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Clin Med II Final > Pituitary gland disorders > Flashcards

Pituitary gland disorders Flashcards

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1
Q

Anterior pituitary hormones

A

ACTH, TSH, LH, FSH, GH, Prolactin

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2
Q

Posterior pituitary hormones

A

Oxytocin

ADH

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3
Q

ACTH

A

increases production and release of cortisol by the cortex of the adrenal gland

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4
Q

TSH

A

stimulates thyroid gland to produce T4 and T3, stimulating the metabolism of many tissues in the body

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5
Q

LH

A

triggers ovulation and development of corpus luteum (females)
stimulates production of testosterone (males)

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6
Q

FSH

A

stimulates growth of ovarian follicles (female)

stimulates formation of secondary spermatocytes (males)

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7
Q

GH

A

stimulates growth, cell reproduction and cell regeneration

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8
Q

Prolactin

A

milk production (females)

works w/ LH and T to increase reproductive function (males)

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9
Q

Posterior pituitary action

A

does not synthesize hormones: ADH and oxytocin are made by hypothalamus

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10
Q

ADH release

A

released in response to hypertonicity and causes kidney to reabsorb water –> leads to concentrated urine and reduced urine volume

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11
Q

Oxytocin role

A

increases uterine contractions, and promotes stretching of cervix and uterus during labor

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12
Q

intermediate pituitary

A

synthesizes and secretes melanocyte-stimulating hormone (MSH, which controls skin pigmentation

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13
Q

Sx of sellar mass

A

neuro sx: vision changes (compression of optic chiasm), h/a
Incidental finding on MRI
hormonal abnormalities

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14
Q

Most common visual complaint with sellar mass

A

bitemporal hemianopsia

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15
Q

Etiologies of sellar masses

A

benign tumors: PITUITARY ADENOMAS, craniopharyngioma, meningioma

Cysts, abscesses, AV fistula of cavernous sinus

Malignant tumors: primary- germ cell tumor, chordoma, lymphoma
metastatic- breast, lung CA

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16
Q

make up 60% of all pituitary tumors

A

prolactinomas

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17
Q

Classification of pituitary tumor by size

A

microadenoma <1cm

macroadenoma >1cm

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18
Q

cell origin of pituitary adenomas

A

gonadotroph: non-functioning
thyrotroph: increased TSH secretion
Corticotroph: increased cortisol causing cushing’s
Lactotroph: increased prolactin causing hyperprolactinemia (and therefore hypogonadism)
somatotroph: increased GH causes acromegaly

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19
Q

Dx of sellar mass

A

MRI

Hormonal hypersecretion: serum prolactin
serum IGF-1
24- hour urine cortisol
T3, T4, TSH

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20
Q

Anterior pituitary disorders

A 
prolactinoma
GH Excess: giganticism, acromegaly
GH deficiency: short stature, adult deficiency
Hypogonadotropic hypogonadism
pan-hypopituitary syndrome
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21
Q

most common pituitary tumor

A

prolactinoma

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22
Q

Premenopausal prolactinoma sx and dx

A

infertility; oligomenorrhea/amenorrhea; galactorrhea (spontaneous flow of milk from breath)

Dx: serum prolactin >30; MRI

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23
Q

Postmenopausal prolactinoma sx and dx

A

h/a, impaired vision, galactorrhea (rare)

dx: serum prolactin >20 MRI

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24
Q

Male prolactinoma

A

decreased libido, impotence, infertility, gynecomastia, galactorrhea (rare)

