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Endocrinology > Disorders of the Pituitary Gland > Flashcards

Disorders of the Pituitary Gland Flashcards

1
Q

What are the major target organs of growth hormone?

A

Liver

Adipose tissue

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2
Q

What are the major physiologic effects of growth hormone?

A

Promotes growth (indirectly via IGF-1)

Control of protein, lipid, and carbohydrate metabolism

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3
Q

What are the findings in adults who are growth hormone deficient?

A

Non-specific symptoms:
Mild to moderate obesity
Reduced strength and exercise capacity
Fatigue
Decrease bone mass

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4
Q

What are the findings in children who are growth hormone deficient?

A

Growth retardation
Short stature
Fasting hypoglycemia
Intelligence is usually normal

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5
Q

What is the gold standard for diagnosis of growth hormone deficiency?

A

Insulin tolerance test

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6
Q

Describe how the insulin tolerance test tests for growth hormone deficiency?

A

Regular insulin is administered via IV to reduce the blood glucose level to a value below 50mg/dL

Blood samples collected at regular intervals for the next 3 hours to measure GH and cortisol

GH and cortisol will rise in response to hypoglycemia (Will have low levels in hypopituitary)

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7
Q

How is the growth hormone deficiency treated?

A

Growth hormone may be replaced by daily SC injection

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8
Q

What is the most common cause of growth hormone excess?

A

GH producing pituitary adenoma

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9
Q

What is the condition called when a child has excess growth hormone?

A

Gigantism - They are large but proportional

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10
Q

What is the condition called when an adult has excess growth hormone?

A

Acromegaly

Clinically presents as overgrowth of bone and connective tissue

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11
Q

Acromegaly is associated with what other comorbidities?

A

Type 2 DM
OSA
HTN
CHF
arthritis
Visceromegaly (enlarged liver and spleen)
Neuropathies and arthropathy
Malignancies

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12
Q

What are some physical traits seen in patients with acromegaly?

A

Physical changes are described as having “coarse facial features”
Spade-like hands
Large feet
Frontal bossing
Large and fleshy nose
Prognathism
Increased ring and shoe sizes

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13
Q

What malignancy is associated with acromegaly?

A

colon cancer

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14
Q

Why is the growth hormone not a good test to determine if excess or deficiency?

A

Not useful to measure GH level as level fluctuates widely

It is a pulsatile hormone

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15
Q

What level/lab should be measured to assess for growth hormone excess?

A

Measure insulin-like growth factor IGF-1

Excellent for diagnosis, monitoring, and screening

It is made in the liver in response to GH

If elevated, then give 100g glucose (glucose should suppress GH secretion)

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16
Q

If you diagnose a patient with growth hormone excess, what imaging needs to be done next?

A

MRI of pituitary gland

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17
Q

What is the treatment of choice for patients with adenomas that are resectable, or large and cause visual impairment?

A

Transsphenoidal resection

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18
Q

What type of treatment alone is not sufficient in treating growth hormone excess?

A

Medical - not usually sufficient by itself

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19
Q

What is the medical treatment of choice in treating growth hormone excess?

A

Somatostatin analogue: Octreotide

50% achieve normal GH levels

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20
Q

Which medication is useful in Acromegaly refractory to
somatostatin analogues?

A

Pegvisomant (GH receptor blocker)

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21
Q

What are the major target organs of the thyroid hormone?

A

Thyroid gland

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22
Q

What are the major physiologic effects of the thyroid hormone?

A

Stimulates secretion of thyroid hormones

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23
Q

Which TSH level can be life threatening? (deficiency or excess?)

A

TSH Deficiency

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24
Q

Replacing target gland products is easier than replacing what?

