Pituitary Pathophysiology Flashcards Preview

Endocrinology > Pituitary Pathophysiology > Flashcards

Flashcards in Pituitary Pathophysiology Deck (20):
1

What are hormonal consequences of pituitary and hypothalamic diseases?

Hypersecretion: only pituitary adenomas
Hyposecretion: Any disease of pituitary/hypothalamus for anterior pituitary hormones

Hyposecretion of vasopressin can only be caused by disease of hypothalamus or infundibulum

2

What are signs of GH deficiency? (3)

Short stature prior to epiphyseal closure
Decreased muscle/increased fat mass
Decreased BMD

3

GH Replacement: What is it approved for and what is its effect

Approved for short stature.
Effects: growth, increase in BMD

4

Which adenomas involve peptide hormones? What is noticeable effect?

Adenomas involving somatotrophs, lactotrophs, corticotrophs.

Effect: people "look funny"

5

Which adenomas involve glycoprotein hormones? Are they recognizable?

Ones involving gonadotrophs, thyrotrophs

Only recognizable once they are much larger

6

Somatotroph Adenomas: Presenation

Acromegaly (huge facial features, big hands) and gigantism

7

Somatotroph Adenomas: Diagnosis via chemical confirmation (2)

Lack of suppression of Gh in response to oral glucose load
Elevated IGF-1

8

Somatotroph Adenomas: Dx via pathologic confirmation

Histologic appearance of pituitary adenoma
IHC staining

9

Consequences of Somatotroph Adenomas (7)

Arthritis (OA), cancer (esp colon cancer), CVD, DM, Neuropathy (carpal tunnel), sleep apnea, death

10

Somatotroph Adenomas: Pharma Options (3) and other options (2)

Pharmacologic: DA agonists (cabergoline), SS analogs (octreotine), GH receptor antagonists (pegvisomant)
Surgical
Radiation

11

How does pegvisomant antagonize GH receptor?

Dimerizes GHR

12

Lactotroph adenomas: Clinical Syndromes
Premenopausal women? (2)
Postmenopausal women? (1)
Men? (3)

Premenopausal: amenorrhea and galactorrhea
Postmenopausal: neurological syndromes
Men: Decreased libido, fertility, potency

13

Causes of hyperprolactinemia: Physiologic (4) and pathologic (6)

Phys: Pregnancy, nursing, exercise, stress
Path: lactotroph adenomas, DA receptor antagonist, catecholamine inhibitor, H2 antagonists, estrogens, opiates

14

Treatment of lactotroph adenomas

Dopamine agonists: cabergoline, bromocriptine

15

Px of Corticotroph Adenomas (2)

Cushing's syndrome, neurological symptoms

16

Thyrotroph Adenoma Presentation (2)

(Hyperthyroidism): A-fib and CHF

17

Thyrotroph Adenoma Treatment and Effect

SS Analogs (octreotide): reduces T4 and TSH...also decreases adenoma size

18

Gonadotroph Adenomas: Clinical Px (3)

Neurological symptoms: visual field impairment and headaches
Incidental finding on MRI
Hormonal abnormality: Premature puberty in boys, ovarian hyperstimulation

19

Lab values in Gonadotroph Adenomas:

Elevated FSH, alpha subunit, estradiol
Low LH

20

What do you see on US in women with gonadotroph adenomas?

Big ol ovaries (due to hyperstimulation)