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STEP 2 Endocrine > Endocr. Anterior pituitary 11-01 (1) > Flashcards

Endocr. Anterior pituitary 11-01 (1) Flashcards

1
Q

Prolactinoma.
causes? 3

A

Prolactin secreting tumor - Benign.

Other causes of hyperprolactinemia:
Dopamine antagonists.
Very high TRH levels (hypothyroidism).

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2
Q

Prolactinoma.
CP women?

A

Women:
▪ Amenorrhea; due to suppression of GnRH.
▪ Galactorrhea.
▪ Presents earlier –> microadenoma. No field cuts.

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3
Q

Galactorrhea is milk production from the breast unrelated to pregnancy or lactation.

A

.

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4
Q

Prolactinoma.
CP men?

A

Decreased libido.
infertility, impotence, gynecomastia

Macroadenoma –> Bitemporal hemianopsia, headache.

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5
Q

Amenorrhea is the absence of menstruation.

A

.

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6
Q

Prolactinoma. In premenopausal women CP?

A

related to hormones - galactorrhea, amenorrhea, decr. bone density

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7
Q

Prolactinoma. In postmenopausal women CP?

A

mass effect - headache, visual field

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8
Q

Prolactinoma.
Labs. prolactin?

A

> 200
correlates with size of prolactinoma

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9
Q

Prolactinoma.
what to check when diagnosig? 4 things

A

Check medications first
TSH levels
Prolactin levels
MRI for tumor

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10
Q

Prolactinoma. what to rule out when diagnosing?

A

Renal insuff - lab: Cr
Hypothyroidism - lab: TSH, tyroxine

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11
Q

Prolactinoma. imaging for diagnosis?

A

MRI

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12
Q

Prolactinoma. management scheme in premenopausal. First step?

A

Detailed clinical evaluation
+
Rule out secondary cause (eg pregnancy)

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13
Q

Prolactinoma. management scheme in premenopausal. Clinical + secondary cause —> what next?

A

MRI of pituitary

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14
Q

Prolactinoma. management scheme in premenopausal. MRI = asymptomatic prolactinoma (<10 mm) –> treatment?

A

NO TREATMENT

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15
Q

Prolactinoma. management scheme in premenopausal. MRI = MACROPROLACINOMA (>10 mm)
OR
Symptomatic microprolactinoma –> treatment?

A

Abu variantai:

Dopamine agonists
arba
Resection: Very large (>=3 cm) arba incr. in size while on drug treatment.

Jeigu galima, tai pradedam drugs –>jeigu neefektyvu –> resection

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16
Q

Acromegaly. pathophysiology?

A

Growth hormone increases hepatic production of insulin-like growth factor (IGF-1) –> causes excessive growth of bone and soft tissue

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17
Q

Acromegaly.
Surgery can minimize the hypertrophic stages but will not
reverse degenerative changes.

Diastolic heart failure due to hypertension.

A

.

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18
Q

Acromegaly. first step test?

A

Suspected acromegaly –> IGF-I level

19
Q

Acromegaly.
IGF-I level –> elevated –> what next step?

A

Oral glucose suppression test

20
Q

Acromegaly.
IGF-I level –> elevated –> normal –> next step?

A

normal level rules out acromegaly

21
Q

Acromegaly.
IGF-I level –> elevated –>Oral glucose suppression test –> adequate suppression –>?

A

suppression rules out acromegaly

22
Q

Acromegaly.
IGF-I level –> elevated –>Oral glucose suppression test –> NO adequate suppression –>?

A

MRI of brain

23
Q

Acromegaly. in general sequence in diagnosis?

A

elevated IGF-I –> Inadequate GH suppression on oral glucose suppression test –> do MRI.

24
Q

Acromegaly.
IGF-I level –> elevated –>Oral glucose suppression test –> NO adequate suppression –> MRI pituitary mass –> ?

A

Surgical versus medical management

25
Q

Acromegaly.
IGF-I level –> elevated –>Oral glucose suppression test –> NO adequate suppression –> MRI NO pituitary mass –> ?

A

Evaluate extrapituitary cause of acromegaly (ectopic GH and GHRH secreting tumor)

26
Q

Acromegaly.
Glucose test mechanism?

A

Oral glucose given –> insulin increases –> growth hormone should decrease but it stays the same.

27
Q

yra atspausdinta lentele su clinical features of untreated acromegaly.

A

.

28
Q

Acromegaly.
Surgery can minimize the hypertrophic stages but will not
reverse degenerative changes.

A

.

29
Q

Hypopituitarism. acute. causes?

A

Causes: infection, infarction, or iatrogenic.

30
Q

Hypopituitarism. acute. diagnosis?

A

Assessment of cortisol and T4 levels

31
Q

Hypopituitarism. acute. treatment?

A

replace hormones

32
Q

Hypopituitarism. acute. RECOGNIZE sheenan and apoplexy

A

.

33
Q

Sheenan CP?

A

Lactation failure (decr. prolaclin)

Amenorrhea, hot flashes, vaginal atrophy(decr. FSH, LH)

Fatigue, bradycardia (decr. TSH)

Anorexia, weight loss, hypotension (decr. ACTH)

Decreased lean body mass (decr. growth hormone)

34
Q

Hypopituitarism. Chronic. causes?

A

Causes: autoimmune, deposition disease, or slow growing tumor.

35
Q

Hypopituitarism. Chronic. cp?

A

GH and FSH/LH will be sacrificed to maintain TSH and ACTH.

Decreased libido.
Fatigue.
Menstrual irregularities

36
Q

Hypopituitarism. Chronic. diagnosis?

A

a) Insulin stimulation test.
Give insulin –> glucose drops –> GH should increase but it stays the same.

b) Vasopressor stimulation test.

If tests positive –> MRI.

37
Q

Hypopituitarism. Chronic. treatment?

A

Replace the hormones.

Fix underlying disease.

38
Q

Hypopituitarism. table. Pituitary causes? 3

A

Primary (eg adenoma) or metastatic

Infiltration (hemochromatosis, lymphocytic hypophysitis)

Hemorrhage (apoplexy) or infarction (sheenan)

39
Q

Hypopituitarism. table. Hypothalamic causes? 5

A

Mass lesion
Radiation therapy
Infiltration (sarcoidosis)
Trauma to skull base
Infections (TBC meningitis)

40
Q

Hypopituitarism. table. CP.
ACTH deficiency (secondary adrenal insuf)?

A

Postural hypotension, tachy, fatigue, weight loss, hypoglycemia, eosinophilia

41
Q

Hypopituitarism. table. CP.
Hypothyroidism (central)?

A

Fatigue, cold intolerance, constipation, dry skin, brady, slowed deep tendon reflexes

42
Q

Hypopituitarism. table. CP.
Gonadotropins?

A

Women - amenorrhea, infertility

Men - infertility, loss of libido

43
Q

Empty Sella syndrome:
Pituitary is not in the Sella –> located somewhere else.

CP, diagnosis and treatment?

A

● C/P: asymptomatic.
● Diagnosis: MRI.
● Treatment: do nothing.

44
Q

Pituitary apoplexy. CP?

Sudden hemorrhage into an enlarged pituitary adenoma.

A

Headache, ptosis, and vision changes.

Adrenal crisis.

STEP 2 Endocrine (3 decks)

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