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ClinMed exam III > Pituitary > Flashcards

Pituitary Flashcards

(52 cards)

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1
Q

How do exocrine glands secrete substances

A

via ducts

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2
Q

How do endocrine glands secrete substances

A

through the cells and rich capillary system

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3
Q

What control the anterior pituitary

A

hypothalamus

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4
Q

What is the best imaging to see the pituitary gland

A

MRI

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5
Q

What is the pituitary close to in the brain

A
  • optic chiasm
  • cranical nerves III,IV, VI
  • trigeminal ganglion
  • ophthalmic division V
  • carotid artery
  • cerebral circulation
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6
Q

What hormones does the anterior pituitary produce

A
  • GH
  • prolactin
  • ACTH
  • TSH
  • LH
  • FHS
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7
Q

What hormones are stored in the posterior pituitary

A
  • ADH

- oxytocin

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8
Q

What does somatostatin inhibit

A

growth hormone release

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9
Q

What does dopamine inhibit

A

prolactin release

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10
Q

What is a pituitary ademona? two types?

A

benign mass of the pituitary gland

can be functional or nonfunctional

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11
Q

What are the malignant masses of the pituitary gland

A
  • germ cell tumor
  • sarcoma
  • chordoma
  • pituitary carcinoma
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12
Q

What are the cell types of pituitary adenomas

A
  • gonadotroph
  • thyrotroph
  • corticotroph
  • lactrotroph
  • somatotroph
  • lactrotroph/somatotroph
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13
Q

What is the most common cell type in pituitary adenomas

A

lactotroph

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14
Q

Which disease/disorder does each pituitary adenoma cell type cause

A
  • gonadotroph: clinically nonfunctioning
  • thyrotroph: hyperthyroidism
  • lactotroph: hyperprolactenemia
  • corticotroph: Cushing’s disease
  • somatotroph: acromegaly
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15
Q

What genes may play a role in pituitary adenomas

A
  • MEN1
  • GS aplha
  • PTTG
  • FGF receptor 4
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16
Q

What are the signs and symptoms of pituitary adenomas

A
  • neurologic sx (visual changes, headache, CFS rhinorrhea)

- hormonal abnormlaities

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17
Q

Why do people usually seek medical attention for pituitary adenomas

A

visual changes (bitemporal hemianopia)

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18
Q

What is pituitary apoplexy

A

infarct or hemorrhage into the ademona

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19
Q

What are the symptoms of pituitary apoplexy

A
  • severe, acute onset of headache
  • vomiting
  • visual field defects
  • other cranial nerve dysfunction
  • fever, neck stiffness
  • AMS
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20
Q

What lab do you check for a lactotroph

A

serum prolactin

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21
Q

What lab do you check for a somatotroph

22
Q

What labs do you check for corticotroph

Study These Flashcards
A

24 hr urinary free cortisol and elevated ACTH

23
Q

What labs do you check for thyrotroph adenoma

Study These Flashcards
A
  • alpha subunit
  • T4
  • TSH
24
Q

What labs do you check for gonadotroph

Study These Flashcards
A
  • luteinizing hormone

- follicle stimulating hormone

25
What do you do if you find an incidentaloma >10mm
typical hormone evaluation
26
What do you do if you find an incidentaloma <10 mm
- only measure serum prolactin | - MRI at 6 months and 12 months
27
Treatment goals for nonfunctioning pituitary adenomas
- relief of visual impairment and neurologic sx - removal of macroadenomas to avoid recurrance - management of hormonal deficiencies
28
Treatment for pituitary adenoma
- surgical - medical - adjuvant radiation
29
What postoperative hormone deficiency are present after adenoma removal
- hypocortisolism | - diabetes insipidus or SIADH
30
Physiological causes of hyperprolactinemia
- sleep - physical exertion - food - stress/trauma - sex - pregnancy/post partum - nursing/nipple stimulation - surgery
31
Causes of hyperprolactinemia
- prolactinoma - acromegaly - primary hypothyroidism - seizures - PCOS - neurogenic causes - renal insufficiency - cirrhosis
32
What drugs can induce hyperprolactinemia
- ranitidine - cocaine/amphetamines - metoclopramide - opiods - risperidone - SSRIs - verapamil - hydroxyzine
33
Are prolactinomas usually macro or micro
MICRO
34
What is associated with prolactinomas
MEN1
35
Clinical manifestation of hyperprolactemia
- galactorrhea - infertility - osteopenia - decreased libido - gynecomastia in men
36
What do you need for diagnosis of a prolactinoma
- significantly elevated serum prolactin level | - MRI with a pituitary lesions
37
Labs to order for hyperprolactemia evaluation
- prolactin - TFTS - LFTs - Ca - Cre/BUN - HCG - IGF 1 (mixed adenoma)
38
When wold you treat a prolactinoma
- tumor growth - oligo or amenorrhea/ hypogonadism - bothersome galactorrhea - infertility
39
Treatment of prolactinomas
``` -Dopamine agonist (first choice) carbergoline- 1st choice bromocriptine for pregnancy -surgery -radiation ```
40
When is surgery indicated for a prolactinoma
- visual field defects unresponsive to medical therapy - macroadenomas unresponsive to medical therapy - tumor growth while on medical therapy - intolerance to medical therapy - pituitary apoplexy - CSF rhinorrhea -
41
Presentation of acromegaly
- prognathism - headaches - vision defects - skin tags - ennlarged tongue - frontal bossing - coarse features (acral enlargement) - enlarged hands and feet - osteoarthritis - carpal tunnel
42
What are comorbidities with acromegaly
- HTN/ heart disease - CVA - headache - arthritis - insulin resistant diabetes - sleep apnea
43
Baseline evaluation labs for acromegaly
- IGF 1 - pituitary function test (if macro) - PRL - glucose - LFTs - Cr/BUN - MRI - visual field
44
Medical treatment for acromegaly
- somatostatin analogs (octerotide, lanreotide) - dopamine agonists (bromocriptine, cabergoline) - GH receptor antagonist (pegvisomant)
45
Where do metastatic pituitary tumors come from
breast cancer in women | lung cancer in men
46
Where does a pituicytoma arise
posterior pituitary
47
How does a pituicytoma present
sellar mass, often mistaken for a pituitary adenoma but there is no hormone secretion
48
Signs and symptoms of germ cell tumors
- headache - N/V - lethargy - diplopia - hypopituitary - diabetes insipidus - Parinaud's syndrome
49
What is Parinaud's syndrome
paralysis of disconjugate gaze seen in germ cell tumors
50
Where do germ cell tumors arise
third ventricle
51
Signs and symptoms of chordomas
- headache - visual impairment - anterior pituitary hormonal def
52
Symptoms of metastatic disease to pituitary
- diabetes insipidus - visual field defects - anterior pituitary hormonal def - retroorbital pain and ophthalmoplegia

ClinMed exam III (7 decks)

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