Endocrine 1

Question 1

Most common cause of adult pituitary dysfunction

Answer 1

Pituitary adenoma

Question 2

What is the most common form of pituitary adenoma

Answer 2

Micro (60%) vs macro (40%) 
Prolactinoma is the most common, which increases prolactin release. 
Onset early adulthood
M=F
Tx with drugs.

Question 3

Pituitary adenoma can cause which 3 conditions?

Answer 3

Pituitary apoplexy - sudden vascular damage to the pituitary. Hemorrhagic or ischemic.

Hypopituitarism- can lead to diabetes insidious or dwarfism.

Hyperpituitarism- can lead to gigantism (in children) and acromegaly (in adults)

Question 4

Adrenal disorders big picture groups

Answer 4

HYPOcortisol –> addisons

HYPERcortison –> Cushings (disease vs syndrome) or
–> Pheochromocytoma (associated with
(VHL)

Question 5

Addisons disease has low levels of what ?
Occurs at ___% destruction of the adrenal gland
Due to what type of disease?
How to dx?

Answer 5

Hypocortisol.
Low cortisol and/or low aldosterone 
90% destruction 
Due to autoimmune disease
Dx using anti-adrenal antibodies or ACTH stimulating test. When you inject ACTH, cortisol levels should rise. They will not in addisons.

Question 6

Pheochromocytoma

• What is it?
• most common form (benign vs malig) and (uni vs bi)
• Associated with what syndrome ?
• Inheritance

Answer 6

Tumor of the adrenal medulla that secretes excess catecholamines.
90% benign, 90% unilateral
Associated with VHL syndrome (10-20%) which is the loss of a tumor suppressor gene
Autosomal dom inheritance

Question 7

VHL syndrome

Answer 7

Loss of a tumor suppressor gene. Without = tumor.

10-20% association with pheochromocytoma- tumor of the adrenal gland that secretes excess catecholamines.

Question 8

Cushings symptoms

Answer 8

Thinning of hair on scalp, but increase in body hair
Moon face
Easy bruising
Purple striae
Ocular symptoms: Central serous choriodpathy, posterior sub capsular cataracts, steroid response glaucoma due to increase IOP.

Question 9

Difference between cushings disease and syndrome

Answer 9

Disease: Most commonly secondary to adenoma.
Excessive anterior pituitary secretion of ACTH= excess cortisol.
F> M, 20 yr onset
DX: increase in ACTH

Syndrome: Not related to pituitary gland.
ex: Adrenal adenoma.
Exogenous steroid use is most common cause!!!!!
Symptoms: Truncal obesity, moon face.
Dx: Blood cortisol levels. No elevation of ACTH.

Question 10

Hormones released by pituitary gland

Answer 10

Anterior: 
GH
FSH
LH
ACTH
TSM
PRL

Posterior:
Oxytocin
ADH/vasopressin

Question 11

How could a pituitary adenoma affect the VF

Answer 11

Puts pressure on chiasm.
Result in bitermporal hemianopsia.
More dense superior than inferior.

Question 12

Common symptoms of pituitary apoplexy

Answer 12

**HA (60-100%), syncope, nausea
*VF defect (40-100%), diplopia, blurry vision.
adrenal insufficiency –> Hypotension, hypoglycemia= death.

Question 13

Main cause of pituitary apoplexy

Answer 13

Pituitary adenoma

Or pregnancy, shock, sickle cell, DM, trauma (due to change in blood flow)

Question 14

Hyperpituitarism is due to an increase in which 4 anterior pituitary gland hormones?

Answer 14

PRL, ACTH, GH, TSH

Most commonly secondary to pituitary adenoma.

Question 15

Complications of gigantism

Answer 15

Type 2 DM
Cardiomgaly (increase in heart size to keep up = HF)
Heart failure
Sleep apnea

Question 16

How to test for acromegaly

Answer 16

MRI

GH suppression test - tests for excessive GH

Question 17

Complications of cushings

Answer 17

Hyperglycemia, DM
Hypertension
Osteoporosis

Question 18

Ocular complications of cushings due to increased cortisol levels

Answer 18

Central serous choriodpathy, posterior sub capsular cataracts, steroid response glaucoma due to increase IOP, VF defect, diabetic retinopathy.

Question 19

Why do you get sympathetic symptoms with pheochromocytoma?

Answer 19

Because the adrenal gland is secreting excess catecholamines- NE and Epi. Sympathetic NT.

HTN 
HA
Flushing
Tachy 
Weight loss

Question 20

VHL syndrome. What conditions are not required?

• What kind of inheritance
• Ocular association

Answer 20

Hypoxia is not required. VEGF is regulated by itself.
Autosomal dominant 50% to offspring
Retinal capillary hemangioma (red nodule of excess blood vessels) Benign.

Question 21

Sheehan’s syndrome

Answer 21

Postpartem hemorrhage

Question 22

Diabetes insipidus

Answer 22

Insufficient ADH= inability to concentrate urine= dilute urine= dehydration, polyuria, polydipsia.

Usually idiopathic, resulting in the decrease of ADH from post pituitary- prob due to pituitary adenoma.

Treat with ADH

Question 23

Two types of dwarfism.

Answer 23

1. Disproportionate- most common

2. Proportionate-

Question 24

What percentage of dwarfism cases are genetic

Answer 24

70%

Question 25

Addisonian crisis

Answer 25

Acute adrenal insufficiency
Life threatening due to corticosteroid withdrawal, stress or trauma. results in low blood pressure/blood sugar –> Shock –> coma and death.