Pituitary Disorders - up to Hypopituitaratism

Question 1

Management for an <1 cm incidentaloma

Answer 1

Prolactin level

MRI (yearly)

Question 2

Management for an >1 cm incidentaloma

Answer 2

9:
Prolactin level
MRI (yearly)
24-hour urine cortisol
TSH
T4
LH
FSH
IGF
Test visual fields for evidence of optic chiasm compression

Question 3

Empty Sella Syndrome etiologies

Answer 3

associated with surgery, obesity, and radiation therapy; however, 70% are
idiopathic.

Question 4

Empty Sella Syndrome management

Answer 4

“Check

thyroid and adrenal function.

Question 5

Panhypopituitarism WEIRD name etiologies

Answer 5

Rathke cleft cysts, meningiomas,

craniopharyngiomas,

Question 6

Panhypopituitarism Presentation

Answer 6

Hormone deficiency specific

can be any of them! creo

Question 7

Panhypopituitarism general etiology

Answer 7

anything that damages

the brain, from tumor to stroke to infection to trauma, can cause panhypopituitarism.

Question 8

Prolactin deficiency: cx fx

Answer 8

NONE in men

Women: inhibits lactation after childbirth.

Question 9

LOW Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): Women
cxfx

Answer 9

will not be able to ovulate or menstruate normally and will become
amenorrheic.

Question 10

CxFx if LOW Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): men

Answer 10

Men will not make testosterone or sperm.

erectile dysfunction and decreased muscle mass.
FSH

Question 11

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) what happen in both sex?

Answer 11

Both will have

decreased libido and decreased axillary, pubic, and body hair.

Question 12

Kallmann syndrome Etiology

Answer 12

KAL-1 mutation

Question 13

Kallmann syndrome

FSH and LH?

Answer 13

Decreased FSH and
LH from decreased
GnRH

Question 14

Kallmann syndrome cxfx

Answer 14

Anosmia
Renal agenesis in
50%
delayed or absent puberty.

Question 15

Kallmann syndrome tx

Answer 15

In male individuals: testosterone

In female individuals: estrogen and progesterone

Question 16

Klinefelter syndrome Etiology

Answer 16

47 XXY karyotype

Question 17

Klinefelter syndrome

FSH and LH?

Answer 17

Androgen deficiency through insensitivity to FSH and LH despite
high FSH/LH levels

Question 18

Klinefelter syndrome tx

Answer 18

Replace testosterone

Question 19

Growth hormone (GH) deficiency Children cxfx

Answer 19

present with short stature and

dwarfism.

Question 20

Growth hormone (GH) deficiency Adults

Answer 20

Central obesity
Increased LDL and cholesterol levels
Reduced lean muscle mass

Question 21

Panhypopituitarism One important Lab

Answer 21

Hyponatremia is common secondary to hypothyroidism and isolated glucocorticoid underproduction.
K is normal!

Question 22

Panhypopituitarism initial tests

Answer 22

TSH, T4, IGF, estrogen,

testosterone, LH, FSH, and prolactin.

Question 23

GH deficiency Dx

Answer 23

best initial
stimulatory test is injecting growth hormone–releasing hormone (GHRH). The
normal response to GHRH is a rise in GH level

Question 24

What confirmatory test to do after: Low thyroid-stimulating hormone (TSH) and low thyroxine levels

Answer 24

Decreased TSH response to thyrotropin-releasing

hormone (TRH)

Question 25

What confirmatory test to do after: Decreased adrenocorticotropic hormone (ACTH) and decreased cortisol level

Answer 25

Normal response to *cosyntropin stimulation test* of the adrenal. Cortisol will rise (adrenal is normal) in recent disease, but abnormal in chronic disease because of adrenal atrophy.

Question 26

What confirmatory test to do after: Decreased LH and FSH levels Decreased testosterone level

Answer 26

No confirmatory test

Question 27

When suspecting hypopituitarism You receive this test GH levels low, ( and we know this finding is not helpful since GH is pulsatile and maximum at night.) What confirmatory test would you do next to confirm your presumption?

Answer 27

GH stimulation test. Results: No response to GH releasing hormone (GHRH) No response to arginine infusion

Question 28

What confirmatory test to do after: Prolactin level low, but not helpful

Answer 28

No response to TRH

Question 29

when performing *cosyntropin stimulation test*, An elevated baseline cortisol level means that:

Answer 29

it excludes pituitary insufficiency.

Question 30

Metyrapone test an older and less useful test. How does it work?

Answer 30

``` Metyraprone inhibits 11-beta hydroxylase. this ↓output of the adrenal gland. this normally cause ACTH levels to ↑, as cortisol goes ↓ ```

Question 31

Insulin stimulation:

Answer 31

The normal effect of insulin-inducing hypoglycemia is a rise in GH level. GH increases glucose levels because it is a stress hormone. “Insulin-induced hypoglycemia” as a test is always the wrong answer.

Question 32

panhypopituitarism Tx

Answer 32

``` Replace deficient hormones with: Cortisone FIRST Thyroxine AFTER cort Testosterone and estrogen Recombinant human growth hormone ```

Question 33

sheehan's sx

Answer 33

also known as postpartum pituitary gland necrosis, is hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth. Causes panhypopituitarism

Question 34

apoplexy

Answer 34

after a known or unknown pituitaty tumor, it starts to bleed, it is developed coma, nuchal rigidity, headache, visual defect. Causes panhypopituitarism

Question 35

chronic hypopituitarism etiologies

Answer 35

autoinmune desposition (sarcoid or amyloid) tumor

Question 36

chronic hypopituitarism cx fx

Answer 36

symptoms of fsh and gh insufficency decreased libido fatige menstrual cycle

Question 37

chronic hypopituitarism dx

Answer 37

insulin stimulation test. vasopresin stimulation test. MRI

Question 38

high urinary Osmo and Na are important in serum psmo and Na low

Answer 38

SIADH

Question 39

SIADH etiologies

Answer 39

``` brain lesion lung lesion (small cell CA) tho any granuloma, any pneumonia, can do it, often a malignancy ``` high adhn

Question 40

SIADH tx

Answer 40

water restriction. Reverse underlying disease if none works:Demeclocycline, induces Diabetes insupidus NMT: si no te orina diles "DEMEclocycline"

Question 41

kinds of diabetes insipidus and patho

Answer 41

Central Nephrogenic patho: low adh

Question 42

diabetes insipidus dx

Answer 42

water deprivation test. It rules out psycogenic polidypsia. Measures de uri osmo during water depriv. results: if just after deprivation osmo rises up:psycogenic pd. If it only goes up after ADH=diabetes insipidus central. If even after giving ADH, osmos is same ... so it is nephrogenic dbtinsp

Question 43

diabetes insipidus tx

Answer 43

central. DDAVP, "vasopresin! intranasal | nephrogenic: gentle diuresis: hydroclorotiazide + amilioride