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ENDO 1 MOD > pituitary d/o & ED > Flashcards

pituitary d/o & ED Flashcards

(60 cards)

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1
Q

name the two hormones secreted by POST pit

A

Oxytocin and ADH

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2
Q

negative feedback loop

A

causes a decrease in function
more common feedback

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3
Q

positive feedback loop

A

increases a function till outcome is reached or stimulus is removed
ex. oxytocin production

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4
Q

how is oxytocin production controlled

A

positive feedback mechanism
causes milk release or labor contractions which signals more production of oxytocin and continues till delivery or feeding is done

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5
Q

what symptom is caused by excess prolactin hormone

A

galactorrhea/amenorrhea
hypogonadism in men & women

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6
Q

what is galactorrhea

A

milky nipple discharge unrelated to normal milk production

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7
Q

condition of excess ACTH

A

Cushing Disease

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8
Q

condition of excess TSH w/ normal T4

A

hyperthyrotropinemia

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9
Q

condition of excess LH/FSH

A

hypergonadotropinemia

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10
Q

general rule of what causes hyperprolactinemia

A

anything that disrupts the pituitary stalk and blocks dopamine inhibition

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11
Q

what is the most common pituitary tumor

A

prolactinoma

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12
Q

what controls prolactin secretion

A

dopamine. presence of dopamine inhibits the secretion of prolactin

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13
Q

causes of hyperprolactinemia

A

physiologic (stress, pregnancy, etc)
pharmacologic (anti-depressants, H2 blockers, opiods, etc)
pathologic (prolactinoma, renal failure, etc)

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14
Q

drugs that induce hyperprolactinemia

A

anti depressant/anti-psychotics
estrogen
H2 blockers

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15
Q

what is a prolactinoma

A

most common functioning adenoma; can cause hyperprolactinemia

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16
Q

mass effect of prolactinomas result in… (2 things)

A

visual changes (bitemporal hemianopsia)
headache

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17
Q

treatment for prolactinoma

A

dopamine agonist
surgery (transphenoidal resection)
XRT (radiation)

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18
Q

what are the two dopamine agonists that can be used to treat prolactinomas? what are their ADR?

A

bromocriptine & cabergoline
ADR- nausea, lightheadedness, congestion

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19
Q

what labs are needed if a pituitary tumor is suspected?

A

1 Prolactin

TSH, LH, GH, FSH
Estrogen, pregnancy test

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20
Q

what are normal prolactin levels

A

men <20, women <25 pregnant is up to 400

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21
Q

what would be seen on an MRI if theres pituitary tumor

A

stellar mass

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22
Q

acromegaly vs gigantism

A

acromegaly– growth plates closed so they are not super tall
gigantism– before epiphyses close so they get very tall

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23
Q

etiology of gigantism and acromegaly

A

GH secreting adenoma

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24
Q

sx of GH excess

A

increased growth of distal parts (spade like hands, phalangeal bony overgrowth)
macroglossia, enlarged sinus/frontal bossing (lantern jaw)
organomegaly (liver, spleen, kidneys)
prominent nasolabial folds

