answer 36

No

Question 37

Are most pituitary tumors familial or sporadic?

Answer 37

95% sporadic

Question 38

Which gene has been identified as a mutated gene in patients with familial isolated pituitary adenomas?

Answer 38

AIP

Question 39

What can a Rathke cleft cyst lead to?

Answer 39

DI

Question 40

What is the most common cancer to metastasize to the pituitary?

Answer 40

Breast cancer

Question 41

Which tumor type primarily affects children?

Answer 41

Craniopharyngioma

Question 42

CRH and GHRH are coupled to which G protein?

Answer 42

Gs

Question 43

Somatostatin is coupled to which G protein?

Answer 43

Gi

Question 44

What is the action of oxytocin?

Answer 44

Secreted during birth, sexual intercourse, and in response to suckling.

Question 45

What chronically suppresses PL?

Answer 45

DA

Question 46

Upon binding of PL to its receptor, which pathway is activated?

Answer 46

JAK/STAT

Question 47

What are the lab findings of Primary AI?

Answer 47

Very high ACTH, low cortisol aldosterone and adrenal androgens. Hyponatremia and hyperkalemia.

Question 48

What are the features of Autoimmune polyglandular syndrome-1?

Answer 48

AI (Addison's), Hypoparathyroidism, DM Type 1, and mucocutaneous candidiasis

Question 49

What are the features of Autoimmune polyglandular syndrome-2?

Answer 49

AI (Addison's), Hypoparathyroidism, and DM Type 1

Question 50

What are the lab findings of Secondary AI?

Answer 50

Low ACTH, low cortisol, low adrenal androgens, and NORMAL aldosterone because it is controlled mainly by RAAS

Question 51

What are the two most common causes of secondary AI?

Answer 51

Glucocorticoids and opioids

Question 52

What is the treatment of primary AI?

Answer 52

Mineralocorticoid and glucocorticoid replacement

Question 53

What is the treatment of secondary AI?

Answer 53

Glucocorticoid replacement only

Question 54

What are the three clinical features of primary aldosteronism?

Answer 54

HTN, hypokalemia, and metabolic alkalosis