Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine Clin med > pituitary & hypothalamus > Flashcards

pituitary & hypothalamus Flashcards

1
Q

what is hypopituitarism

A

low functioning pituitary gland
*either a problem with the hypothalamus upstream OR pituitary gland itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of hypopituitarism

A

Hypothalamus or pituitary lesions
*pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of adenoma is most common cause of hypopituitarism

A

prolactinomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What age group is at highest risk for pituitary adenomas

A

30-40
*can be inherited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does hypopituitarism present

A

Headaches /visual changes (mass effect)
-fatigue, dizziness, hypotension, confusion, polydipsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If someone has GH deficiency, how will they present

A

short stature
micropenis
central obesity
hyperlipidemia
reduced muscle/bone mass
CV dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If someone has a gonadotropin deficiency, how will they present

A

FSH and LH deficiency
*hypogonadism and infertility, impaired/absent puberty, sexual dysfunction, loss of secondary male characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how is hypopituitarism diagnosed

A

through evaluation of hormone levels or downstream effects
-evaluation of GH level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can you evaluate GH levels

A

Via stimulation testing
*no GH increase w/ exercise
*no GH increase with glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can you test for adrenal deficiency

A

Low AM serum cortisol
Low serum ACTH
Low serum DHEA
Low ACTH w/ cosyntropin stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of imaging is done to assess the pituitary

A

MRI of hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who will have an MRI of their hypothalamus to assess the pituitary

A

Men>16 with low LH & serum testosterone.

2+ pituitary hormone deficiencies

Persistent hyperprolactinemia

symptoms of mass effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What will be seen on imaging with hypopituitarism

A

Distinct mass
generalized pituitary enlargement
thickening of pituitary stalk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat hypopituitarism

A

Resection of tumors or other masses

dopamine agonist in prolactinomas (first line)

radiation as a last line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the dopamine agonists used for prolactinomas

A

bromocriptine or cabergoline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If the pituitary gland is removed, what does the patient need to take for the rest of their life

A

-Glucocorticoid replacement (hydrocortisone)

-levothyroxine AFTER glucocorticoid initiation

-Gonadotropin replacement

-hGH replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a pituitary adenoma

A

Benign tumor arising from any one of the pituitary cell types

*most common cause of hypo and hyperpituitarism in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the classifications of pituitary adenomas

A

Micro vs Macro
Functioning vs Non-functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a functioning pituitary adenoma

A

secretion of hormones by the tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a macro adenoma

A

> 1cm diameter -> generally get mass effect and hypopituitarism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the test of choice for a pituitary adenoma

A

MRI with gadolinium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a secondary hormone dysfunction workup

A

Basal prolactin
insulin like growth factor
24hr urinary free cortisol
FSH & LH
Thyroid function test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are acidophils

A

GH
Prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are basophils

A

TSH
LH/FSH
ACTH

25
Q

If the pituitary adenoma is small, how do you treat

A

Annual MRI to monitor
*if no growth, can reduce frequency

26
Q

How do you treat a macro adenoma

A

Resection via a transsphenoidal approach
+/- radiation

27
Q

What medications can inhibit a pituitary adenoma

A

Somatostatin
dopamin
*both inhibit

28
Q

what is the most common pituitary hormone hypersecretion syndrome

A

Hyperprolactinemia

29
Q

What are the underlying causes of hyperprolactinemia

A

Physiologic: exercise, inherited, sleep

Pharmacologic: amphetamines, opioids, nicotine, TCA, SSRI

Pathologic: Acromegaly, Hypothalamic disease, hypothyroidism, tumors

30
Q

What is a normal prolactin level in males

A

<20ng/mL

31
Q

What is a normal prolactin level in non-pregnant women? Pregnant?

A

<25ng/mL
40-800ng/mL

32
Q

What prolactin levels are indicative of a prolactinoma (excluding pregnancy)

A

> 200ng/mL

33
Q

How do you workup hyperprlactinemia

A

Evaluate for underlying causes (test all other pituitary hormones)

If no physiological change or pharmacologic cause -> MRI

34
Q

What is gigantism

A

excessive growth in childhood, prior to physical closure (long bones)

35
Q

What is acromegaly

A

excessive growth after physical closer (no long bone involvement)
-hands
-feet
-head

36
Q

How do you test for acromegaly and gigantism

A

Random serum IGF-1
*if normal= ruled out

37
Q

How is gigantism physically differentiated from acromegaly

A

They have a tall stature and delayed puberty, where as acromegaly the bones would be wider than normal

38
Q

What is the workup for acromegaly and gigantism

A

Fasting, no exercise, and no illness
-serum IGF-1
-prolactin level
-Glucose
-LFTs,BUN,creatinine
-serum calcium
-free T4 and TSH

39
Q

What kind of imaging can be done for acromegaly and gigantism

A

pituitary MRI
Skull xray (enlarged sella, thick skull)
Xray of hand and feet

40
Q

What will be seen on the hand and feet X-rays with acromegaly

A

tufting of phalanges (spade looking)
Enlarged calcaneous

41
Q

What is the treatment of choice for acromegaly and gigantism

A

Transsphenoidal resection

42
Q

What is the most common skeletal dysplasia

A

achondroplasia

43
Q

What type of genetic disease is achondroplasia

A

Autosomal dominant
fibroblast GF receptor 3 gene
*if homozygous = Letha;

44
Q

What are some clinical features of achondroplasia

A

Disproportionate short stature
large head
delayed motor development
short fingers
exagg. lumbar lordosis
prominent forehead

45
Q

How can achondroplasia be confirmed

A

genetic testing
+FGFR3 mutation

46
Q

What complications arise from achondroplasia

A

recurrent OM
OSA
Obesity
spinal stenosis
narrow foramen magnum (can cause hydrocephalus)

47
Q

What is Diabetes insipidus

A

deficiency in ADH (vasopressin) - posterior pituitary

loss of renal H2O reabsorption = polyuria

48
Q

What are the types of diabetes insipidus

A

Central (ADH deficiency)
- primary cause being no lesion

Nephrogenic (kidney just isn’t responding to ADH)

49
Q

What is the presentation of diabetes insipidus

A

intense thirst
cravings for ice water
polyuria
enuresis

50
Q

If urine has high volume and low specific gravity, how is it classified

A

dilute

51
Q

What testing can rule of DI

A

24hr urine collection with less that 2L collected

52
Q

How do you treat diabetes insipidus

A

DDAVP (desmopressin)
Nasal, SQ or IV (nasal / oral preferred)
start low and go slow

53
Q

What is SIADH

A

Inappropriate release of ADH

54
Q

Who is at increased risk for DI

A

Pituitary tumor
Craniotomy
head injury

55
Q

What causes SIADH

A

Central (metabolic, CNS, psychiatric, iatrogenic)

Lungs (infection, mechanical, tumors- specifically small cell)

56
Q

How does SIADH present

A

decreased fluid output even with adequate or increased intake

*fluid overload-> edema, hyponatrema, BP

57
Q

What would workup show with SIADH

A

Serum hyponatremia
hypoosmolality
increased urine sodium concentration
normal thyroid/adrenal function

58
Q

What is the treatment of SIADH

A

Treat underlying causes
fluid restriction***
if severe -> IV sodium chloride

Endocrine Clin med (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions