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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
Q

If a patient is cortisol deficient as well as TSH deficient, which should you fix and why?

A

If multiple deficits exist, start replacing cortisol first, followed by
thyroxine (thyroid accelerates the catabolism of cortisol)

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26
Q

What are the major target organs of ACTH?

A

Adrenal gland (cortex)

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27
Q

What are the major physiologic effects of ACTH?

A

Stimulates secretion of glucocorticoids and adrenal androgens

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28
Q

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

A

ACTH Deficiency

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29
Q

ACTH deficiency is replaced by what taken orally either twice daily?

A

hydrocortisone

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30
Q

What are the major target organs of prolactin?

A

Mammary gland

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31
Q

What are the major physiologic effects of prolactin?

A

Milk production

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32
Q

What are signs/symptoms of prolactin deficiency?

A

Overall asymptomatic
Loss of lactation in postpartum period

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33
Q

What is the most common cause of prolactin excess?

A

functional pituitary adenoma – prolactinemia

34
Q

Cells in the anterior pituitary which produce prolactin in response to signals including dopamine, estrogen, progesterone, and TSRH

A

Lactotrophs

35
Q

What are some causes of prolactin excess?

A

Functional pituitary adenoma
Defective transport mechanisms
Drugs
Stimulation of lactotrophs

36
Q

Early manifestation of prolactin hypersecretion in women presents as what?

A

galactorrhea and menstrual irregularities, notably amenorrhea

37
Q

Early manifestation of prolactin hypersecretion in men presents as what?

A

Erectile dysfunction or loss of libido in men

38
Q

Lactation that occurs in the absence of nursing

A

Galactorrhea

39
Q

A prolactin level of what is diagnostic for prolacin excess?

A

> 200ug/L

40
Q

What imaging is the test of choice in prolactin excess?

A

MRI – Pituitary and hypothalamus

41
Q

What class of medications is the treatment of choice for most prolactinemias?

A

Dopamine agonists – first line

42
Q

In the treatment of a prolactinoma, is surgery or medication more effective?

A

Not as successful as pharmacotherapy for prolactinoma

43
Q

What are the major target organs of FSH and LH?

A

Ovary and testis

44
Q

What are the major physiologic effects of FSH and LH?

A

Control of reproductive function

45
Q

What are some signs/symptoms of FSH and LH deficiency in pediatric females?

A

Failure to enter normal puberty:

Delayed breast development
Scant pubic and axillary hair
Primary amenorrhea

46
Q

What are some signs/symptoms of FSH and LH deficiency in pediatric males?

A

Failure to enter normal puberty:

Penis and testes remain small
Body hair is sparse

47
Q

What are some signs/symptoms of FSH and LH deficiency in adult females?

A

Amenorrhea

48
Q

What are some signs/symptoms of FSH and LH deficiency in adult males?

A

Reduced beard growth
Decreased libido
Difficulty/decrease in erections

49
Q

Genetic condition with delayed or absent puberty and an impaired sense of smell due to mal-development of olfactory lobes

A

Kallmann’s syndrome

50
Q

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?

A

For fertility, FSH is required (subQ injections)

51
Q

What are the major target organs of ADH?

A

kidney

52
Q

What are the major physiologic effects of ADH?

A

Conservation of body water

53
Q

Water resorption in collecting ducts is proportional to the release of which pituitary hormone?

A

ADH release

54
Q

What level of ADH produces dilute urine and reduced volume of body fluids?

A

Low ADH

55
Q

What level of ADH produces concentrated urine?

A

High ADH

56
Q

ADH deficiency is also known as what disorder?

A

Diabetes Insipidus

57
Q

What is the hallmark characteristic of diabetes insipidus?

A

Hypernatremia with dilute urine

58
Q

What are the clinical features of diabetes insipidus?

A

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
Q

What are the two types of diabetes insipidus?

A

Central/Neurogenic
Nephrogenic

60
Q

In which type of diabetes insipidus is ADH low and why?

A

Central/Neurogenic

posterior pituitary fails to secrete ADH

61
Q

In which type of diabetes insipidus is ADH high and why?

A

Nephrogenic

kidneys not responding to the hormone (ADH resistance)

62
Q

What diagnostic test is used to diagnose diabetes insipidus?

A

Water deprivation test

63
Q

What test is used to differentiate between central and
nephrogenic diabetes insipidus?

A

DDAVP Challenge

64
Q

In the DDAVP challenge, an increase >50% indicates which type of diabetes insipidus?

A

central DI

65
Q

DDAVP challenge, a small or absent response suggests which type of diabetes insipidus?

A

nephrogenic DI

66
Q

What is the treatment of choice in central/neurogenic diabetes insipidus?

A

Desmopressin acetate is the treatment of choice

67
Q

What is the treatment of diabetes insipidus for nephrogenic cause?

A

Drugs that reduce polyuria:

Thiazide diuretics
Prostaglandin synthesis inhibitors
Potassium-sparing diuretics

68
Q

Too much ADH/hypersecretion is also referred to as what?

A

Syndrome of Inappropriate ADH Secretion (SIADH)

69
Q

What are causes of SIADH?

A

Disorders affecting the central nervous system or the lungs

Medications can increase ADH or its actions

Some carcinomas autonomously secrete ADH

70
Q

What are the clinical features of SIADH?

A

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
Q

What medication can be helpful in SIADH?

A

Demeclocycline administered (inhibits ADH action on renal tubules)

72
Q

What are the major target organs of oxytocin?

A

Ovary and testis

73
Q

What are the major physiologic effects of oxytocin?

A

Stimulates milk ejection

Stimulates uterine contractions

74
Q

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

A

Pituitary Adenoma

75
Q

Most common lesion found in the sella

A

Pituitary Adenoma

76
Q

Pituitary tumors can cause headaches and what other finding/presentation?

A

bitemporal hemianopsia by compressing optic chiasm

77
Q

loss of vision in half of the visual field of one eye or both eyes

A

Hemianopsia

78
Q

What is the imaging of choice in a suspected pituitary adenoma?

A

MRI

79
Q

In a pituitary microadenoma, what is the size of the tumor?

A

Microadenoma: <10 mm diameter

80
Q

In a pituitary macroadenoma, what is the size of the tumor?

A

Macroadenoma: >10 mm diameter

81
Q

Pituitary adenomas are classified by what?

A

Pituitary adenomas are classified by size - Microadenoma and Macroadenoma

82
Q

The most common functional pituitary adenoma secretes which hormone?

A

prolactin

Endocrinology (7 decks)

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