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clin med II, exam 4 > disorders pituitary gland > Flashcards

disorders pituitary gland Flashcards

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1
Q

pituitary is attached to the hypothalamus via a stalk called

A

the infundibulum

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2
Q

Pituitary gland lies where in the body

A
  • lies near optic chiasm
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3
Q

What is the most common type of sellar mass

A

pituitary adenoma

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4
Q

sellar masses typically present in one or a combination of what 3 ways

A
  1. with neurologic symptoms, such as visual impairment or HA
  2. as an incidental finding on MRI
  3. with hormonal abnormalities
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5
Q

What visual defect is most common with sellar masses

A

bitemporal hemianopsis

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6
Q

In a lactotroph ademoma, check serum levels

A

prolactin

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7
Q

In a somatotroph ademoma, check serum levels

A
  • IGF-1
  • GH
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8
Q

In a thyrotropin ademoma, check serum levels

A

serum TSH

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9
Q

In a corticotroph ademoma, check levels

A
  • 24 hr urine cortisol
  • serum ACTH
  • serum cortisol
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10
Q

If patient has hormonal hyposecretion (caused by hypothalamic or other pituitary lesion, NOT an adenoma) then get what labs

A
  • FSH
  • LH
  • testosterone, free and total: males
  • estradial, free and total: females
  • vasopressin
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11
Q

What is hte single best imaging study for pituitary mass

A
  • MRI with and w/o gadolinium
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12
Q

differentiate between a microadenoma and macroadenoma

A
  • microadenoma: < 1 cm
  • macroadenoma: > 1 cm
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13
Q

Clincal presentation

  • men: low libido, impotence, infertility, gynecomastia, galactorrhea
  • female: infertility, oligomenorrhea, amenorrhea
  • all: visual disturbances, HA
A

Prolactinoma (lactrotroph adenoma)

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14
Q

If patient has signs and symptoms of prolactinoma, check these things first

A
  1. med use
    • cimetidine, methyldopa, verapamil, antidepressants, estrogen will all increase serum prolactin
  2. pregnant
  3. h/o renal disease: inability to clear prolactin
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15
Q

Serum prolactin levels greater than is consistent with hyperprolactinemia. Levels greater than is consistent with adenoma

A
  1. > 20 ng/mL
  2. > 200 ng/mL
    • as long as pregnancy (-)
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16
Q

Tx of Prolactinoma

A
  • Bromocriptine: Dopamine agonist
    • will shrink tumor to size acceptable for surgery
  • Cabergoline: non ergot dopamine agonist
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17
Q

side effects of Bromocriptine

A
  • nausea, constipation, dizziness, HA
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18
Q

What is the most common complication following transphenoidal resection of prolactinoma

A
  • instability of vasopressin leading to SIADH
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19
Q

Growth hormones excess in children and adults leads to what 2 different conditions

A
  • peds: gigantism
  • adult: acromegaly
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20
Q

Growth hormone is synthesized in . It is released in large pulses. When is the largest peak

A
  • anterior pituitary
  • 1 hr after onset of sleep
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21
Q

What is the most accurate maker for GH

A

IGF-1

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22
Q

List the stimulators of GH

Study These Flashcards
A
  • GHRH
  • sleep
  • exercise
  • hypoglycemia
  • dietary protein
  • estradiol
  • arginine
23
Q

List the inhibitors of GH

Study These Flashcards
A
  • somatostatin
  • circulating concentrations of GH and IGF-1
  • dietary carbohydrates
  • glucocorticoids
24
Q