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25
diagnostics if suspecting excess GH
serum GH IGF-1 MRI
26
what must you do before collecting serum GH
give insulin first-- glucose suppresses GH levels so give it clear up glucose and see true GH levels
27
tx for excess GH
#1 surgery (transphoenoidal resection) #2 pharm: (dopaminergic drug or GH blocker- octreotide or pegvisomant) #3 XRT
28
ADR of surgical or XRT
hypopituitarism
29
effect of cortisol on hypothalamus & pituitary
inhibitory effects via negative feedback reduces CRH from hypothalamus & ACTH from pituitary
30
what is Sheehan's syndrome
hypopituitarism d/t postpartum hemorrhage causing pituitary gland necrosis
31
classic signs of sheehans syndrome
fatigue inability to lactacte low BP irregular or amenorrhea thinning of vaginal lining loss of pubic hair & wt gain
32
sequalae of sheehans syndrome
adrenal insufficiency hypothyroidism amenorrhea DI inability to breast-feed
33
diagnostics for sheehans syndrome
serum pituitary hormone levels (would be low) MRI/CT
34
how is sheehans syndrome treated?
lifelong HRT
35
hormones incharge of testosterone & spermatogenesis
LH--> Leydig cells--> testosterone FSH--> Sertoli cells--> Spermatogenesis/Inhibin B negative feedback
36
first test to check for male reproductive potential
semen analysis 2-3 separate counts at least 2-4 weeks apart
37
normal semen analysis
volume: 2-6 mL sperm conc: 20-100 mill/mL >50% motility w/ forward progression >12% normal forms <1 mill/mL WBC
38
factors contributing to male infertility
varicocele (cause 44% of time)-- bag of worms; too hot trauma-- torsion, tumor infections, high fever/heat drugs-- chemotherapy, ETOH, marijuana, tobacco, steroids, pesticides
39
Kleinfelters syndrome
47 XXY low testosterone, reduced muscle mass, facial & body hair breast enlargement little or no sperm
40
Kleinfelters syndrome
47 XXY low testosterone, reduced muscle mass, facial & body hair breast enlargement little or no sperm
41
diagnostics for kleinfelters syndrome
genetic test
42
treatment for kleinfelter syndrome
testosterone replacement & fertility treatment
43
____% of infertility amongst couple is traced back to the male
30%
44
workup for infertility
semen analysis & ovulation
45
mechanism of erections
increased arterial flow to penis relaxation of smooth muscle of trabeculae whereby blood is shunted into corpora cavernosa
46
if a young male presents with ED, it could be a hallmark sign for CV dz, what should you do to check?
lipid panel A1C they have risk of major cardiac even in 7-10 yrs
47
Organic vs Psychogenic ED
organic: gradual, have RF, consistent dysfx, no sleep erections, can have orgasms psychogenic: sudden, No RF, situational & varying dysfx, no orgasm, have sleep erections
48
RF for ED
obesity HTN, DM smoking dyslipidemia sedentary age
49
ED tx options
#1 PDE-5 inhibitors intracavernosal injections intraurethral suppository (can use w/ PDE-5) vacuum penile prosthesis (highest patient & partner satisfaction)
50
MOA of PDE5 inhibitors
potentiate effects of cGMP to prolong erections and increase sexual satisfaction
51
ADR of PDE5 inhibitors
blue tinges in vision & muscle pain (most common) HA, nausea Rhinitis flushing dyspepsia
52
if you're going to prescribe PDE5i what should you make sure of?
that pt isn't taking alpha blocker-- risk of hypotension from double smooth muscle dilation that pt isnt taking nitrate-- absolute contraindication
53
list the four PDEi meds (-afil)
sildenafil (viagra) vardenafil tadalafil-- longer half life & enhanced erectile fx (the weekender) avanafil-- shorter onset of action
54
what is Alprostadil
a prostaglandin E1 analog; vasodilator penile injection that increases cAMP
55
what is hypogonadism and how do you test for it?
low testosterone #1 measure total testosterone bioavailable testosterone if needed
56
"total" testosterone vs bioavailable testosterone
Total: free T + albumin bound T + sex hormone binding globulin (SHBG) bound T bioavailable: free T + albumin bound T
57
sx of hypogonadism (not signs)
decreased libido, energy & muscle mass increased body fat cognitive changes & depressed mood
58
Signs of hypogonadism
truncal obesity, anemia, decreased bone density
59
Tx for hypogonadism
testosterone gel & patch- daily; gel has risk of transference IM q 3 wks SQ pellets q 3 months nasal
60
when would you not want to give testosterone
male of reproductive age who wants to have kids

ENDO 1 MOD (4 decks)

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