Darrow pituitary diseases part I

Question 1

increased hat and glove size

Answer 1

acromegaly

Question 2

skin tags and enlarged tongue

Answer 2

acromegaly

Question 3

how can acromegaly cause abnormal menstrual cycles

Answer 3

can co secrete PRL
can activate PRL R
the GH adenoma can compress pituitary stalk and inhibit dopamine release

Question 4

PRL feedback on hypothalamus

Answer 4

inhibits GnRH release

Question 5

What can cause + Tinels

Answer 5

myxedema, edema, DM, infiltration, amyloid, neoplasms, trauma, RA, acromegaly and pregnancy

Question 6

how does pain and stiffness in back/hips/knees relate to acromegaly

Answer 6

synovial thickening at the knees

Question 7

why is snoring a component of acromegaly

Answer 7

increased glands

Question 8

HA with coughing, nausea from pain?

Answer 8

look for brain tumor

Question 9

what causes the acanthosis nigricans and skin tags in acromegaly

Answer 9

increased IGF-1

Question 10

what cancers can cause increased hat size and skin tags

Answer 10

breast, thyroid, colon and renal cell cancers

Question 11

what tests to order for suspected acromegaly with increased fasting blood sugar

Answer 11

glucose, PRL, BUN, AST, ALT, Ca, phosphorus
T4,TSH cortisol
Uosm/Posm
serum GH after 75 mg glucose

Question 12

when give glucose what should the GH levels be

Answer 12

decreased

Question 13

what is a + GH suppression test with glucose

Answer 13

if the GH is less than 1 ng/ml

or less than 0.4 in supersensitive assay

Question 14

effects of GH on metabolism

Answer 14

lipolysis
gluconeogenesis
increased conversion lactate and glycerol to glucose

Question 15

causes of acromegaly

Answer 15

microadenoma with somatotroph mutation
macroadenoma
Ectopic GH or GHRH production

Question 16

what mutation causes microadenoma secreting GH

Answer 16

mutation of alpha subunit of GTP binding protein on Gsalpha

causes increased cAMP producing GH secretion

Question 17

syndromes assoc with acromegaly

Answer 17

MEN1
carney complex
mcCune Albright syndrome

Question 18

what causes carney complex

Answer 18

mutation in tumor suppressor gene for protein kinase A

Question 19

what are signs of MuCune Albright syndrome

Answer 19

PFD, cafe au lait sports, endocrine hyperfunction

Question 20

MEN1

Answer 20

pituitary, pancreas, PTHgland

also can have hyper Ca, peptic ulcers, hypoglycemia

Question 21

complications with GH secreting adenoma

Answer 21

mass effects

Question 22

how is a pituitary adenoma secreting GH Tx

Answer 22

surgery
radiation
drugs: dopamine agonists, somatostatin analogs
GH R antagonist (pegvisomat)

Question 23

side effect of somatostatin analogs

Answer 23

gallstones

Question 24

side effects pegvisomat

Answer 24

liver function abnormalities

Question 25

enlarged pituitary and on surgery it is hyperplasia, no evidence of adenoma

Answer 25

ectopic hormone production | e.g small cell/oat cell carcinoma that produces GHRH

Question 26

long term follow up for GH adenoma

Answer 26

follow GH and IGF1 levels

Question 27

goals of Tx for GH adenoma

Answer 27

with suppression test to have GH level under 0.4

Question 28

``` F amenorrhea, galactorrhea with dysparunia, mild hirsutism and acne takes resperidone, verapamil, lisinopril and somtimes metoclopramide for nausea elevated BP BUN/Cr 10:1 high Cl no anion gap low HCO3 elevated PRL ```

Answer 28

Chronic renal failure renal cause from BUN:Cr | hyperchloremic non anion gap acidosis

Question 29

how does increased PRL lead to osteoporosis and amenorrhea

Answer 29

decreased GnRH so decreased LH and decreased estrogen

Question 30

how does increased PRL lead to dysparunia, hirsutism, and acne

Answer 30

decreased estrogen will lead to dec sex hormone binding globulin which increases free testosterone and DHEAS leading to hirsutism and acne

Question 31

what other conditions (not pituitary or hypothalamic) can cause increased PRL

Answer 31

hypothyroidism and kidney diseases

Question 32

endocrine cuases hyper PRL

Answer 32

pituitary adenoma, hypothalamic disease, hypothyroidism, pregnancy

Question 33

what drugs can cause hyperPRL

Answer 33

CNS acting meds, antiHTN, sex hormones, certain H2 blockers, metoclopromide, PI, opiates

Question 34

lisinopril can do what to kidneys

Answer 34

type IV RTA

Question 35

another name for hyperchloremia acidosis

Answer 35

hypoaldosteronism, hyporenin

Question 36

type of RTA caused by DM

Answer 36

type IV hypoaldosterone hyporenin

Question 37

if Cl is high what should HCO3 be

Answer 37

drop in HCO3, if not then Pt will vomit

Question 38

prolactinoma level of PRL

Answer 38

>200

Question 39

how would a men present with PRLoma

Answer 39

low libido | usually presents later on

Question 40

patient has >200 PRL levels but no Sx and negative MRI

Answer 40

macroprolactinemia

Question 41

what do you do if suspect macroprolactinmeia

Answer 41

precipitate IgGs with polyethylene glycol and then remeasure | screen for pituitary insufficiency: cortisol and T4 levels

Question 42

Tx prolactinemia

Answer 42

Dopamine agonists surgery radiation

Question 43

what are the side effects from dopamine agonists activating D1 R

Answer 43

nausea, fatigue, psychiatric Sx

Question 44

peripartum cardiomypopathy

Answer 44

women secreting abnormal prolactin levels