Endo Path - Pituitary (FA)

Question 1

What is the most common pituitary adenoma?

Answer 1

Prolactinoma

Question 2

How do non functional pituitary tumors present?

Answer 2

Mass effects: Visual disturbances, hypopituitarism, headache

Question 3

How do prolactinomas present in men vs. women?

Answer 3

Men: low libido, infertility
Women: galactorrhea, amenorrhea

Question 4

How would a somatotropinoma present?

Answer 4

Acromegaly or gigantism

Question 5

What is the treatment of a prolactinoma and its MoA?

Answer 5

Bromochromine: Dopamine agonist –> prolactin inhibitor

Question 6

How does excess GH affect glucose tolerance?

Answer 6

Decreased tolerance due to insulin resistance

Question 7

Adult with large hands, feet, and tongue. Labs show increased IGF-1 and GH are high after a glucose tolerance test. Dx and most common cause of death?

Answer 7

Acromegaly, cardiac failure

Question 8

What are the treatment options of somatotropin ademona?

Answer 8

Resection, octreotide (somatostatin analog), and pegvisomant (GH-R antagonist)

Question 9

What is the pathophysiology of Diabetes Insipidus?

Answer 9

Lack of available ADH or lack of ADH effect.

Question 10

What are the two categories of DI?

Answer 10

Central: Lack of available ADH
Nephrogenic: Mutation of ADH receptor in kidney

Question 11

What lab finding will differentiate between central and nephro DI?

Answer 11

Central: decr ADH
Nephro: normal ADH

Question 12

What test, and results, will differentiate between Central and Nephro DI?

Answer 12

Water restriction test
> 50% increase in urine osmolarity = central
no change in urine osmolarity = nephrogenic

Question 13

What Rx is used in central DI and its MoA?

Answer 13

DDAVP is an ADH analog

Question 14

What diuretic is used for nephro DI?

Answer 14

HCTZ

Question 15

Patient with edema, hyponatremia, and urinary osmolarity > serum?

Answer 15

SIADH

Question 16

What are 4 common causes of SIADH?

Answer 16

Ectopic (sm. cell lung cancer)
CNS disorder / trauma
Pulmonary disorder
Drugs (chemotherapy)

Question 17

What is the physiology behind hyponatremia in SIADH?

Answer 17

High blood volume –> decreased renin –> decreased aldosterone –> decr. Na retention w/ increased H2O

Question 18

What is pontine myelinolysis?

Answer 18

Rapid hyponatremia correction –> demyelination

Question 19

What are the common causes of hypopituitarism?

Answer 19

Non functional adenoma
Sheehan
Enpty sella syndrome
Brain injury
Radiation

Question 20

How does Sheehan usually present?

Answer 20

Failure to lactate postpartum