Acromegaly is most commonly the result of

Study These Flashcards
A

a somatotroph (growth hormone secreting) pituitary adenoma

25
clinical presentation * visual field defects * LVH, HTN * organomegaly * OA of large joints, increasing hat size, ring or shoe size, enlarging gap between teeth
acromegaly
26
Workup of acromegaly involves
* TSH, **GH, IGF-1**, CMP, CBC, AM cortisol, ACTH, prolactin, UA, rheumatology panels * **2 hr glucose tolerance test**
27
what calcium value is consistent with acromegaly
hypercalciuria
28
explain the 2 hr glucose tolerance test in relation to acromegaly
* if GH level suppresses to \< 1 mcg/L during 2 hrs after glucose administration, then acromegaly is excluded
29
patients with acromegaly are at high risk for
* premature mortality * insulin resistance * LVH/CHF * colon CA * musculoskeletal abnormalities
30
What is the most effective tx for rapid reduction of GH in acromegaly
surgical management
31
Medical managment of acromegaly
* somatostatin analogues * GH receptor agonist
32
List the causes of GH deficiency from pituitary dysfunction
* mass * infarction * infiltrative * genetic
33
List the causes of GH deficiency from hypothalamic dysfunction
* mass * infiltrative (sarcoidosis) * trauma * infection (TB)
34
List the causes of GH deficiency from iatrogenic
* radiation * pituitary surgery * side effect of uncontrolled DM
35
If patient has any lab abnormalites that point to GH deficiency, need to further confirm with either
1. insulin-induced hypoglycemia (stimulation test) 2. **arginine-growth hormone-releasing hormone** \*\*recommended
36
Management of growth hormone deficiency
* do not treat unless confirmed deficiency * treat if severe * recombinant GH * dose based on weight, SQ once daily in evening
37
Define male hypogonadism. Differentiate between primary and secondary
* impairment of either testosterone or sperm production by testis * **primary**: failure of testis (**hyper**gonadotrophic hypogonadism) * **secondary**: defect in HPT axis (**hypo**gonadotrophic hypogonadism)
38
What levels of testosterone, FSH, and LH would you expect to see in * primary hypogonadism (hyper) * secondary hypogonadism (hypo)
* a) primary: * low testosterone * high FSH, LH * b) secondary: * low testosterone * low/nml FSH, LH
39
List causes of hypogonadatrophic hypogonadism
* congenital (rare) * acquired * hypothalamic: impaired GnRH secretion * pituitary: suppression of gonadotropins * GnRH resistance * hyperprolactinemia * exogenous steroid * chronic narcotic * DM * pituitary: damage to gonadotroph cells * sarcoidosis * hemochromatosis
40
clinical presentation * change in hair growth or distribution * changes in voice * decreases muscle mass or strength * low libido, ED * shrinking testicles * visual disturbances
hypogonadatrophic hypogonadism
41
if hypogonadism suspected, first obtain what labs
* LH * FSH * free and total testosterone * will tell if primary or secondary
42
If secondary hypogonadism, the get what tests
* prolactin, TSH, CBC\< CMP * MRI pituitary
43
Before treating patient with hypogonadatrophic hypogonadism, make sure what
* DRE and PSA are within normal limits
44
most common tx of hypogonadatrophic hypogonadism
* androgens intramuscular 200 mg q 2 weeks
45
patients on tx for hypogonadatrophic hypogonadism needs to have what checked
1. CBC q monthly for the first 6 months (risk of erythrocytosis) 2. free estradiol q 2 months for first 6 months 3. PSA and DRE annually
46
define panhypopituitarism
* deficient secretion of majority of pituitary hormones * TSH, ACTH, GH, FSH, LH, prolactin
47
What is central diabetes insipidus
* insufficient ADH production * serum osmolarity is preserved as normal * urine is **dilute** * **​urine osmolarity \< 300 mOsm/kg**
48
ADH levels in central vs nephrogenic DI
* central: ADH is low * nephrogenic: ADH high
49
clinical presentation * dilute urine and polyuria * dehydration * intense thirst
diabetes insipidus
50
diagnostic work up of Diabetes insipidus (nephrogenic or central)
* 24 hr urine * serum electrolytes and glucose * urine osmolarity * urine specific gravity * **water deprivation and vasopressin challenge** * in central will see \> 100% increase in urine osmolarity with challenge * in nephrogenic will see no elevation in urine osmolarity
51
tx of central DI
desmopressin (DDAVP)
52
tx of nephrogenic DI
* indomethacin with * HCTZ * DDAVP
53
What is SIADH and how does it present
* excessive production of ADH * concentrated urine * hyponatremia

clin med II, exam 4 (6 decks)

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