Pituitary Disorders Flashcards
(92 cards)
1
Q
What part of the pituitary gland synthesizes and secretes hormones?
A
Anterior pituitary
2
Q
Does the anterior pituitary respond to negative or positive feedback?
A
Negative
3
Q
ACTH comes from what cells?
A
Corticotrophs
4
Q
TSH comes from what cells?
A
Thyrotrophs
5
Q
LH and DSH comes from what cells?
A
Gonadotrophs
6
Q
GH comes from what cells?
A
Somatorophs
7
Q
Prolactin comes from what cells?
A
Lactotrophs
8
Q
What 6 hormones does the anterior pituitary release?
A
- ACTH
- TSH
- LH
- FSH
- GH
- Prolactin
9
Q
What hormones stimulates production and release of cortisol by adrenal cortex?
A
ACTH
10
Q
What hormones
stimulates the thyroid to produce T3/T4 → stimulates metabolism of many tissues in the body?
A
TSH
11
Q
What hormone triggers ovulation and development of corpus luteum in females?
A
LH
12
Q
What hormone stimulates Leydig cell production of testosterone in men?
A
LH
13
Q
What hormone stimulates growth of ovarian follicles?
A
FSH
14
Q
What hormone stimulates formation of secondary spermatocytes?
A
FSH
15
Q
What hormone Stimulates growth, cell reproduction, and cell regeneration?
A
GH
16
Q
What hormone stimulates milk production?
A
Prolactin
17
Q
What hormone works with LH and testosterone to increase reproductive function
A
Prolactin
18
Q
What part of the pituitary only secretes hormones synthesized in the hypothalamus?
A
Posterior pituitary
19
Q
What are the 2 hormones of the posterior pituitary?
A
- ADH
2. Oxytocin
20
Q
What hormone is released in response to hypertonicity and causes the kidneys to reabsorb solute- free water producing concentrated urine and reduced urine volume?
A
ADH
21
Q
What hormone increases uterine contractions?
A
Oxytocin
22
Q
What hormone is released via positive feedback loop?
A
Oxytocin
23
Q
What hormone promotes stretching of cervix and uterus during labor and stimulates milk release?
A
Oxytocin
24
Q
What part of the pituitary synthesizes and secretes MSH?
A
Intermediate pituitary
25
What is the most common place to develop brain masses?
Sellar turcica
26
Visual impairment and diplopia, +/- HA are sx of what?
Sellar mass
27
What is the most common type of visual impairments associated with a sellar mass due to midline compression/lesion of the optic chiasm?
bitemporal hemianopsia
28
What is the most common type of benign sellar tumors?
Pituitary adenoma
Other: craniopharyngioma, meningioma, cysts
29
What is the most common pituitary adenoma?
Prolactinoma (60%)
30
How are pituitary adenomas generally classifed?
Size and cell of origin from anterior pituitary
31
Is a microadenoma bigger or smaller than 1 cm?
Smaller (< 1 cm)
32
Is a macroademona bigger or smaller than 1 cm?
Bigger (> 1 cm)
33
Are the following benign or malignant causes of sellar masses?
1. primary-germ cells tumor
2. chordoma
3. lymphoma
4. metastatic breast or lung cancer
Malignant
34
When and why would you check the following once a sellar mass has been identified?
1. Serum prolactin
2. serum IGF-1
3. 24-hour urine cortisol, 4. T3/T4/TSH
You would check the following if the mass is symptomatic or causing hormonal abnormalities to determine a treatment plan
35
30 y/o F presents with amenorrhea, galactorrhea, and concerns of infertility. What disease are you concerned about?
Prolactinoma ( serum prolactin is > 30 ng/mL)
36
60 y/o F presents with headache and impaired vision. On exam her serum prolactin in > 20 ng/mL. What disease are you concerned about?
Prolactinoma
37
35 y/o M presents with decreased libido, gynecomastia and concerns of impotence/infertility. What disease are you concerned about?
Prolactinoma (serum prolactin > 20 ng/mL)
38
Penothiazine, halperidol, benzodiazepines can all cause hyper secretion of what hormone?
Hyperprolactinemia
39
What 2 meds do you used to treat prolactinoma?
1. Cabergoline (prolactin antagonist)
| 2. Bromocriptine
40
What is the standard of care for treating prolactinoma?
Transphenoidal resection
41
What is recommended to do prior to a tansphenoidal resection to make the treatment more effective?
Radiotherapy to shrink the size of the tumor
42
Acromegaly is a result of an excess of what hormone?
GH
43
Acromegaly is most commonly caused by what?
Benign pituitary macroadenoma
44
Serum levels of what hormone are an important marker for excess GH?
IGF-1 (released from the liver)
45
On exam of 40 y/o M pt you find enlargement of hands, feet, and jaw. What disease are you concerned about?
Acromegaly.
Also will have enlargement of internal organs, specifically the heart
46
Pts w/ acromegaly are at an increased risk of developing what 3 diseases?
DM, HTN, CAD
47
When evaluating a pt w/ suspected acromegaly, what lab do you check first?
Serum IGF-1 (if low, no GH excess)
48
If serum IGF-1 is normal/elevated in pt w/ suspected acromegaly. What test should you order 2nd to help make a dx?
2 hr OGTT
49
What test is gold standard for dx of acromegaly?
2 hr OGTT
50
If 2 hr OGTT is preformed on pt w/ suspected acromegaly, what are the expected results?
