Chapter 15: Endocrine Flashcards
Prolactinoma, GH cell adenoma, ACTH cell adenomas are all examples of what?
A pituitary adenoma - Benign tumor of the anterior pituitary
What Sx would a patient with a non-functional pituitary adenoma present with (3)?
- BITEMPORAL HEMIANOPSIA - compression of the optic chiasm
- Hypopituitarism: due to compression of normal pituitary tissue
- HA
What is the most common type of pituitary adenoma?
Prolactinoma
What are the presenting symptoms of a Prolactinoma?
Females: galactorrhea, amenorrhea
Males: decreased libido, headache
What is the treatment for a prolactinoma?
Dopamine agonists (Bromocriptine or cabergoline): - suppresses prolactin production (tumor shrinks) or surgery for larger lesion
How will a Growth hormone cell adenoma presentation differ in children vs adults?
Children: Gigantism - increased linear bone growth (epiphysies are not fused)
Adults: Acromegaly - enlarged bones of hands, fee, jaw; growth of visceral organs leading to dysfunction (Cardiac failure); enlarged tongue
-Secondary diabetes mellitus is often present
How is a GH cell adenoma diagnosed?
Elevated GH and insulin growth factor-1 (IGF-1) levels along with lack of GH suppression by oral glucose
What is the treatment of a CH cell adenoma?
Octreotide (somatostatin analog that suppressed GH release
GH receptor antagonist
Surgery
What will be the major complication associated with ACTH cella denomas?
Cushing sydnrome
How much of the pituitary parenchyma must be lost before symptoms will arise from hypopituitarism?
75%
Pituitary adenomas in adults or craniopharyngiomas in children will cause what pituitary issue due to mass effect or pituitary apoplexy?
Hypopituitarism
What is Sheehan syndrome?
Pregnancy-related infarction of the pituitary gland.
- Gland doubles in size during pregnancy, but blood supply does NOT increase significantly; blood loss during parturition precipitates infarction.
How will a mother with Sheenhan syndrome present?
Poor lactation, loss of pubic hair [secondary to decreased LH], and fatigue
-Will have hypopituitarism
What is Empty sella syndrome?
Congenital defect of the sella
- herniation of the arachnoid and CSF into the sella compresses and destroys the pituitary gland
- Pituitary gland is “absent” (empty sella) on imagine
- Is a cause of hypopituitarism
What is Central Diabetes Insipidus?
ADH deficiency
-Due to hypothalamic or posterior pituitary pathology
A patient presents with polyuria, polydipsia, hypernatremia, high serum osmolality, and low urine osmolality and specific gravity. He is is found to have an issue with the posterior pituitary gland. What does he have?
Central diabetes insipidus
How do you diagnose Central Diabetes Insipidus?
Water deprivatoin test FAILS to increase urine osmolality
How do you treat Central Diabetes insipidus?
Desmopressin (ADH analog)
What is nephrogenic diabetes insipidus?
Impaired renal response to ADH
- Due to inherited mutations or drugs [lithium, demeclocycline]
- No response to desmopressin
What is Syndrom of inappropriate ADH (SIADH) Secretion?
Excess ADH secretion
What causes SIADH?
Most often due to ectopic ADH production [small cell carcinoma of the lung]
-other causes: CNS trauma, pulmonary infection, and drugs [cyclophosphamide]
A patient presents with hyponatremia and low serum osmolality. The patient also has mental status changes and seizures. The patient is found to have excessive ADH secretion and a problem with the posterior pituitary. What do they have?
SIADH secretion
What is the treatment for SIADH secretion
Free water restriction or demeclocycline - blocks effect on ADH
What is a thyroglossal duct cyst, and where does it come from?
- Cystic dilation of thyroglossal duct remnant
- a persistent thyroglossal duct that did not involute - which then underwent cystic dilation.
- Presents as an anterior neck mass