Anterior Pituitary Issues Flashcards
what is the most common cause of hyperprolactinemia?
prolactinoma
name two issues that can lead to hyperprolactinemia other than prolactinoma
acromegaly and other sellar masses that compress the stalk
name 4 drug classes that lead to hyperprolactinemia?
anti hypertensives
antipsychotics
anti depressants
GI meds
name three findings of hyperprolactinemia in women
galactorrhoea
menstrual irregularity
infetility
name clinical manifestations of hyperprolactinemia in men
galactorhoea impotence visual field abnormalities headache extraocular muscle weakness anterior pituitary malfxn
who presents first with hyperprolactinemia, men or women?
women
what is Rx for hyperprolactinemia?
dopamine agonists
name the two dopamine agonists used in hyperprolactinemia
cabergoline
bromocriptine
what are the common SEs of dopamine agonists?
nausea and vomiting
how is GH released from ant pit?
in pulsatile fashion
what is GH effect on bone?
growth induction
what is GH effect on fat?
lipolysis
what is GH effect on muscle?
protein synthesis
what is the molecule in the systemic area that is similar to GH and induced by GH, but not known as GH?
IGF-I
name five changes with excess GH
bone growth leading to acral changes thickening of skin hypertension neuromuscular and psych issues neoplasia
what heart problem can you have with increased GH?
cardiomyopathy
name two MSK diagnoses seen in excess GH?
carpal tunnel syndrome and arthritis
does GH increase or decrease with increase in glucose?
GH drops with increasing glucose
name two tests to diagnose acromegaly
measure IGF-1 and glucose test by giving glucose and not seeing GH drop
what are three general treatment modalities for acromegaly?
surgical removal
conventional radiation therapy
medications
what is the first class of medications given for acromegaly?
somatostatin analogs
why are somatostatin analogs used in acromegaly?
they inhibit the secretion of GH from ant pit
aside from somatostatin analogs, what other drug class (random) works for acromegaly?
dopamine agonists will work for some patients
what is the last med tried in acromegaly?
pegvisomant
what is MoA of pegvisomant?
GH receptor antagonist
name three findings of hypopituitary in neonates
hypoglycemia
mid line defects
micropenis
name three findings of hypopituitary in children
decreased growth
delayed puberty
deficient TSH/ATCH
what time do you measure cortisol to see if ACTH or cortisol is low?
best to measure in morning..this is when it is highest
what are signs of GH deficiency in kids?
truncal obesity/adiposity
immature cherubic facies with prominent forehead
delayed dentition
delayed puberty
what are the two tests to diagnose GH deficiency in kids?
IGF-1
and
glucose restriction test
what should happen to GH if you induce hypoglycemia?
GH should go up
what is number 1 cause of hypopituitarism in adults?
pituitary tumors
what do many of the non functioning pituitary tumors secrete?
alpha subunit of pituitary hormones
what is the alpha subunit of pituitary hormones?
a subunit of hormones produced by pituitary tumors
what is order of hormone loss in progressinf hypopituitary?
GH loss then LH/FSH loss then TSH loss then ACTH loss
what is signs of low FSH?LH in females
oligo or amenorhea, vaginal dryness and hot flashes
what are signs of low FSH/LH in men
low libido, erectile dysfxn
what are signs of low TSH in hypopituitary?
fatigue, cold intolerance, constipation, dry skin, hari loss
what are signs of low aCTH in hypopotuitary?
fatigue, anorexia, weight loss, postural hypotension
how do panhypopituitary ppl appear?
overweight with fine wrinkling of skin and decreased pigmentation and absent pubic hair
what are signs of GH loss in adults?
decrease exercise performance decrease energy decrease muscle mass increase fat high LDL and low HDL
