Pituitary disorders Flashcards

(21 cards)

1
Q

What is panhypopituitarism

A

Any condition that compresses or damages pituitary gland - tumors, trauma, radiation, infection, autoimmune, etc

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2
Q

What are the different presentations of panhypopituitarism

A
  1. ) Prolactin deficiency - men unaffected, women inhibits lactation after birth
  2. ) LH/FSH deficiency: Women become ammenorheic, men cannot make tesosterone or sperm and erectile dysfunction. Both decreased libido, decreased sex hair
  3. ) GH deficiency: Children have short stature, adults few symptoms
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3
Q

What are some specific diagnostic tests you can order for panhypopituitarism

A
  1. ) TSH levels - confirm with TRH injection
  2. ) ACTH/Cortisol levels - confirm with cosynthropin stimulation of adrenal (recent disease = normal rise, chronic disease atrophy = decreased rise), after CRH injection
  3. ) Decreased LH/FSH/testosterone - no test
  4. ) GH - no response to arginine or GHRH
  5. ) Prolactin - no response to TRH
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4
Q

What are other less useful tests for panhypopituitarism

A
  1. ) Metyrapone - inhibits 11-B hydroxylase, causing ACTH levels to rise because cortisol goes down
  2. ) Insulin stimulation - should cause GH to rise due to decreased glucose
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5
Q

What is the treatments for panhypopituitarism

A

Replace end hormones, not the stimulating hormones

Thyroxine, cortisone, testosterone/estrogen, GH

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6
Q

What is diabetes insipidus, the etiology of each, and the causes

A

Definition: Decrease in amount of ADH from pituitary (central DI) or its effect on kidney (nephrogenic DI)

  1. ) Central: Same causes as panhypopituitarism, idiopathic, or tumor producing
  2. ) Nephrogenic: Kidney diseases such as chronic pylonephritis, amyloidosis, myeloma, sickle cell disease. And hypercalcemia and hypokalemia. Caused by medications lithium and demeclocycline
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7
Q

What are the symptoms of diabetes insipidus

A

High volume urine and excessive thirst

If you don’t match it with drinking water, will develop hypernatremia and subsequent neurological symptoms

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8
Q

How can you differentiate central and nephrogenic diabetes insipidus

A

Inject vasopressin - normal response = central, no response = nephrogenic

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9
Q

What is the treatment for central diabetes insipidus

A

Vasopressin long-term

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10
Q

What is the treatment for nephrogenic diabetes insipidus

A

Correct underlying cause, or hydrochlorothiazide, amiloride, and NSAIDS

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11
Q

What is acromegaly

A

Overproduction of GH leading to soft tissue growth through entire body

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12
Q

What is the number one, almost always cause of acromegaly

A

Pituitary adenoma, either alone or apart of MEN syndrome

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13
Q

How would a patient with acromegaly present on the USMLE

A
  1. ) Increased hat, ring, shoe size
  2. ) Carpal tunnel syndrome/OSA (compression from tissues)
  3. ) Body odor - sweat gland hypertrophy
  4. ) Coarsening facial features
  5. ) Deep voice/macroglossia
  6. ) Colonic polyps
  7. ) Arthralgias - joints growing out of alignment
  8. ) Hypertension
  9. ) Cardiac dysfunction
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14
Q

What is the diagnostic test for acromegaly

A

Best initial test - insulin like growth factor levels

Most accurate - Glucose suppression test (injecting glucose normally suppresses GH)

MRI - only after lab values are confirmed

Test prolactin too because cosecreted with GH

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15
Q

The treatment for acromegaly has both a surgical and medical one. What is the surgery

A

Transphenoidal resection of pituitary adenoma - 70% respond

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16
Q

The treatment for acromegaly has both a surgical and medical one. What is the medical treatments

A
  1. ) Cabergoline - dopamine inhibiting GH release
  2. ) Octreotide - somatostatin inhibiting GH release
  3. ) Pegvisomant - GH receptor antagonist - inhibits IGF from liver
17
Q

What should you do if someone with acromegaly does not respond to surgery or medical treatment

18
Q

What are the causes of hyperprolactinemia

A

Acromegaly (cosecreted) and hypothyroidism (high TRH)
Physiologic: Intense exercise and cutting pituitary stalk (dopamine eliminated), pregnancy, chest wall stimulation
Drugs: Think psych drugs - antipsychotics, SSRI’s, tricyclics, metoclopramide, etc

19
Q

What is the presentation for both men and women who have hyperprolactinemia

A

Women - galactorrhea, amenorrhea, and infertility
Men - Erectile dysfunction, decreased libido

All same symptoms as not having LH/FSH

20
Q

What diagnostic tests should you do after you find that prolactin levels is high

A

Thyroid function tests, pregnancy test, kidney test since it can raise prolactin

Do MRI after these things are confirmed

21
Q

What is the treatment for hyperprolactinemia

A

Dopamine agonists - cabergoline

Transphenoidal surgery if medications are not working