Anterior Pituitary Issues

Question 1

what is the most common cause of hyperprolactinemia?

Answer 1

prolactinoma

Question 2

name two issues that can lead to hyperprolactinemia other than prolactinoma

Answer 2

acromegaly and other sellar masses that compress the stalk

Question 3

name 4 drug classes that lead to hyperprolactinemia?

Answer 3

anti hypertensives
antipsychotics
anti depressants
GI meds

Question 4

name three findings of hyperprolactinemia in women

Answer 4

galactorrhoea
menstrual irregularity
infetility

Question 5

name clinical manifestations of hyperprolactinemia in men

Answer 5

galactorhoea
impotence
visual field abnormalities
headache
extraocular muscle weakness
anterior pituitary malfxn

Question 6

who presents first with hyperprolactinemia, men or women?

Answer 6

women

Question 7

what is Rx for hyperprolactinemia?

Answer 7

dopamine agonists

Question 8

name the two dopamine agonists used in hyperprolactinemia

Answer 8

cabergoline

bromocriptine

Question 9

what are the common SEs of dopamine agonists?

Answer 9

nausea and vomiting

Question 10

how is GH released from ant pit?

Answer 10

in pulsatile fashion

Question 11

what is GH effect on bone?

Answer 11

growth induction

Question 12

what is GH effect on fat?

Answer 12

lipolysis

Question 13

what is GH effect on muscle?

Answer 13

protein synthesis

Question 14

what is the molecule in the systemic area that is similar to GH and induced by GH, but not known as GH?

Answer 14

IGF-I

Question 15

name five changes with excess GH

Answer 15

bone growth leading to acral changes
thickening of skin
hypertension
neuromuscular and psych issues
neoplasia

Question 16

what heart problem can you have with increased GH?

Answer 16

cardiomyopathy

Question 17

name two MSK diagnoses seen in excess GH?

Answer 17

carpal tunnel syndrome and arthritis

Question 18

does GH increase or decrease with increase in glucose?

Answer 18

GH drops with increasing glucose

Question 19

name two tests to diagnose acromegaly

Answer 19

measure IGF-1 and glucose test by giving glucose and not seeing GH drop

Question 20

what are three general treatment modalities for acromegaly?

Answer 20

surgical removal
conventional radiation therapy
medications

Question 21

what is the first class of medications given for acromegaly?

Answer 21

somatostatin analogs

Question 22

why are somatostatin analogs used in acromegaly?

Answer 22

they inhibit the secretion of GH from ant pit

Question 23

aside from somatostatin analogs, what other drug class (random) works for acromegaly?

Answer 23

dopamine agonists will work for some patients

Question 24

what is the last med tried in acromegaly?

Answer 24

pegvisomant

Question 25

what is MoA of pegvisomant?

Answer 25

GH receptor antagonist

Question 26

name three findings of hypopituitary in neonates

Answer 26

hypoglycemia mid line defects micropenis

Question 27

name three findings of hypopituitary in children

Answer 27

decreased growth delayed puberty deficient TSH/ATCH

Question 28

what time do you measure cortisol to see if ACTH or cortisol is low?

Answer 28

best to measure in morning..this is when it is highest

Question 29

what are signs of GH deficiency in kids?

Answer 29

truncal obesity/adiposity immature cherubic facies with prominent forehead delayed dentition delayed puberty

Question 30

what are the two tests to diagnose GH deficiency in kids?

Answer 30

IGF-1 and glucose restriction test

Question 31

what should happen to GH if you induce hypoglycemia?

Answer 31

GH should go up

Question 32

what is number 1 cause of hypopituitarism in adults?

Answer 32

pituitary tumors

Question 33

what do many of the non functioning pituitary tumors secrete?

Answer 33

alpha subunit of pituitary hormones

Question 34

what is the alpha subunit of pituitary hormones?

Answer 34

a subunit of hormones produced by pituitary tumors

Question 35

what is order of hormone loss in progressinf hypopituitary?

Answer 35

GH loss then LH/FSH loss then TSH loss then ACTH loss

Question 36

what is signs of low FSH?LH in females

Answer 36

oligo or amenorhea, vaginal dryness and hot flashes

Question 37

what are signs of low FSH/LH in men

Answer 37

low libido, erectile dysfxn

Question 38

what are signs of low TSH in hypopituitary?

Answer 38

fatigue, cold intolerance, constipation, dry skin, hari loss

Question 39

what are signs of low aCTH in hypopotuitary?

Answer 39

fatigue, anorexia, weight loss, postural hypotension

Question 40

how do panhypopituitary ppl appear?

Answer 40

overweight with fine wrinkling of skin and decreased pigmentation and absent pubic hair

Question 41

what are signs of GH loss in adults?

Answer 41

``` decrease exercise performance decrease energy decrease muscle mass increase fat high LDL and low HDL ```