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GI Block > Endo: Pit Dysf (PRL, GH, Adrenal) > Flashcards

Endo: Pit Dysf (PRL, GH, Adrenal) Flashcards

1
Q

Compare central and peripheral hormone disorders.

A

Central: problem is in hypothalamus or pituitary gland

Peripheral: problem is in end organ (eg. adrenal, ovaries, etc)

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2
Q

What is a Rathke’s cleft cyst?

What are the symptoms?

A
  • Rathke’s cleft cyst is a remnant of Rathke’s pouch
  • Asymptomatic
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3
Q

Is craniopharyngioma malignant or benign?

A

Craniopharyngiomas are benign, slow-growing tumors (Grade I)

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4
Q

Describe the type of craniopharyngioma most common in children.

(Name, CT feature, 3 sx)

A
  • Adamantinomatous
  • Calcifications on CT
  • Sx: growth failure, delayed puberty, tunnel vision
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5
Q

An adult walks in with headache, vision changes, and hypopituitary function.

What is one possible neoplasm?

A
  • Papillary craniopharyngioma
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6
Q

Are pituitary adenomas usually sporadic or inherited?

Do they always produce hormones?

A

Pituitary adenomas are usually sporadic.

They may or may not produce hormones

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7
Q

A patient presents with headaches, bitemporal hemianopsia, opthalmoplegia, and pituitary hormone deficits.

Why are these symptoms occuring?

A
  • Pt has a pituitary tumor
  • Headache, visual field deficits, and cranial nerve palsies are due to mass effect (tumor pressing on other structures)
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8
Q

What is the order in which pituitary hormones will decrease with a pituitary adenoma?

A

Gonna - GH

Lose - LH/FSH

The - TSH

Anterior - ACTH

Pituitary - PRL

(or, “go look for the adenoma please”)

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9
Q

Describe the HPA axis for growth hormone (4)

A
  1. Hypothalamus releases GHRH
  2. GHRH stimulates GH release by anterior pituitary somatotrophs
  3. GH stimulates liver to release IGF-1

*Hypothalamus can also release Somatostatin, which inhibits anterior pituitary release of GH

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10
Q

What is the effect of glucose on GH release?

Effect of sleep?

Effect of exercise?

Effect of puberty?

A
  • Glucose suppresses GH release
  • Sleep, exercise, and puberty all increase GH release
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11
Q

Name 2 effects of IGF-1

A
  • Increased muscle growth
  • Increased bone growth
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12
Q

Compare the onset and signs of gigantism and acromegaly

A
  • Gigantism: GH excess before puberty
    • Tall
  • Acromegaly: GH excess after puberty
    • Increased hand, feet, head size
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13
Q

How do you diagnose GH excess?

Why do we use this method?

A
  • Increased IGF-1 level
  • Don’t measure GH directly b/c GH has a short half-life and is released in pulsatile waves, so difficult to get a representative measurement
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14
Q

What is the medical treatment of acromegaly and gigantism?

A

Octreotide (somatostatin analog)

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15
Q

What are the symptoms of GH deficiency in adults? (4)

Is this always pathalogic?

A

GH deficiency causes

  • Increased fat
  • Decreased muscle
  • Decreased bone density, fractures
  • Increased cholesterol

*All occur with normal aging, too

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16
Q

What is the treatment of GH deficiency in adults?

A

GH can be administered, but its use is controversial

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17
Q

How do you diagnose GH deficiency? (2)

A
  • Low IGF-1
  • Induce hypoglycemia with insulin and see if GH rises (it should)
18
Q

What hormone released by the hypothalamus stimulates PRL release from ant pituitary?

A

Thyroid releasing hormone (TRH)

19
Q

A woman presents with galactorrhea, menstrual irregularity, and infertility.

What tumor could cause this?

A

These are all symptoms of prolactinoma.

20
Q

A male presents with visual field abnormalities, headache, opthalmoplegia, and impotence.

What tumor could cause this?