A

pituitary peptide hormones

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25
If a patient is cortisol deficient as well as TSH deficient, which should you fix and why?
If multiple deficits exist, start replacing cortisol first, followed by thyroxine (thyroid accelerates the catabolism of cortisol)
26
What are the major target organs of ACTH?
Adrenal gland (cortex)
27
What are the major physiologic effects of ACTH?
Stimulates secretion of glucocorticoids and adrenal androgens
28
Which ACTH level can be life threatening? (deficiency or excess?)
ACTH Deficiency
29
ACTH deficiency is replaced by what taken orally either twice daily?
hydrocortisone
30
What are the major target organs of prolactin?
Mammary gland
31
What are the major physiologic effects of prolactin?
Milk production
32
What are signs/symptoms of prolactin deficiency?
Overall asymptomatic Loss of lactation in postpartum period
33
What is the most common cause of prolactin excess?
functional pituitary adenoma – prolactinemia
34
Cells in the anterior pituitary which produce prolactin in response to signals including dopamine, estrogen, progesterone, and TSRH
Lactotrophs
35
What are some causes of prolactin excess?
Functional pituitary adenoma Defective transport mechanisms Drugs Stimulation of lactotrophs
36
Early manifestation of prolactin hypersecretion in women presents as what?
galactorrhea and menstrual irregularities, notably amenorrhea
37
Early manifestation of prolactin hypersecretion in men presents as what?
Erectile dysfunction or loss of libido in men
38
Lactation that occurs in the absence of nursing
Galactorrhea
39
A prolactin level of what is diagnostic for prolacin excess?
>200ug/L
40
What imaging is the test of choice in prolactin excess?
MRI – Pituitary and hypothalamus
41
What class of medications is the treatment of choice for most prolactinemias?
Dopamine agonists – first line
42
In the treatment of a prolactinoma, is surgery or medication more effective?
Not as successful as pharmacotherapy for prolactinoma
43
What are the major target organs of FSH and LH?
Ovary and testis
44
What are the major physiologic effects of FSH and LH?
Control of reproductive function
45
What are some signs/symptoms of FSH and LH deficiency in pediatric females?
Failure to enter normal puberty: Delayed breast development Scant pubic and axillary hair Primary amenorrhea
46
What are some signs/symptoms of FSH and LH deficiency in pediatric males?
Failure to enter normal puberty: Penis and testes remain small Body hair is sparse
47
What are some signs/symptoms of FSH and LH deficiency in adult females?
Amenorrhea
48
What are some signs/symptoms of FSH and LH deficiency in adult males?
Reduced beard growth Decreased libido Difficulty/decrease in erections
49
Genetic condition with delayed or absent puberty and an impaired sense of smell due to mal-development of olfactory lobes
Kallmann’s syndrome
50
In the treatment of FSH and LH deficiency, sex hormones can be given to patients. However, which hormone is required for fertility and must be corrected?
For fertility, FSH is required (subQ injections)
51
What are the major target organs of ADH?
kidney
52
What are the major physiologic effects of ADH?
Conservation of body water
53
Water resorption in collecting ducts is proportional to the release of which pituitary hormone?
ADH release
54
What level of ADH produces dilute urine and reduced volume of body fluids?
Low ADH
55
What level of ADH produces concentrated urine?
High ADH
56
ADH deficiency is also known as what disorder?
Diabetes Insipidus
57
What is the hallmark characteristic of diabetes insipidus?
Hypernatremia with dilute urine
58
What are the clinical features of diabetes insipidus?
Excretion of large volumes of urine (polyuria) Excretion of a dilute urine (osm <200) Elevation of plasma osmolality and serum Na+ Stimulation of thirst (polydipsia)
59
What are the two types of diabetes insipidus?
Central/Neurogenic Nephrogenic
60
In which type of diabetes insipidus is ADH low and why?
Central/Neurogenic posterior pituitary fails to secrete ADH
61
In which type of diabetes insipidus is ADH high and why?
Nephrogenic kidneys not responding to the hormone (ADH resistance)
62
What diagnostic test is used to diagnose diabetes insipidus?
Water deprivation test
63
What test is used to differentiate between central and nephrogenic diabetes insipidus?
DDAVP Challenge
64
In the DDAVP challenge, an increase >50% indicates which type of diabetes insipidus?
central DI
65
DDAVP challenge, a small or absent response suggests which type of diabetes insipidus?
nephrogenic DI
66
What is the treatment of choice in central/neurogenic diabetes insipidus?
Desmopressin acetate is the treatment of choice
67
What is the treatment of diabetes insipidus for nephrogenic cause?
Drugs that reduce polyuria: Thiazide diuretics Prostaglandin synthesis inhibitors Potassium-sparing diuretics
68
Too much ADH/hypersecretion is also referred to as what?
Syndrome of Inappropriate ADH Secretion (SIADH)
69
What are causes of SIADH?
Disorders affecting the central nervous system or the lungs Medications can increase ADH or its actions Some carcinomas autonomously secrete ADH
70
What are the clinical features of SIADH?
Dilution effect leads to hyponatremia, usually <125 mmol/L Low serum osmolality but inappropriately high urine osmolality Vagueness, confusion, nausea, irritability 🡪 progressing to seizures and coma
71
What medication can be helpful in SIADH?
Demeclocycline administered (inhibits ADH action on renal tubules)
72
What are the major target organs of oxytocin?
Ovary and testis
73
What are the major physiologic effects of oxytocin?
Stimulates milk ejection Stimulates uterine contractions
74
A benign neoplasm that arises form one of the five anterior pituitary cell types Usually found in adults – peak incidence from 35 to 60 years of age Account for approximately 15% of all intracranial neoplasms
Pituitary Adenoma
75
Most common lesion found in the sella
Pituitary Adenoma
76
Pituitary tumors can cause headaches and what other finding/presentation?
bitemporal hemianopsia by compressing optic chiasm
77
loss of vision in half of the visual field of one eye or both eyes
Hemianopsia
78
What is the imaging of choice in a suspected pituitary adenoma?
MRI
79
In a pituitary microadenoma, what is the size of the tumor?
Microadenoma: <10 mm diameter
80
In a pituitary macroadenoma, what is the size of the tumor?
Macroadenoma: >10 mm diameter
81
Pituitary adenomas are classified by what?
Pituitary adenomas are classified by size - Microadenoma and Macroadenoma
82
The most common functional pituitary adenoma secretes which hormone?
prolactin

Endocrinology (7 decks)

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