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Clin Med II Liza > Pituitary Disorders > Flashcards

Pituitary Disorders Flashcards

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0
Q

Pit Adenomas can be part of which hereditary ds

A

Multiple Endocrine Neoplasia - MEN I : 3 Ps: pit ad, parathyroid hyperplasia, pancreatic

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1
Q

Most pituitary adenomas are what type

A

Microadenomas < 1 cm

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2
Q

Which is the most common type of Pit Ad secretory or non secretory?

A

Secretory

Prolactinomas are most common

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3
Q

High prolactin level can be due to

A

!Pit stalk (infindibulum) compression
!Physiologic stiumuli: suckling, chest wall trauma
! Hormonal : pregs, estrogen therapy, hypothyroidism
! Drugs: psych meds, cimetidine, verapamil, opiates
! Renal or liver failure

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4
Q

Renal or liver failure can cause

A

high prolactin

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5
Q

Posterior pituitary secretes which Hs

A

ADH (vasopressin)
Oxytosin
Both are MADE by Hypothalamus!
PP does not PRODUCE any hormones, just secretes it

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6
Q

what are the sx of nonsecretory adenomas?

A

asx usually

Dx by accident on imaging

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7
Q

Pit adenomas

A

asx = common
Sx: pit H dysfx
Mass effect sx:
HA, Nausea, lethargy, altered mind, cranial nerve palsies, visual field defects, compression - part or complete hypopituitarism

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8
Q

what visual defect is common in pit adenomas?

A

no peripheral vision = “temporal hemianopsia”?

refer to optomology and endo

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9
Q

Med therapy for Pit Adenomas

A

Dopamine agonists = supress Prolactin release:
bromocriptine and cabergoline
tx excess hormone secretion
reduce tumor size

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10
Q

Do Surgery for pit adenomas if

A
  • secretory: GH (growth h), ACTH, TSH
  • large, non fx’l tumors: mass effect, visual compromise
  • potl complications (of surgery?): D Insipidus, Hupopituitarism
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11
Q

what tx after surgery if tumor remains?

A

radiotherapy

potl complication: hypopituitarism

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12
Q

Excess GH

A

GH secreting pit adenoma

results in gigantism or acromegaly

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13
Q

Gigantism

A

kids, prior to closure of epiphysis
excess growth of long bones
very rare

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14
Q

Acromegaly

A

enlargement/thickening and elongation of hand, feet, jaw, internal organs
does NOT affect long bones (vs gigantism does)
onset in 30s
dx’d in 50s

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15
Q

etiology of acromegaly

A

Macroadenoma is most common >1 cm

often ass with prolactin (PRL) secretion

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16
Q

risks of acromegaly

A

DM, HTN, CAD !!!
OVERT HF !!! at Dx in 10%
increased mortality due to CVD if untreated

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17
Q

Sx

A

CVD, CAD, DM
deep boice
acne

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18
Q

radiographic findings in acromegaly

A

skull: enlarged sella, thickened skull

hands/feet: tufting (unreveling) of terminal phalanges

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19
Q

Dx studies for GH excess

A

!! Random GH not accurate as levels fluctuate (pulsatile in acrom)
1) Random serum IGF-1 (hepatic):
if normal for age, rules out acromegaly
if elevated 5x, likely GH secreting adenoma (not truly Diagnostic)
2) 75 gm 1 hr glucose tolerance test (GTT)
shows failure of GH to suppress
3) PRL prolactin
GH-secreting tumors often co-secrete PRL
4) MRI - imaging test of choice BUT must do biochem studies BEFORE doing imagins

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20
Q

Which is the imaging test of choice for GH excess?

A

MRI but

must do biochem studies before do imaging!

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21
Q

Tx of GH excess

A 
combo surg, meds, radio
transsphenoidal microsurgery, Dopamin to decr PRL bromocriptine,mcabergolide, GH rec antag expensive
SOMATOSTATIN analogs: (decrease GH)
octreotide/lanreotide
decrease GH sectons, 
injections
- radiation
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22
Q

Tx of excess GH

Study These Flashcards
A 
Dopamine agonist:
bromocriptine
cabergolide
GH receptor antagonist
Pegvisomant injection
blocks hepatic IGF-1 production

Radiation

23
Q

GH deficiency in kids

Study These Flashcards
A

pit dwarfism:
fail to grow
Causes: congenital, tumor (craniopharyngioma), severe brain injury
Often co-occurs with deficiences of other pit hormones

