ENDO Flashcards
hyperprolactinemia:
5 causes?
(3 main)
- pituitary microadenoma
- Drugs- SSRIs
- hypothyroidism
- renal failure
- cirrohosis
hyperprolactinemia:
what do high prolacitn levels do?
4 overall sxs?
4 sxs in women?
3 sxs in men?
high prolactin levels supress GnRH and lead to decreased LH/FSH resuling in hypogonadotropin
vision changes from compression of optice nerve, N/V and headache PLUS
women:
galactorreah
amoenorrhea
infertility
decreased libido
**since these sxs are so bothersome in women it is usually detected earlier**
men
decreased libido
erectile dysfunction
gynecomastia
acromegaly/gigantism
what is in excess?
MC from what?
what alllows these effects to happen?
what else do these commonly secrete?
excessive GH release, almost always from pituitary adenoma
and effects are mediated by insulin like growth factor-1 (IGF-1) in liver**causes growth in bons or visceral organs**
**often times these tumors also secrete prolactin which cause additionaly sxs***
acromegaly/gigantism
difference between children and adults?
what caues each?
sxs in adults? 7
5 associated sxs that are common?
gigantism in children:
- unfused long bones
- effects everything
acromegaly in adults:
- after boes fuse
- enlarged hands lips, face, feet, deep voice, coarse facial hair, visceral organs
ASSOCIALTED FINDINGS:
1. HTN
2. CARDIOMEGALY
3. INSULIN RESISTANCE AND DIABETES (GH counteracts the actions of insulin)
4. cardiovascular disease and premature death
5. hypogonadism (if tumor cosecretes prolactin which is common)
acromegaly/gigantism
4 dx?
- overnight fasting IGF-1 (5x normal) (alsomay see high prolactin if tumor secretes it or elevated glucose if progressed to diabetes)
- TSH (of low suggestes additional pituitary pathology
- glucose challenge test post fast-suppresses GH levels to confirm dx
4. MRI to find tumor
acromegaly/gigantism
2 tx
- transphenoidal microsurgery toc
**keep in mind this can cause permanent hypopituiarism and may need replacement tx**
- octreotide-samatostatin (shrinks tumor and suppres GH secretion)
***used in patients who continue to have excessive GH release post op**
pituitary dwarfism
what are the 3 types of this?
what does each one lack?
middle: sxs6
last: who mos common in? 3
2 measureable levels
1. idiopathic GH deficiency
lack of hypoathalmc GHRH
includes those with familial short stature and delay in growth or puberty
2. pituitary tumors, agenesis of pituitary
Lack GH
- shorter than normal birth length*
- decreased growth rate first 1-2 years*
normal intelligence
- obesity and immature facial features*
- delay in skeletal muscle*
micophallus-abnormmal small penis
3. laron-type dwarfism
Rare, abnormal GH receptor
high levels of GH and low levels of IGF-1
meditterean descent esp sepharidic jews** **and african pygmies
Amennorhea
define 1* and secondary
PRIMARY=never get it by 16
SECONDARY=had it, lost it
3 mo if reg, 6 mo if irregular
what is psychosocial dwarfism?
3 sxs?
who does it occur in?
hypopituitarism that is seen in emotionally deprived children
- poor growth
- potbelly
- poor eating and drinking habits
**usually in those who hare severely neglected or disciplined**
child returns to normal removed from situation
dwarfism
(green book)
what is the most common type?
occurs from?
10 sxs?
tx
achondroplasia is the most common non-lethal type
most common type of short-limbed dwarf and occurs from failure of the cartilage to ossify
average height of ~4 ft
sxs:
- short limbs
- long narrow trunks
- large heads with medface hyperplasia
- prominent brows
- delayed motor milestones
- intelligence is normal
- bowing of the legs
- obesity
- dental problesm
- frequenct ottis media
TX:
orthopedic problems fixed with orthopedic intervention
achondroplasia:
what is the gene that is mutated?
FGFR3
pituitary dwarfism can present with what two clues?
micropenis
hypoglycemia
Amenorhea
what is the most common cause of secondary
PREGNANCY
also think female athlete triad