Failure of GH to decrease (definitive dx)
51
Is a random serum GH an accurate test for diagnosing acromegaly?
No. Levels fluctuate
52
What imaging will show a prolactinoma?
MRI
53
What imaging would you order in pt w/ acromegaly to ID a pituitary tumor?
MRI
54
What is the medication tx for acromegaly?
Somatostatin analogs (octreotide, lanreotide) → inhibitory and may decrease tumor size
55
What is surgical tx for a pituitary tumor?
Transsphenoidal microsurgery
56
When will Transsphenoidal microsurgery be most successful for pt w/ acromegaly? (2)
1. GH levels are low
| 2. Small tumor
57
What long term follow up is needed in pts with acromegaly?
Measure IGF-1 every 3-6 mos
58
What is the #1 cause of adult onset GH deficiency?
Pituitary ademona
59
Sheehan syndrome is a rare disease that will cause what hormonal deficiency?
GH deiciency
60
Hx of GH deficiency in childhood is a RF for what disease?
Adult onset GH deficiency
61
A 30 y/o M pt presents with:
↓ Lead body mass & ↑ fat mass
↓ bone mineral density
↓ QoL.
What disease are you concerned for?
Adult onset GH deficiency
62
What is the tx for GH deficiency if onset in childhood?
GHRT - daily subQ injections
63
What are the possible SEs of GH therapy? (4)
1. peripheral edema
2. arthralgia
3. paresthesia
4. worsening of glucose tolerance (DM risk)
64
Low T and high FSH/LH levels are diagnostic for primary or secondary hypogonadism?
Primary (hypergonadotropic hypogonadism)
65
What is the cause in secondary hypogonadism?
Defects in the HPT axis levels
66
30 y/o M presents w/ hot flashes, ED and decreased libido, muscle mass and body hair. What disease should you be concerned about?
Secondary hypogonadism (hypogonadotropic hypogonadism)
67
Low T and normal to low FSH/LH levels are diagnostic for primary or secondary hypogonadism?
Secondary
LH/FSH levels are low b/c no feedback loop due to ↓ ant. pituitary
68
Hx of prostate cancer is a contraindication for what HRT?
Testosterone
69
What two tests do you need to conduct before starting hypogonadic male on T therapy?
1. DRE
| 2. PSA
70
What is the initial T regimen for male w/ hypogonadism?
IM injections Q 2 wks
Other: Transdermal patch/cream/gel applied daily
71
Once T levels are back w/in normal range, how does the tx regimen change for T replacement therapy in male w/ hypogonadism?
Pellets placed subQ Q 3 months
72
How does testosterone therapy place you at an increased coagulation risk?
T increases RBC production (erythrocytosis)
73
In addition to lifelong monitoring of free and total T and free estradiol in a M w/ hypogonadism, what tests do you need to preform annually? (2)
DRE
| PSA
74
Global anterior pituitary dysfunction that leads to decreased ant. pituitary hormones is what disease?
Pan-hypopituitarism
75
What are the two most common causes of pan-hypopituitarism?
1. radiation therapy
| 2. sheehan syndrome
76
What disease is caused by postpartum pituitary gland necrosis due to blood loss and hypovolemic shock during/ after childbirth?
Sheehan syndrome
77
What is the most common initial sx of Sheehan syndrome?
Agalactorrhea/difficulties with lactation
78
Decreased serum levels of ACTH, TSH, LH, FSH, GH, and prolactin are concerning for what disease?
Pan-hypopituitarism
79
Extensive hormone replacement therapy & Ca + Vit. D supplementation is the tx for what ant. pituitary disease?
Pan-hypopituitarism
80
What is the most common cause of central diabetes insipidus?
idiopathic
81
Will ADH levels be high or low w/ CDI?
low
82
Pt presents to you with polyuria, polydipsia, nocturia/ enuresis. Do you expect them to have concentrated or dilute urine?
Dilute (central diabetes insipidus)
83
Labs for a pt show:
Hypernatremia (Na > 135)
Serum osmolality = N/↑
Urine osmolality = ↓ (< 250 mOSM/kg)
24 hr urine collection (polyuria > 3L/day)
What disease are you concerned about?
central diabetes insipidus
84
What is the drug therapy for central diabetes insipidus?
Desmopressin (DDAVP) intranasal
85
Nephrogenic DI is due a lack of production of ADH or a defect in the kidney's sensitivity to ADH?
kidney defect (insensitive to ADH)
86
What is the tx for nephrogenic DI?
- Diuretics (ADH antagonist)
| - Low salt/ low protein diet (correct hyponatremia)
87
An ↑ in release of ADH due to CNS disorders, ectopic ADH by malignancies, drugs, surgery/stress, pain is concerning for what disease?
SIADH
88
PT presents with N/V and lethargy. Their labs show:
24 hr urine collection = ↓
Serum Na = ↓
Serum osmolality = ↓
Urine osmolality = ↑
What disease are you concerned about?
SIADH
89
A pt presents w/ hyponatremia, concentrated urine and decreased urine volume. Do you expect their urine osmolality to be increased or decreased?
Increased (SIADH)
90
What is the TX for SIADH?
fluid restriction (< 800 mL/day)
91
What physiologic conditions can cause an increase in prolactin? (4)
1. Pregnancy
2. Breast feeding
3. Exercise
4. Stress
92
Will ADH levels be high, low, or normal w/ nephrogenic DI?
Normal
