Anterior Pituitary

Question 1

Dx acromegaly

Answer 1

elevate IGF-1

oral glucose tolerance test - normally glucose suppresses GH levels within 2 hours, glucose will no decrease below 1ng/ml in acromegaly

Question 1

General causes of panhypopoituitaryism / hypopituitarism

Answer 1

Mass lesion

treatment of sellar, parasellar, hypothalamic diseases (surgy)

infiltrative disease (autoimmune, sarcoidosis, hemochromatosis

trauma

Vascular (Sheehans syndrome, pituitary tumor apoplexy

Medications

Infectious

Genetic

Developmental

Question 2

Rx for Acromegaly

Answer 2

Octreotide+ Lanreotide (Somatostatin receptor ligands)

Cabergoline (DA agonist, limited effectiveness)

Pegvisomant (GH receptor blockade in liver)

Question 2

normal potassium and no hyperpigmentation seen in ___ adrenal insufficiency

Answer 2

secondary

Question 4

hormones of posterior pituitary

Answer 4

ADH

Oxytocin

Question 4

DA agonists used for hyperprolactinemia, prolactin secreting adenomas, acromegaly, parkinsons

Answer 4

Bromocriptine

Cabergoline

Question 5

clinical signs of GH def in neonate

in child

Answer 5

Neonate: jaundice

hypoglycemia

microphallus

traumatic delivery

Child: hypoglycemia

increased fat

high pitched voice

absent/late puberty

physical defects of skull, craniofacial abnls

Question 6

GH receptor antagonist used for acromegaly

Answer 6

Pegvisomant

Question 7

Testing procedures for ACTH

Answer 7

Cortisol 8am fasting

inuslin tolerance test (30, 60min) (insuf if cortisol repsonse

Question 8

non-Rx treatment of Prolactinemas

Answer 8

Transsphenoidal ressection in patients not tolerating DA agonists

asymtpomatic require no treatment

Radiation for hihg surgical risk

Question 8

Acromegaly etiology

Answer 8

typically GH-secreting pituitary tumor

Question 9

Rx for GH def

side effects

Answer 9

recombinent humone growth hormones rGH

(SubQ nightly)

side effects: slipped femoral epiphysis

scoliosis

psuedotumor cerbri

snoring/sleep apnea from tonsil growth

Question 9

somatostatin analogs used to treat acromgelly

Answer 9

Octreotide

lanreotide

Question 11

contents of cavernous sinus

Answer 11

Internal carotids

CN III IV V1, V2, VI

(3+4+5.1+5.2+6)

Question 12

clinical presentation ACTH deficiency (as in hypopituitarism)

Answer 12

weight loss

weakness, fatigue

nausea/vomiting/anorexia

abdl pain

arthralgias + myalgias

orthostatic hypotension

hyponatremia + glycemia

Question 13

mechanism underlying decrease in male libido and decrease in menses in women seen in hyperprolactinemia

Answer 13

inhibition of pituitary gonadotropins FSH and LH

Question 14

dx of hyperprolactinemia

Answer 14

serum prolactin above reference range

Question 14

Endocrine/metabolic changes in Acromegaly

Answer 14

**menstrual abnls+male hypogonadism **- (PRL production by tumor or compression of gonadotrophs)

**galactorrhea - **PRL production or GH stimulation of PRL binding sites in breasts

**DM2 +impaired glucose tolerance - **anti-insulin effects of GH

Question 15

hormones secreted from posterior pituitary originate in

Answer 15

paraventricular nuclei of hypothalamus

(transport via supraopticohypophyseal tract)

Question 17

80% of IGF-1 circulates bound to

Answer 17

IGFBP-3

Question 18

regulation of GH

Answer 18

GHRH and somatostatin (both from hypothalamus)

IGF-1 inhibits (negative feedback)

Question 20

metabolic actions of GH

Answer 20

antagonizes insulin action

> increase lipolysis, Free FA porduction

increase protein synthesis

Question 21

GH testing procedures

Answer 21

Basal IGF

GHRH arginine stimulation test

glucagon stimulation test

Question 22

hormones of anterior pituitary

Answer 22

Prolactin

GH

ACTH

FSH

LH

TSH

Question 23

clincila presentation of GH deficiency in adult

Answer 23

increased visceral fat, reduced lean body mass

reduced eneryg, social isolation, emotional lability+depression

reduced bone mineralization

elevated LDL and TG, low HDL

Question 25

mild-moderate hyperprolactinemia most likely

Answer 25

infudibular stalk compression by a tumor, inhibition dopamine trasnport to lactotroph

Question 26

systemic causes of hyperprolactinemia

Answer 26

neurogenic - chest trauma, surgery, herpes zoster

chronic renal failure due to decreased breakdown of PRL

Cirrhosis

Primayr hypothyroidism

Polycystic ovaran disease

Question 27

physiological causes of hyperprolactinemia

Answer 27

pregnancy

lactation

exercice

sleep

stress

Question 29

Rx hyperprolactinemia

Answer 29

DA agonists bromocrptine (esp in fertility induction)

cabergoline (preferred)

Question 29

TSH or thyroid hormones is replaced with ___

ACTH or cortisol is replaced with ___

Answer 29

TSH or thyroid with levothyroxine or T4

ACTH or cortisol with hydrocortisone or prednisone

Question 31

testing procedures for FSH LH

Answer 31

males - 8am fasting T (if below normal range or low with inappropriately normal LH+FSH)

females - basal serum estradiol

Question 32

GH stimulates rlease of

Answer 32

IGF-1

Question 33

clinical presentation of TSH deficiency or secondary hypothyroidism

Answer 33

weight gain

weakness, fatigue, lethary

cold intolerance

arthralgias+myalgias

Dry skin and hair

Constipation

diffuse edema, periorbital edema

bradycardia

Question 34

drugs causing hyperprolactinemia

Answer 34

metoclopramide

risperidone

(both DA antagonists)

Question 35

control of prolactin synthesis and secretion

Answer 35

tonic inhibition via Dopamine from hypothalamus

stimulation via thyrotropin releasing hormone

estrogen

vasopressin

VIP

oxytocin

EGF

(Thy Expression Varies Very Oddly, Ed

Question 36

Acromegaly non-Rx treatment

Answer 36

must treat both the tumor an GH IGF-1 levels

1. Transsphenodal surgery
2. radiation therapy (10-15 years to see full effect)
3. (Rx)