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FA17 Endocrine > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

(57 cards)

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1
Q

hypothalamus is controlled by

A

controlled by cortical centers in brain and responds to emotions and sensory inputs

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2
Q

pituitary location

laterally and superiorly

A

laterally: cavernous sinuses
superiorly: optic chiasm

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3
Q

optic chiasm

A

crossing of the optic nerves

superior to pituitary

pituitary tumors lead to loss of peripheral vision

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4
Q

anterior pituitary hormones list (7)

A 
TSH 
ACTH 
FSH
LH
GH
PRL 
Endorphins
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5
Q

hypothalamus/pituitary

anterior communication

A

hypothalamus and transported to anterior lobe by pituitary portal circulation

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6
Q

posterior pituitary hormones list (2)

A

oxytocin

vasopressin (ADH_

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7
Q

posterior pituitary/hypothalamus communication

A

transported directly by neural network to the stalk and posterior lobe

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8
Q

products of hypothalamus

A 
CRH 
GnRH 
GHRH
Somatostatin 
TRH 
Dopamine
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9
Q

hypothalamus function

A

affects appetite, sleep, activity of autonomic NS and pituitary hormone secretions

hormones cause growth + release of hormones

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10
Q

HPA/Pituitary/Target:

Thyroid

A

TRH -> TSH -> T3/T4

thyroid gland

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11
Q

HPA/Pituitary/Target:

growth axis

A

GHRH -> GH -> IGLF-1

Liver

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12
Q

HPA/Pituitary/Target:

adrenal

A

CRH -> ACTH -> cortisol

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13
Q

HPA/Pituitary/Target:

gonadal

A

GnRH -> LH/FSH -> Testosterone/Progesterone, Estradiol/Inhibin

ovary, testes

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14
Q

functioning pituitary tumors

A

produce hormones

GH and prolactin

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15
Q

pituitary tumor effects depends on

A
  1. amount and kind of hormones produced
  2. location and size of tumor
  3. age/gender of patient
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16
Q

microadenomas

A

pituitary gland tumor

<10 mm

non cancer

prolactin producing

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17
Q

macroadenomas

A

pituitary gland tumor

> 10mm

growth hormone producing

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18
Q

carniopharyngioma

A

benign tumor arising from squamous cell nests

pediatric intracranial neoplasm

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19
Q

meningioma

A

typically benign and non functional pituitary gland

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20
Q

how do you screen for pituitary adenomas

A

screens for functionality by obtaining serum levels of prolactin, GH, TSH, ACTH, LH, FSH

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21
Q

symptoms of prolactinomas in women

A

menstrual irregularities or amenorrhea

vaginal dryness, pain with intercourse, and osteoporosis, galactorrhea

LH/FSH suppression and increased prolactin

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22
Q

symptoms of prolactinomas in men

A

typically present with macroadenoma and compression

decreased libido, erectile dysfunction, infertility

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23
Q

DDX of prolactinemia

Study These Flashcards
A

drugs that inhibit dopamine

pregnancy***

ESRD/cirrhosis

endocrine disorder

pituitary or hypothalamic pathology

24
Q

prolactinoma workup

Study These Flashcards
A

prolactin level, TSH, and pregnancy test

MRI with contrast, thin cuts

25
prolactinoma treatment
yearly MRI + observation can be treated with dopamine agonists(bromocriptine, stimulate DA r., surpasses prolactin and shrinks) transsphenoidal pituitary adenomactomy
26
macroadenomas (children v. adults)
secrete growth hormone child- epiphyses (growth plates) open and susceptible to GH, gigantism adult - epiphyses are closed, bones larger not longer, acromegaly
27
GH normal function
secreted by somatotropin in anterior pituitary pulsatile fashion induces ILGF-1 secretion in liver regulate muscle and bone growth + gluconeogenesis
28
GH secretion inhibited by
somatostatin and ILGF-1, hyperglycemia, leptin, multiple other peptides
29
GH secretion stimulated by
hypoglycemia fasting or starvation ghrelin
30
GH excess (macroadenomas)
acromegaly or gigantism typically due to functional pituitary adenoma
31
gigantism
GH excess in children dramatic linear growth acceleration rare disorder
32
acromegaly
insidious onset excess of GH + IGLF-1 causes insulin resistance but NOT change in height
33
clinical manifestations of acromegaly
headache, visual loss soft tissue overgrowth/skin thickening coarsening of facial features and macroglossia macroganthia deepening of voice spade hands parasthesia/carpal tunnel hyperhydrosis enlargement soft tissue of tongue, larynx, pharynx visceral enlargement
34
complications of acromegaly
increased CV disease obstructive sleep apnea diabetes mellitus increased colon cancer
35
diagnosis GH macrodaenomas
random serum IGF-1 GOLD STANDARD: GH suppression test (if levels fall below 1 -normal) thin slice MRI of pituitary
36
macro adenoma treatment
transphenoidal microsurgery can do pharmacological (octreotide- somatostatin analog)
37
hypopituitarism
destruction of pituitary gland rare, presents subtly can have some or all hormone axises symptoms, treatment depend on axis affected
38
hypopituitarism etiologies
1. ischemia/infarction (Sheehan's syndrome/preg.) 2. tumor 3. infiltrating disease 4. infectious disease 5. iatrogenic
39
hypopituitarism symptoms GH loss
hypoglycemia
40
hypopituitarism symptoms LH/FSH
failure of puberty female- amenorrhea, loss of pubic/axillary hair, breast atrophy male - erectile disfunction, decreased muscle mass, libido
41
hypopituitarism symptoms TSH
hypothyroidism (cold intolerance, weight gain, myesdema, fatigue)
42
hypopituitarism symptoms ACTH
adrenal insufficiency shock
43
hypopituitarism treatment ACTH
glugorigoid replacement only hydrocortisone
44
hypopituitarism treatment TSH
administer thyroid replacement
45
hypopituitarism treatment LH/FSH
determine if fertility is desired men treated with testosterone (no fertility) gonadotropins (fertility yes) women HRT (no fertility) or gonadotropins (yes)
46
acondroplasia
short stature, genetics gene coding for growth factor is mutated short limbed dwarfism (proximal), brachydactyly
47
congenital GH deficiency
genetic mutation patient falls off the chart by 6-12 months of age
48
diabetes insipidus
passage of large volumes of dilute urine via central DI (decreased ADH secretion) or Nephrogenic (decreased ability to concentrate urine)
49
cardinal diabetes insipidus symptoms
polyuria, polydipsia, nocturia
50
polyuria
>3 L of urine output daily differential: DM, DI, Primary polydipsia (psychiatric)
51
central DI etiologies
idiopathic malignant or benign brain tumors cranial surgery head trauma
52
nephrogenic DI etiologies
Meds (LITHIUM) renal disease prganncy hypokalemia/hyper kalemia
53
manifestations of diabetes insipidus
if free access to water, may be relatively asymptomatic urine can be 3-20 L/day normal physical exam
54
central DI treatment
due to DEFICIENCY of ADH secretion DDAVP (synthetic ADH) low salt diet and access to water
55
nephrogenic DI treatment
resistance of kidney to ADH low solute diet HCTZ +/- amiloride
56
why do i give someone with DI a diuretic?
decreases available water in collecting tubules (so hold onto water) therefore proximal tubule senses less water, and takes up more water
57
pituitary metastases
very rare present with mass effects typically in posterior pituitary often breast, GI, lung CA

FA17 Endocrine (10 decks)

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