A

Prolactinoma

Men tend to have large tumors, so sx largely due to mass effects

21
Q

Bromocriptine: MOA, use

A
  • MOA: Dopamine agonist
  • Use: Tx for prolactinoma
    • Cabergoline is first line, but bromocriptine is better if going to become pregnant
22
Q

What agent is first line in treatment of prolactinoma?

A

Cabergoline, a dopamine agonist

23
Q

What are the symptoms of PRL deficiency in men and women? (1 each)

A
  • Women: failed lactation after childbirth
  • Men: no known effects
24
Q

What are the effects of cortisol?

A

A BIG FIB

  • Appetite increased
  • Blood pressure increased
  • Insulin resistance
  • Gluconeogenesis and lipolysis increased
  • Fibroblast suppression
  • Inflammation suppression
  • Bone formation decreased
25
Q

Symptoms of cortisol excess (Cushing’s)

  • Body habitus (4)
  • Skin (1)
  • Bones (1)
  • Metabolism (2)
  • CV (1)
  • Immune (1)
  • Reproductive (2)
A
  • Body habitus: peripheral wasting, central obesity, buffalo hump, proximal muscle weakness
  • Skin: violet striae
  • Bones: osteoporosis
  • Metabolism: diabetes, hyperTGemia
  • CV: HTN
  • Immune: immunosuppression
  • Reproductive: amenorrhea, hirsutism
26
Q
  • Cortisol levels are highest in ______ (time)
  • Cortisol levels are lowest ______ (time)
A
  • Cortisol levels are highest in early morning
  • Cortisol levels are lowest during sleep
27
Q

Compare Cushing’s disease and Cushing’s syndrome

A

Cushing’s disease is a ACTH-secreting pituitary adenoma

Cushing’s syndrome is elevated cortisol for any reason

28
Q

What are 3 screening tests for Cushing’s syndrome?

A
  1. Midnight salivary cortisol is elevated
  2. Increased free cortisol in urine
  3. Dexamethasone doesn’t suppress cortisol
29
Q

Hypogonadism can be caused by either excess ____ or insufficient ____

A

Hypogonadism can be caused by either excess PRL or insufficient FSH/LH

30
Q

Compare primary, secondary, and tertiary HPA disorders

A

Primary: problem is in end organ

Secondary: problem is in pituitary

Tertiary: problem is in hypothalamus

31
Q

What is the origin of craniopharyngiomas?

A

Derived from ectopic Rathke’s pouch remnant

32
Q

What is another name for growth hormone?

What is another name for IGF-1?

A

GH = somatotropin

IGF-1 = somatomedin

*Somatotatin inhibits GH’s release

33
Q

Describe the HPA axis for Prolactin

A
  1. Hypothalamus releases TRH
  2. TRH stimulates lactotrophs in anterior pituitary to release prolactin
  3. Prolactin causes lactation and mammary gland growth

*Dopamine inhibits Prolactin release from anterior pituitary

34
Q

How do you diagnose prolactinomas?

A

Random PRL level

35
Q

Effects of prolactin (2)

A
  • Stimulates milk production and mammary gland growth
  • Suppresses GnRH release, preventing ovulation/spermatogenesis
36
Q

Describe the HPA axis for cortisol

A
  1. Hypothalamus secretes CRH
  2. CRH stimulates anterior pituitary to release ACTH
  3. Adrenal secretes cortisol
37
Q

A patient has symptoms of Cushing’s syndromes and a low ACTH.

What does this tell you?

A

Low ACTH means that the excess cortisol secretion is not being driven by pituitary dysfunction.

38
Q

What is central adrenal insufficiency?

What is the most common cause?

A
  • Central adrenal insufficiency is low CRH or ACTH release (pituitary or hypothalamus dysfunction)
  • Usually due to glucocorticoid use (drug-induced)
39
Q

A patient presents with fatigue, anorexia, weight-loss, scant axillary & pubic hair, sugar/salt craving.

Diagnosis?

A

Adrenal insufficiency

40
Q

How do you diagnose adrenal insufficiency?

A
  • Measure random cortisol level
  • Induce hypoglycemia with insulin, and see if cortisol rises (it should)

GI Block (77 decks)

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