dx: serum prolactin >20; MRI

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25
Causes of hyperprolactinemia
pregnancy stress lactation exercise drugs: phenothiazine, haloperidol, benzos Pathologic: microprolactinoma, macroprolactinoma, hypothyroidism
26
Drugs that cause hyperprolactinemia
phenothiazine haloperidol benzodiazepines
27
Tx for prolactinoma
medical: bromocriptin, Cabergoline Surgical: transsphenoidal resection, radiotherapy
28
Drugs for prolactinoma
bromocriptine | Cabergoline***
29
most common etiology of GH excess
benign pituitary adenoma >1 cm
30
Other etiologies for GH excess
ectopic tumors, MEN type 1, neurofibromatosis
31
Result of GH
release of insulin like growth factor 1 (IGF-1 from liver)
32
Risk in acromegaly
DM (30%) HTN CAD
33
Acromegaly
adults (30's) | enlargement of hands, feet, jaw, internal organs
34
Dx of acromegaly
Serum IGF-1*** Serum prolactin 2-hour oral glucose tolerance test ** (gold standard) - will show failure of GH to decrease to less than 2 mcg/L random serum GH NOT accurate -- fluctutuates MRI - pituitary tumor in 95% of patients
35
Gold standard for GH dx
2-hour oral glucose tolerance test (OGTT)
36
Tx for acrometay
SS analog (octreotide/lanreotide) - inhibit and may decrease tumor size Transsphenoidal microsurgery *** = most successful in pts w/ GH <50 and pituitary tumors <2cm Measure IGF-1 every 3-6 months - linked to morbidity and mortality
37
When is transsphenoidal microsurgery best
GH <50 | tumor <2cm
38
Drugs for acromegaly
octreolide | lanreotide
39
More common: giganticism or acrometaly?
acromegaly
40
Etiology of GH deficiency
pituitary adenoma (most common) ``` tx of tumor - surgery or radiation Extrapituitary tumors (craniopharyngioma) Sheehan Syndrome (rare) ```
41
Sx of GH deficiency (adult-onset)
``` decreased lean body mass decrease bone mineral density (BMD) decrease quality of life increase fat mass increased rate of fx increase in CVD increase mortality ```
42
Who to evaluate for GH deficiency?
adults w/ known hypothalamic or pituitary disease w/ a hx of GH deficiency in childhood
43
Dx of GH deficiency in adults
MRI: tumors are #1 cause CBC, CMP, lipid panel, fasting insulin DEXA scan serum IGF-1
44
who to treat for GH deficiency
childhood onset (short stature)
45
effects of GH treatment
increase muscle mass, decrease fat mass
46
Tx for GH deficiency
daily SC injections of GH (in evening)
47
SE of GH deficiency
peripheral edema arthralgia paresthesias worsening of glucose tolerance
48
What is male hypogonadism
impairments of either testosterone production or sperm production by the testis
49
Primary hypogonadism
due to failure of testis (hypergonadotrophic hypogonadism)
50
Secondary hypogonadism
due to defects in HPT axis levels (hypogonadotrophic hypogonadism)
51
Values for primary hypogonadism
low T | High FSH, LH
52
Values for secondary hypogonadism
low T | low/nml FSH, LH
53
Common congenital cause of primary hypogonadism
klinefelter
54
Common congenital cause of secondary hypogonadism
kallman's
55
Sx of hypogonadism
decreased energy, libido, muscle mass, and body hair | hot flashes, gynecomastia, infertility
56
Dx of hypogonadism
free and total serum Testosterone LH FSH If secondary . (low LH, FSH): prolactin, TSH, CBC, CMP, consider semen analysis MRI
57
Tx for hypogonadotropic hypogonadism
IM injection of testosterone q 2 weeks transdermal cream/gel/patch applied daily pellets place SC q 3 months
58
Before initiating testosterone treatment
check DRE and PSA
59
Contraindication to testosterone therapy
Prostate CA
60
Treatment monitoring of testosterone therapy
free and total T CBC (risk of erythrocytosis) free estradiol Annual DRE and PSA
61
pan-hypopituitary syndrome
global anterior pituitary dysfunction, resulting in decreased anterior pituitary hormones (decreased ACTH, TSH, LH, FSH, GH, prolactin)
62
Etiologies of pan-hypopituitary syndrome
radiation therapy (50%)*** pituitary tumor (44%) extrapituitary tumors Sheehan syndrome ***
63
Dx of pan-hypopituitary syndrome
hx and PE full hormone workup MRI of the brain stimulation test as indicated to exclude primary disease
64
Tx of pan-hypopituitarism
EXTENSIVE HORMONE REPLACEMENT: levothyroxine, dexamethasone, testosterone (in males) estrogen-progestin (females), GH 1500 mg Ca w/ 800 IU of Vit D per day to protect bones
65
Sheehan's syndrome
postpartum pituitary gland necrosis due to blood loss and hypovolemic shock during and after childbirth
66
Sheehan's is a major cause of
pan-hypopituitarism | rare cause of GH deficiency
67
Posterior pituitary disorder
Central diabetes insipidus | Syndrome of inappropriate antidiruetic hormone secretion (SIADH)
68
ADH released in response to
hypertonicity
69
Result of ADH
water reabsorption concentrated urine reduce urine volume
70
Central DI
decreased release of ADH cause: idiopathic (most common, tumor of posterior pituitary (2nd most common)
71
Presentation of central DI
``` overly dilute urine and polyuria* dehydration polydipsia w/ fluid intake (up to 20L/day)* ice water craving nocturia/enuresis* hypernatremia ```
72
Dx of central DI
24 hours urine collection (polyuria >3L/day)*** serum and urine osmolality (urine osmolality <250 mOsm/Kg) *** ``` serume electrolytes (Na >135) glucose urine specific gravity water deprivation- Desmopressin Testing MRI of pituitary ```
73
Urine volume: normal vs DI
normal: 800-2000 mL/day DI: >3L/day
74
Serum sodium: normal vs DI
normal: 135-145 DI: normal to high
75
Serum osmolality
normal: 285-295 DI: normal to high
76
urine osmolality
Nml: 50-1200 DI: Low
77
Urine specific gravity
Nml: 1.010-1.030 DI: <1.005
78
Tx for central DI
Desmopressin (DDAVP): ADH analog; intranasal**, oral or parenteral Chlorpropamide, carbamazepine, thiazide diuretics, and NSAIDS low solute diet (mostly low sodium, low protein)
79
Tx for nephrogenic DI
chlorpropamide, carbamezpine, thiazide, NSAIDS, low salt/protein diet
80
ADH levels in DI
central: low Nephrogenic: high
81
SIADH
inappropriate release of ADH (too much)
82
Etiology of SIADH
CNS disorder ectopic production by malignancy drugs surgical procedures
83
Presentation of SIADH
``` concentrated urine, decreased volume decrease serum osmolality, increase urine osmolality no acid-base disturbance serum uric acid concentration low hyponatremia* ```
84
Dx of SIADH
``` 24 hour urine electrolytes (Na<135) Serum/urine osmolality urine sodium CT/MRI of head to r/o CNS disorder CXR to r/o lung tumor ```
85
SIADH values
``` urine volume: low serum sodium: low Serum osmolality: low Urine osmolality: high Urine sodium: >40 ```
86
Tx for SIADH
correct hyponatremia Fluid restriction* (<800 mL/day) IV hypertonic saline (3%) if severe or resistant consider oral salt intake consider vasopressin receptor antagonists (vaptans)

Clin Med II Final (6 decks)

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