24
look at the pit dwarfism ss
slide 37
25
Pit dwarfism dx tests
PE + hand x-ray to determine BONE AGE ???????? !!! IGF-1 below nl for age and gender supports dx !!! GH stimulation test: insulin-induced hypoglycemia ASK?????????? measure other hormones MRI of head GH is pulsatile, not helpful for Dx
26
GH deficiency in adults sx
``` reduced E depressed mood emotional lability diminished libido decrease muscle mass, strength increased abdominal adiposity decreased exercise capacity ```
27
Tx for GH deficiency
SC injection SE: HA, fluid retention, m and joint aches, slipped capital femoral epiphysis (peds)
28
Diabietes Insipidus (DI)
Insipid = tastless | polydipsia, polyuria and DILUTE URINE (vs hunger in DM)
29
DI has a problem with which hormone?
ADH | secreted in response to osmoreceptors and baroreceptors in the carotids, atria and aorta
30
cental DI is
deficincy of ADH , can't secrete
31
nephrologic DI
resistance of kidney to ADH, can't bind ADH | often due to lithium use
32
which med often contributes to nephro DI
lithium
33
What is the serium osmolality in DI?
It is normal (285-295)
34
What is the urine osmolality and spesific gravity SG in DI?
Urine OSM < 300 (low) Plasma OSM >287 (high but normal) Urine Spec Gravity <1.005
35
urine volume, osm, etc in DI vs normal
Normal urine volume: 800-2000 ml.day DI: >3 L /day Serum OSM: 285-295 DI: >287 thirst at 290 mOsm no thirst mech in DI Urins Osm 50-1200 normal DI: < 300 Urine SG: 1.010-1.030 DI: <1.005
36
Is ADH high or low in central DI
ADH is low bc unable to produce.secrete ADH
37
Is ADH high or low in nephro DI?
ADH is high bc brain can produce it but kid can't respond to it
38
When does central DI happen most
after head trauma or neurosurgery in adulthood responds to desmopressin (DDAVP)
39
When is nephro DI most commone
``` Lithium!!! Childhood Chronic renal fail hypercalcemia, hypokalemia No response to DDAVP (desmopressin) ```
40
DI SS
``` ???????? intense thirst fluid intake up to 20L per day Ice water craving Large volume polyuria Enuresis (bed wetting) HyperNa why ??????????, dehydration possible ```
41
See slide 47 for DI pic
ok
42
Dx studies for DI
?????? 24 hour urine to measure volume serum electrolytes and glucose to ro osmotic diureces?? !!! SIMULTANEOUS URINE and serum OSMOLALITY!!! must do SIMULTANEOUSLY - call lab urine osm - low 287 (normal but high) -urine SG <1.005
43
DI dx
?????? water deprivation and vasopressin challenge? ?if central - double urine osmolality ? if nephro - little or no elevation in urine osm MRI of pituitary
44
DI tx
``` ???????Mild: adequate hydration Central DI: Desmopressin acetate (DDAVP) Nephro DI: Indomethacin, with or without HCTZ (thiazide?) DDAVP or Amiloride (k sparing but causes hypothyroid?) use with Lithium ```
45
Panhypopituitarism
deficient in GH (HYPOGLYCEMIA, short), ADH (polyuria -> polydipsia, hyperNa, dehydration, lethargy), LH/FSH: low estrogen, delayed puberty, amenorrhea,. TSH (Low T4: fatigue, constipation, cold intolerance bradycardia), ACTH (low cortisol: HYPOglycemia, vomiting, malaise)
46
how to dx panhypopit
S S, provocative tests, MRI last
47
ACTH deficiecy in panhypopit
1) ACTH stimulation test can be neg or pos: if adrenal gland is functional -> positive test if not _> negative 2) tx with Hydrocortisone or Prednisone 3) GIVE above before Thyroid hormone to lower risk of cortisol insufficientcy due to increased metabolism with thyroid meds
48
Which type of pit adenomas have to be removed surgically
1) secretory : GH, ACTH, TSH (goiter) 2) Large non-fx'al tumors that have mass effect and/or visual compromise 3) complications of surgery are: DI, hypopituitarism
49
if you don't want to surgically remove pit adenoma, what medical tx to use
Dopamine agonists: bromocriptine and cabergoline ( to tx excess hormone secretion and reduce tumor size)
50
when to use radiation to tx pit adenomas
following surgery if residual tumor remains
51
ACTHn def in pan pt should carry what?
hydrocortisone vial and syringe | med alert tag
52
Pan tx:
if TSH def: Levothyroxine if Gonadotropin def: estrogen, progest, OCP, test if ADH def: DDAVP (intranasal, oral or sublingual)
53
GH def in PAn
tx with GH
54
Tx of high prolactin in PAN
Stalk effect: compression of pit stalk decreases dopamine | Dopamine inhibits prolactin - so give dopamin?

Clin Med II Liza (6 decks)

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