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Clin-Med B3 > 5: Pituitary Gland disorders > Flashcards

5: Pituitary Gland disorders Flashcards

0
Q

Macroadenoma

A

> 10mm

  • headache
  • visual disturbances
  • cranial nerve palsies
  • pressure atrophy of functioning cells-> hypopituitarism
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1
Q

Microadenoma

A

Incidentaloma

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2
Q

Adenomas- dx

A

MRI- confirmatory*

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3
Q

Adenoma- rx

A

Meds

Surgery- Transphenoidal surgery

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4
Q

Prolactinoma- sx

A

Women- menstrual irregularities and infertility lead to earlier recognition. Vaginal dryness, hot flashes, irritability, osteopenia, hirsutism
Men- decreased libido and erectile dysfunction often attributed to other causes, leading to delayed recognition. Visual impairment, headache, hypopituitarism

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5
Q

Prolactinoma- dx

A

basal PRL levels >200g/mL

MRI

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6
Q

Prolactinoma- rx

A

Dopamine agonist
-Bromocriptine
-Cabergoline
Transphenoidal surgery (if intolerant/resistant to meds)

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7
Q

GH cell adenoma- sx

A 
Childhood- gigantism
Adults- acromegaly
-widening of hands and feet
-coarsening of facial features
-enlargement of frontal sinuses
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8
Q

GH cell adenoma- dx

A

MRI
serum IGF-1- elevated
Oral glucose tolerance test (OGTT)- definitive test**
-positive result: failure of GH to decrease to <1ng/mL after ingesting 50-100g of glucose***

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9
Q

GH cell adenoma- rx

A

Trans-sphenoidal microsurgery (initial therapy of choice)- rapid results
Radiotherapy- results only 20yrs after, usually reserved for post-surgical management to prevent re-growth of residual tumor
Meds
-Octreotide
-Bromocriptine
-Pegvisomant (GH receptor antagonist)

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10
Q

ACTH cell adenoma- dx

A

Elevated urinary free cortisol
Elevated nighttime plasma or salivary cortisol
Normal or elevated ACTH
Suppression during the high-dose dexamethasone test
-Low dose (0.5mg q 6h): both; cortisol > 5micro g/dL
-High dose (2mg q 6h):
–ACTH secreting pituitary tumor; < 5micro g/dL
–Ectopic ACTH secretion; > 5micro g/dL

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11
Q

ACTH cell adenoma- rx

A
  • Trans-sphenoid resection**(TOC)
  • Radiation therapy
  • Meds; ones that block steroid synthesis (Ketoconazole, Metyrapone, Aminoglutethimide, Nifepristone, Trilostane)
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12
Q

Gonadotropin cell adenoma- sx

A
  • sx of local pressure (headache, visual disturbance)

- Hypogonadism (due to constant secretion-> inhibition)

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13
Q

Gonadotropin cell adenoma- dx

A
  • increased gonadotropin (FSH>LH) in the setting of a pituitary mass
  • decreased testosterone despite normal or increased LH
  • TRH administration stimulations LH b subunit secretion
  • retrospective immunohistochemical analysis of surgically resected tumor tissue*
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14
Q

Gonadotropin cell adenoma- rx

A
  • Transphenoidal surgical removal (primary rx)

- Radiotherapy

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15
Q

TSH-secreting pituitary tumors- rx

A
  • Transphenoidal surgery
  • Octreotide
  • Iodine-131 thyroid ablation or thyroid surgery
16
Q

Hypopituitarism- cc

A

1: Pituitary adenoma (MC in adults)
2: Craniopharyngioma
3: Sheehan syndrome
4: Putuitary apoplexy
5: Head trauma
6: Empty sella syndrome
7: Infiltrative disease (Wegner, Sarcoidosis)
8: Cranial radiotherapy to treat non-pituitary tumors

17
Q

GH deficiency in children- dx

A
  • Examining response to provocative stimuli (ie; exercise, insulin-induced hypoglycemia [insulin tolerance test: ITT], IGF-1 tests that normally increase GH> 7ug/L)
  • random GH measurement not done-> pulsatile secretion)**
18
Q

Insulin tolerance test (ITT)

A

GOLD standard for assessing GH reserve

  • hypoglycemia is a potent stimulus for GH secretion
  • Normal peak GH at 60mins:
  • ->5ng/mL in adults
  • ->10ng/mg in children
19
Q

GH deficiency in adult- usual sequential order of hormone loss

A

GH> FSH/LH> TSH> ACTH

- in case of pituitary lesion

20
Q

GH deficiency in adult- dx

A
  • Insulin tolerance test (choice)**

- Alternative stimulation tests: Arginine & GHRH

21
Q

ACTH deficiency- dx

A
  • ITT (choice)**
  • concomitant Cortisol and ACTH determination (<3ug/dL @8am: adrenal insufficiency)
  • random basal ACTH is unreliable: short half life and pulsatile secretion
22
Q

ACTH deficiency- rx

A
  • Hydrocortisone
  • Cortisone acetate
  • Prednisone
  • -dose increased 5- to 10- fold in times of stress (surgery)
  • -dose doubled during minor illness
  • —adrenal insufficiency should be rx upon suspicion and definitive dx made post-therapy
23
Q

Gonadotropin deficiency- dx

A

Women- basal estradiol, LH, FSH
Men- Testosterone (total; free), LH, FSH
–low or inappropriately normal serum gonadotropin levels in the setting of low sex hormone concentrations
MRI

24
Q

Prolactin deficiency- info

A

Elevated prolactin levels may be present in hypothalamic disorders
-increased inhibitory effects of dopamine
TRH test; normal: prolactin level increases after TRH administration (hypopituitarism fails to increase prolactin)

25
Q

Diabetes insipidus- dx: water deprivation test

A

Central DI: Supressed ADH
Nephrogenic DI: normal or increased level of ADH
Primary polydipsia: normal or increased level of ADH

26
Q

Diabetes insipidus- rx

A

Central: desmopressin acetate (DDAVP)
Nephro: diuretics with dietary salt restriction

Clin-Med B3 (17 decks)

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