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Pituitary Disorders - Cryar Flashcards

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1
Q

What are the main pituitary disorders

A 
Hypopituitarism
Hyperprolactinemia
Acromegaly
Cushings disease
Diabetes insipid us
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2
Q

What is hypopituitarism?

A

Diminished or absent secretion of anterior pituitary hormones

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3
Q

What are two ways you can have hypopituitarism?

A

Primary disorder of anterior pituitary cells

Reduced stimulation by the hypothalamus

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4
Q

What is pan hypopituitarism?

A

Generalized loss of anterior pituitary hormones

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5
Q

What are the causes of hypopituitarism?

A 
neoplasms
infections or granulomas
vascular
infiltrative
physical injury
releasing hormone deficiencies
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6
Q

Clinical features of panhypopituitarism

A 
weakness, malaise, nausea, vomiting
amenorrhea, breast atrophy
testicular atrophy
absence of axillary and pubic hair
waxy skin, fine periorbital wrinkling
hypothermia
hypotension, hypoglycemia
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7
Q

What features are not usually present in panhypopituitarism?

A

hyperpigmentation

aldosterone is less frequently involved

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8
Q

What causes the weakness, malaise, nausea and vomitting of panhypo pit?

A

adrenal insufficiency - lack of ACTH secretion from the ant pit

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9
Q

What is often the key diagnostic sign of panhypo pit?

A

absence of axillary and pubic hair

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10
Q

What causes the hypothermia of panhyp pit?

A

lack of thyroid hormones from the ant pit

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11
Q

What causes the hypotension and hypoglycemia of panhypo pit?

A

lack of glucocorticoids

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12
Q

What do the clinical features of Panhypo pit depend on?

A

the specific deficiencies
age
sex

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13
Q

How does age affect the clinical features of panhypo pit?

A

short stature and delayed puberty in children

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14
Q

How does sex affect the clinical features of panhypo pit?

A

impotence in men

ammenorrhea in women

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15
Q

What is pituitary apoplexy?

A

rapid hemorrhage into the pituitary gland

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16
Q

What is pituitary apoplexy characterized by?

A

sudden onset of excruciating headache
diplopia
hypopituitarism

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17
Q

What is the etiology of diplopia in apoplexy?

A

pressure on the oculomotor nerves

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18
Q

Hypopituitarism

A

sella has no way to expand

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19
Q

What is pituitary apoplexy often mistaken for?

A

stroke

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20
Q

What is the most important endocrine consideration for treatment with apoplexy?

A

Treatment of cortisol deficiency

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21
Q

How is pituitary apoplexy treated?

A

surgery for ocular consequences
treat cortisol def.
spontaneous improvement of both ocular and hormonal deficiencies can occur with time so milder cases can be watched and supported

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22
Q

What is Sheehan’s syndrome?

A

infarction after postpartum hemorrhage

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23
Q

How does severe sheehan’s syndrome present?

A

lethargy, anorexia, weight loss, failure to lactate

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24
Q

How does a mild case of Sheehan’s present?

A

failure to lactate and failure to resume menses

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25
What eventually happens to the pituitary in Sheehan's syndrome?
eventual development of small pituitary in a normal sized sella
26
What is Sheehan's sometimes mistaken for?
empty sella syndrome
27
If Sheehan's is suspected, what most be promptly assessed and treated?
adrenal insufficiency - the remaining deficiencies can be evaluated 4-6 weeks later
28
What deficiency from Sheehan's is there no treatment for?
prolactin deficiency - which prevents lactation
29
What do you find on diagnosis of panhypo pit?
low levels of target organ hormones without a compensatory increase in pituitary hormones
30
What levels do you want to avoid measuring as the only screening for a possible hormone deficiency? and why?
anterior pituitary hormones - bc the levels may be low, normal or high - the key is how they are relative to end organ hormone levels
31
How do you treat panhypo pit?
the same way you would treat primary deficiencies
32
What do you need to be cautious of when treating hypothyroidism?
Be sure to recognize and treat any underlying adrenal insufficiencies first
33
How do pituitary neoplasms often present?
headache and visual disturbances (especially if non secretory) excessive secretion or deficiency of ant pit hormones may be present
34
How is prolactin unique among the anterior pituitary hormones?
it is under tonic suppression | this means lesions in the hypothalamus or affecting the pituitary stalk cause increased prolactin secretion
35
What are some causes of hyperprolactinemia?
prolactin secreting pituitary adenoma loss of dopaminergic suppression from the hypothalamus nipple stimulation or chest wall injury estrogen - increase is proportional to levels of estrogen hypothyroidism chronic renal failure multiple drugs
36
What are one of the main classes of drugs causing hyperprolactenemia?
antipsychotics
37
How does hyperprolactermia present in women?
as a microadenoma amenorrhea galactorrhea
38
How does hyperprolacternemia present in men?
macroadenoma impotence visual disturbances
39
Differential of prolactin levels?
normal < 20 intermediate 21 - 150 tumor > 150
40
What is the treatment for hyperprolactinemia?
Dopamine Agonists - bromocriptine - cabergoline
41
What is the major risk of treatment of hyperprolactinemia with cabergoline?
valvular heart disease seen in patients treated for parkinsons disease
42
What is MAINLY seen with acromegaly?
acral enlargement | soft tissue overgrowth
43
What are some other things seen with acromegaly?
``` headache vision loss hypopituitarism cardivascular disease visceral enlargement sleep apnea increased risk for malignancies (colon) ```
44
How do you clinically diagnos acromegaly?
fully developed syndrome is unmistakable | more commonly found in earlier, less pathognomonic stages
45
How do you diagnosis acromegaly with laboratory confirmation?
somatomedin-C (IGF-I) is the best screening test (GH levels are variable)
46
How do you treat acromegaly?
primary treatment is surgical - but it is often not curable | secondary therapy is - radiation of the sella or somatostatin analogues
47
What is cushings syndrome?
clinical manifestations of glucocorticoid excess (from any source)
48
What is cushings disease?
glucocorticoid excess specifically due to ACTH secretion from a pituitary adenoma
49
How do you determine the etiology of Cushing's syndrome?
exogenous steroids or adrenal tumor = low ACTH Cushing's Disease = normal to high ACTH ectopic ACTH = very high ACTH
50
How do you diagnos Cushing's Disease?
Relies on the ability to suppress ACTH | dexamethasone - demonstrate suppressibility of endogenous cortisol production
51
What would a dexamethosone suppression test show on a patient with Cushing's Disease?
No cortisol production suppression
52
Why is imagine problematic in cushing's disease?
50% of patients have a "normal" pituitary on CT or MRI
53
How can you localize the source of ACTH to the pituitary when no adenoma is imaged?
Inferior petrosal sinus testing for ACTH
54
How is ADH secretion regulated?
very tightly regulated by osmolality | osmotic regulation is overridden by volume status
55
What is diabetes insipidus?
failure to appropriately concentrate the urine
56
What is central vs. nephrogenic DI?
central - inadequate ADH | nephrogenic - failure of kidney to respond to ADH
57
What is the etiology of central DI?
trauma, surgery, infiltrative or idiopathic
58
How do you diagnos DI?
polyuria and polydipsia urine volumes > 3L per day dilute urine with a serum osmolality > 295 (although some patients can compensate)
59
What is the water deprivation testing for DI?
water is withheld until urine osmolality stable primary polydipsia - urine osmolality > serum DI - urine osmolality remains low while serum osmolality increases
60
How do you tell the difference bw central or nephrogenic DI?
``` Administer DDAVP (AHD analogue) central DI - urine osmolality increase by 50% nephrogenic DI - no change ```

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