Endocrine Flashcards
The #1 endocrine disorder
diabetes
Dx of DM at what A1C?
> or = to 6.5
Dx of DM at what fasting blood glucose
> or = to 126
Dx of OGTT for gestational DM
> or = 200
What is the classic VF presentation of a pituitary tumor?
bitemporal hemianopia; progression of hemifield loss can also tell you what kind of tumor it is
Why will VFs defects progress superior to inferior?
press on inferior fibers first affected
What is the most common anatomical presentation?
central-fixed, instead of pre or post fixed chiasm
Knee of Von Willebrand
nasal fibers decussate and some fibers travel slightly anteriorly in the contralateral optic nerve before traveling posteriorly
What scotoma does a knee of von willebrand cause?
junctional scotoma
What is the most prevalent pituitary tumor?
prolactinoma 40-45%, secretes prolactin
What are the 4 pituitary tumors from in order of most common?
prolactinoma 45%, somatotrophic adenoma 20%, gonadotrophic 15%, corticotrophic 10%
What does a somatotrophic adenoma secrete?
growth hormone
What does a gonadotrophic adenoma secrete?
follicle stimulating hormone and leutinising hormone
What does a corticotrophic adenoma secrete?
adrenocorticotropic hormone
Anterior pituitary
ACTH, TSH, GH, PRL, FSH, LH, MSH
Posterior pituitary
ADH, Oxytocin
Pituitary apoplexy
emergency condition, intense pain, vomiting, not able to stand
Craniopharyngioma
another common tumor that can present in a bitemporal field loss; however, VF defect created is slightly different
Which tumor is more common in Asian women?
craniopharyngioma
Pituitary apoplexy
a medical emergency, immediate refferal and imaging
Symptoms of pituitary apoplexy
sudden vision loss, severe headache, ocular motility disturbance, loss of consciousness, nosebleeds
How does the VF progress for a craniopharyngioma?
bitemporal hemi that grows inferior to superiorly
What is the reference range for prolactin?
2.1 to 17.7 ng/mL
What does <100 ng/mL mean?
intrasellar microadenomas aka within the boundary of the sella turcica
What does > 200 ng/mL mean?
corresponds to tumor size
What does 1000 ng/mL mean?
extrasellar extension of tumor
What was the pituitary case?
nonfunctional pituitary macroadenoma and s/p resection
Micro-adenoma
less than 10 mm tumor size
Macro-adenoma
greater than 10 mm tumor size
Treatment for pituitary tumors
surgical treatment, trans-sphenoidal microsurgical removal or transcranial surgical removal
Radiation treatment for pituitary
decreased rates of recurrence with immediate therapy postoperatively; 6% of patients with incomplete removal w/ radiation experienced recurrence; 28% of patients with incomplete removal w/o radiation experienced recurrence
Medical treatment only works for
secretory adenomas
Treatment for prolactinomas
dopamine agonist
What is the preferred dopamine agonist for prolactinoma?
cabergoline»_space; bromocriptine due to less side effects
What is the triphasic recover of visual field?
initial fast, delayed slower and late mild
What is initial fast recovery?
minutes to 1 week; restoration of signal conduction along retinal ganglion cell axons
What is delayed slower recovery?
1-4 months; restoration of axoplasmic transport and remyelination of the decompressed optic nerve
What is late mild recovery?
6 months to 5 years, unknown cause
What is the recurrence/regrowth of nonfunctioning macroadenomas?
12-58% of patients within 5 years
What makes risk of tumor relapse more likely?
incomplete resection, cavernous sinus invasion, absence of postoperative radiation therapy
What is the most common reason for recurrence of tumor?
incomplete resection by surgeon, often purposeful to let patient live a normal life
What are predictors of visual function?
tumor size, patient age, duration of symptoms, visual field defects, visual acuity, tests that measure optic nerve function
What are tests that measure optic nerve function?
color vision, optic atrophy, ERG, OCT retinal nerve fiber thinning and ganglion cell analysis
What is the tumor MRI sign?
snowman sign
Testing to perform with patient with Hx of pituitary tumor
BCVA, close eval of pupils, color/red cap/contrast sensitivity, DFE/stereo ONH photo/OCT optic disc cube: RNFL and ganglion cell, HVF 30-2 SITA full threshold, document signs and symptoms of pituitary apoplexy as negative each visit
When to re-eval Hx of pituitary tumor?
3, 6, 9, 12 months post op and then annually
Symptoms of pituitary apoplexy
sudden vision loss, severe HA, ocular motility disturbances, loss of consciousness, nosebleeds
T/F hypopituitarism can be genetic or acquired
true
Genetic hypopituitarism
growth and developmental disorders in children, like laurence-moon-bardet-biedl syndrome with blindness by 30 from retinal degeneration
Acquired hypopituitarism
mostly causes sexual dysfunction in adults, either infiltrative or infectious
Infiltrative acquired hypopituitarism
sarcoidosis granuloma induce DM in adults, delayed growth and mental development in children
Infectious acquired hypopituitarism
TB or syphilis, cause hypo functioning hormone levels, can also cause uveitis
Empty sella syndrome
sella tursica appears empty on imaging (looks empty but it’s there); usually normal pituitary function because there is pituitary tissue rimming sella
T/F empty sella syndrome puts pituitary more at risk if ICP increase
true
Band keratopathy in younger patient think
hypercalcemia
Band keratopathy in older patient think
reaction to drops
What is band keratopathy?
calcium deposition in Bowmans
What does parathyroid hormone do?
regulates Ca, acts on bones to reabsorb Ca, acts on kidneys to reabsorb Ca
Elevated PTH causes
hypercalcemia
S/s of hypercalcemia
fatigue, depression, confusion, nausea, anorexia, decreased urination, cardiac arrhythmias
Ocular signs of hypercalcemia
band keratopathy, conjunctival lithiasis, check PTH levels when signs notice in young/middle age
What is Cushing’s syndrome?
hyperproduction of adrenal glands resulting in excess cortisol
What causes Cushings?
adrenal tumor, prolonged glucocorticoid use, adrenal hyperplasia resulting from pituitary hyperplasia
Appearance of Cushings
moon face, lump on back, red striae on belly
What hormone does the adrenal cortex glomerulosa release?
mineralcorticoid ex: aldosterone
What hormone does the adrenal cortex fasciculata release?
glucocorticoid ex: cortisol
What hormone does the adrenal cortex reticularis release?
androgens ex: dehydroepiandrosterone
What does the adrenal medulla release?
stress hormones ex: NE and Epi
What is primary Addisions?
insufficiency of adrenals; destruction from autoimmune, TB or infarction
What is the appearance of primary Addisons?
bronzing of skin and pigmentation of the folds of the skin, more ACTH tries to kickstart non functioning gland and stimulates melanin-releasing hormones
What is secondary Addisons?
insufficient ACTH from pituitary; no hyperpigmentation
What are symptoms of Addison’s?
weakness, nausea, hypotensive crisis, hyperpigmentation if primary
Which president had Addison’s?
JFK
What is a pheochromocytoma?
tumor of the adrenal medulla causing NE and Epi to go crazy
What does a pheochromocytoma secrete?
catecholamines
What is the result of catecholamines?
extreme systemic HTN, heart palpitations/arrhythmias, HA, profuse sweating, anxiety, impending sense of doom, death
What is treatment of pheochromocytoma?
surgical resection which is highly successful
