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Clin Med II Final > Pituitary gland disorders > Flashcards

Pituitary gland disorders Flashcards

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
Q

Causes of hyperprolactinemia

A

pregnancy
stress
lactation
exercise
drugs: phenothiazine, haloperidol, benzos
Pathologic: microprolactinoma, macroprolactinoma, hypothyroidism

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26
Q

Drugs that cause hyperprolactinemia

A

phenothiazine
haloperidol
benzodiazepines

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27
Q

Tx for prolactinoma

A

medical: bromocriptin, Cabergoline

Surgical: transsphenoidal resection, radiotherapy

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28
Q

Drugs for prolactinoma

A

bromocriptine

Cabergoline***

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29
Q

most common etiology of GH excess

A

benign pituitary adenoma >1 cm

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30
Q

Other etiologies for GH excess

A

ectopic tumors, MEN type 1, neurofibromatosis

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31
Q

Result of GH

A

release of insulin like growth factor 1 (IGF-1 from liver)

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32
Q

Risk in acromegaly

A

DM (30%)
HTN
CAD

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33
Q

Acromegaly

A

adults (30’s)

enlargement of hands, feet, jaw, internal organs

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34
Q

Dx of acromegaly

A

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

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35
Q

Gold standard for GH dx

A

2-hour oral glucose tolerance test (OGTT)

36
Q

Tx for acrometay

A

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
Q

When is transsphenoidal microsurgery best

A

GH <50

tumor <2cm

38
Q

Drugs for acromegaly

A

octreolide

lanreotide

39
Q

More common: giganticism or acrometaly?

A

acromegaly

40
Q

Etiology of GH deficiency

A

pituitary adenoma (most common)

tx of tumor - surgery or radiation
Extrapituitary tumors (craniopharyngioma)
Sheehan Syndrome (rare)
41
Q

Sx of GH deficiency (adult-onset)

A 
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
Q

Who to evaluate for GH deficiency?

A

adults w/ known hypothalamic or pituitary disease w/ a hx of GH deficiency in childhood

43
Q

Dx of GH deficiency in adults

A

MRI: tumors are #1 cause
CBC, CMP, lipid panel, fasting insulin
DEXA scan
serum IGF-1

44
Q

who to treat for GH deficiency

A

childhood onset (short stature)

45
Q

effects of GH treatment

A

increase muscle mass, decrease fat mass

46
Q

Tx for GH deficiency

A

daily SC injections of GH (in evening)

47
Q

SE of GH deficiency

A

peripheral edema
arthralgia
paresthesias
worsening of glucose tolerance

48
Q

What is male hypogonadism

A

impairments of either testosterone production or sperm production by the testis

49
Q

Primary hypogonadism

A

due to failure of testis (hypergonadotrophic hypogonadism)

50
Q

Secondary hypogonadism

A

due to defects in HPT axis levels (hypogonadotrophic hypogonadism)

51
Q

Values for primary hypogonadism

A

low T

High FSH, LH

52
Q

Values for secondary hypogonadism

A

low T

low/nml FSH, LH

53
Q

Common congenital cause of primary hypogonadism

A

klinefelter

54
Q

Common congenital cause of secondary hypogonadism

A

kallman’s

55
Q

Sx of hypogonadism

A

decreased energy, libido, muscle mass, and body hair

hot flashes, gynecomastia, infertility

56
Q

Dx of hypogonadism

A

free and total serum Testosterone
LH
FSH

If secondary . (low LH, FSH): prolactin, TSH, CBC, CMP, consider semen analysis

MRI

57
Q

Tx for hypogonadotropic hypogonadism

A

IM injection of testosterone q 2 weeks

transdermal cream/gel/patch applied daily

pellets place SC q 3 months

58
Q

Before initiating testosterone treatment

A

check DRE and PSA

59
Q

Contraindication to testosterone therapy

A

Prostate CA

60
Q

Treatment monitoring of testosterone therapy

A

free and total T
CBC (risk of erythrocytosis)
free estradiol
Annual DRE and PSA

61
Q

pan-hypopituitary syndrome

A

global anterior pituitary dysfunction, resulting in decreased anterior pituitary hormones (decreased ACTH, TSH, LH, FSH, GH, prolactin)

62
Q

Etiologies of pan-hypopituitary syndrome

A

radiation therapy (50%)**
pituitary tumor (44%)
extrapituitary tumors
Sheehan syndrome **

63
Q

Dx of pan-hypopituitary syndrome

A

hx and PE
full hormone workup
MRI of the brain
stimulation test as indicated to exclude primary disease

64
Q

Tx of pan-hypopituitarism

A

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
Q

Sheehan’s syndrome

A

postpartum pituitary gland necrosis due to blood loss and hypovolemic shock during and after childbirth

66
Q

Sheehan’s is a major cause of

A

pan-hypopituitarism

rare cause of GH deficiency

67
Q

Posterior pituitary disorder

A

Central diabetes insipidus

Syndrome of inappropriate antidiruetic hormone secretion (SIADH)

68
Q

ADH released in response to

A

hypertonicity

69
Q

Result of ADH

A

water reabsorption
concentrated urine
reduce urine volume

70
Q

Central DI

A

decreased release of ADH

cause: idiopathic (most common, tumor of posterior pituitary (2nd most common)

71
Q

Presentation of central DI

A 
overly dilute urine and polyuria*
dehydration
polydipsia w/ fluid intake (up to 20L/day)*
ice water craving
nocturia/enuresis*
hypernatremia
72
Q

Dx of central DI

A

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
Q

Urine volume: normal vs DI

A

normal: 800-2000 mL/day
DI: >3L/day

74
Q

Serum sodium: normal vs DI

A

normal: 135-145
DI: normal to high

75
Q

Serum osmolality

A

normal: 285-295
DI: normal to high

76
Q

urine osmolality

A

Nml: 50-1200
DI: Low

77
Q

Urine specific gravity

A

Nml: 1.010-1.030
DI: <1.005

78
Q

Tx for central DI

A

Desmopressin (DDAVP): ADH analog; intranasal**, oral or parenteral

Chlorpropamide, carbamazepine, thiazide diuretics, and NSAIDS

low solute diet (mostly low sodium, low protein)

79
Q

Tx for nephrogenic DI

A

chlorpropamide, carbamezpine, thiazide, NSAIDS, low salt/protein diet

80
Q

ADH levels in DI

A

central: low
Nephrogenic: high

81
Q

SIADH

A

inappropriate release of ADH (too much)

82
Q

Etiology of SIADH

A

CNS disorder
ectopic production by malignancy
drugs
surgical procedures

83
Q

Presentation of SIADH

A 
concentrated urine, decreased volume
decrease serum osmolality, increase urine osmolality
no acid-base disturbance
serum uric acid concentration low
hyponatremia*
84
Q

Dx of SIADH

A 
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
Q

SIADH values

A 
urine volume: low
serum sodium: low
Serum osmolality: low
Urine osmolality: high
Urine sodium: >40
86
Q

Tx for SIADH

A

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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