Pituitary Disorders Lecture Powerpoint

Question 1

Prolactin is the only hormone without…

Answer 1

….a negative feedback loop (instead inhibited by dopamine)

Question 2

Pituitary tumor characteristics (4)

Answer 2

• 1/3 nonfunctional (not secreting)
• Most produce one solitary hormone in excess
• Bitemporal hemianopsia (tumor forms at optic chiasm)
• Visual field exam (loss of peripheral vision)

Question 3

Micro vs macroadenoma in the pituitary

Answer 3

<10mm in diameter is micro, >10 in macro

Question 4

Pituitary hyperplasia causes that DON’T necessarily require intervention (3)

Answer 4

• pregnancy
• long standing hypothyroidism
• long standing primary hypogonadism

Question 5

Pituitary masses clinical manifestations (3)

Answer 5

• Impaired vision (bitemporal hemianopsia)
• headache
• pituitary apoplexy (bleeding into and impaired blood supply to the pituitary)

Question 6

Sheehan’s syndrome

Answer 6

Post partum pituitary apoplexy and infarction

Question 7

Pituitary incidentaloma

Answer 7

Microadenoma presence up to 10% of people with clinically unsuspected pituitary tumors observed on MRI incidentally

Question 8

Hyperprolactinemia causes (5)

Answer 8

• pregnancy (peak at delivery)
• nipple stimulation
• stress
• Prolactinoma
• chest wall injury

Question 9

Why are men more susceptible to larger prolactinomas than females?

Answer 9

Men don’t have the associated symptoms regarding amenorrhea and galactorrhea while females do much earlier on

Question 10

Prolactinoma is the only tumor that the preferred method of treatment is…

Answer 10

….medication - dopamine agonists (bromocriptine or cabergoline)

Question 11

Most common cause of secondary amenorrhea

Answer 11

Pregnancy

Question 12

Acromegaly

Answer 12

Condition caused by excess growth hormone from pituitary, slow gradual change in appearance of patient from symptoms to diagnosis for up to 12 years, both GH and IGF-1 increased, excess GH secretion making IGF-1 elevated

Question 13

Acromegaly associated conditions (5)

Answer 13

• acral overgrowth
• increased bone density
• hypertension
• LVH
• DM

Question 14

Best study for acromegaly diagnosis and why + one other

Answer 14

• IGF-1 (no diurnal variation)

- MRI of pituitary (adenoma in almost 95% of causes)

Question 15

Acromegaly treatment options (2)

Answer 15

• Transphenoidal surgery

- Medical therapy

Question 16

Hypopituitarism common etiologies (5)

Answer 16

• developmental
• trauma
• neoplastic
• vascular
• infectious

Question 17

Diagnostic studies for hypopituitarism (3)

Answer 17

• Free T4/TSH
• Gonadotropins
• IGF-1

Question 18

Hypopituitarism treatment principle

Answer 18

Supply the hormone that is the product from the pituitary hormone that is missing ex) give T4, testosterone, hydrocortisone (cortisol)

Question 19

Diabetes insipidus

Answer 19

A deficiency of ADH second to many things including trauma, neoplasm, infection, etc. that results in large volumes of dilute urine and polydipsia

Question 20

Diabetes insipidus diagnostic lab evaluation (2)

Answer 20

• 24 hr urine output >50ml/kg

- Fluid deprivation test

Question 21

Diabetes insipidus treatment (1)

Answer 21

Desmopressin (dDAVP) intranasal, oral, or subQ twice a day

Question 22

Syndrome of inappropriate ADH and treatment (2)

Answer 22

Release of excess ADH causing retention and dilution of body fluids (eventually reaching hyponatremia), treated by restricting fluid and taking demeclocycline