Flashcards in pituitary dysfunction Deck (17):
What can go wrong with the pituitary?
hypofunction, hyperfunction, or a mass
pituitary causes of hypofunction
mas, surgery/radiation, infiltrative lesions, infarction, genetics
what are hypothalamic causes of pituitary hypofunction?
mass, radiation, infiltration, trauma, infection
Where do mets to the pituitary usually come frome?
breast and lung
What is the most common hormone-secreting pituitary adenoma?
Prolactinomas: clinical presentation of hormone excess
prolactin stimulates the mammary glands to make mil: galactorrhea
inhibits GnRH secretion and release of LH and FSH: hypogonadism and infertility
erectile dysfunction through a mechanism independent of hypogonadism
Prolactinoma: clinical presentation of mass effect
extension within the pituitary can cause hormone deficiencies
if it goes upward, can compress the optic chiasm and diminish acuity
may compress CN III
may cause CSF rhinorrhea
Non-prolactinoma causes of hyperprolactinemia
PREGNANCY, lactation, and intercourse
pituitary stalk damage (not enough DA)
medications (anti psychotics, anti depressants, opiates)
What is the first line treatment for a prolactinoma? What are the benefits
dopamine agonists- this is the natural suppressor of prolactin anyway
it decreases prolactin levels, reduces tumor size, reverses hypogonadism, and can be withdrawn after 2 yrs if prolactin levels normalize
Indications for surgery of prolactinomas
failure of medical therapy, desire for pregnancy with previous pregnancy complications/refusal of dopamine agonist during gestation, tumor changes during pregnancy not reversed by medical interventions
contriaindications to medical therapy, like psychiatric disease
very severe progressive visual loss
Dx of acromegaly
IGF-1, oral glucose suppression test, prolactin.
clinical presentation of acromegaly
facial features diffierent- look at old pics
hand/foot size, hyperhidrosis, sleep apnea, HTN, DM, colon polyps, skin tags, carpal tunnel
treatment of acromegaly
surgery is only cure, but tumors can't always be completely resected
in those cases, consider somatostatin; maybe radio therapy or dopamine analogues
Cushing syndrome clinical presentation
truncal obesity, moon face, HTN, skin atrophy and bruising, DM, gonadal dysfunction, muscle weakness, hirusitism, osteoporosis, edema
Causes of cushing's syndrome
either ACTH dependent or independent
if dependent, may be pituitary or may be ectopic (like part of another cancer)
if independent, may be adrenal adenoma, carcinoma,
How do you work up cortisol excess
24 hr urine free cortisol, midnight salivary cortisol, low dose dex suppression test
to determine whether an ACTH dependent excess is from pituitary or from ectopic source, try dexamethosone suppression test or inferior petrosal sinus catheterization.