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Pance Re-Up > Endocrine #7 (Pituitary Adenomas & Clean-Up) > Flashcards

Endocrine #7 (Pituitary Adenomas & Clean-Up) Flashcards

1
Q

Gigantism and Acromegaly are both from excessive ________ from a ________

A

IGF-1 from a pituitary adenoma

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2
Q

What separates the two diagnoses?

Both have severe mortality due to heart, lungs, and cancer problems

A

Age of onset:
–Gigantism (early): before growth plates closed
–Acromegaly (late): after growth plates closed

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3
Q

What are some symptoms of gigantism

A

-Tall stature
-Macrocephaly
-Headaches, visual changes
-Front bossing
-Hypopituitarism

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4
Q

What are some symptoms of acromegaly?

A

-Doughy skin
-Thick, hard nails
-Nasal, lower lip enlargement
-Sweating
-Spaced teeth
-Prognathism (overbite)
-Hypertrichosis: excess hair production

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5
Q

How does glucose normally affect growth hormone?

What diagnostic can be done to diagnose gigantism or acromegaly?

A

Normally, increased glucose lowers growth hormone

Give glucose and see if it raises growth hormone

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6
Q

What other imaging study should be done on a patient you suspect to have gigantism or acromegaly?

A

MRI to evaluate the pituitary

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7
Q

Treatment for gigantism or acromegaly

A

-Adenoma resection
-Somatostain Analogues (Pegvisomant) = (GH antagonist)

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8
Q

On the other hand, dwarfism is

What is the treatment?

A

-Growth hormone deficiency

-Recombinant GH replacement

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9
Q

A TSH-secreting pituitary adenoma is a rare cause of __________.

For this reason, symptoms include…(remember there is an eye finding too)

A

-Hyperthyroidism

-Signs of hyperthyroidism: anxiety, heat intolerance, weight loss, fatigue, a-fib, increased metabolic rate, oligomenorrhea

-Diffuse goiter!
-Bitemporal hemianopsia due to compression of optic chiasm.
-Headache
-Mental disturbances

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10
Q

What is seen on diagnostic labs for a TSH-secreting pituitary adenoma?

A

-Secondary hyperthyroidism profile: increased TSH and increased free T4 (both in the same direction)

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11
Q

What is seen on radioactive iodine uptake scan for a patient with a TSH-secreting pituitary adenoma?

A

Diffuse increased uptake (like Graves)

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12
Q

Treatment for TSH-secreting pituitary adenoma

A

-Transsphenoidal surgery

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13
Q

What’s the MC type of pituitary adenoma?

A

Prolactinoma

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14
Q

What is the function of prolactin?

A

-Lactation
-Suppression of pregnancy during lactation
-Suppression of gonadotropin-releasing hormone
-Leads to decreased FSH and LH

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15
Q

What inhibits prolactin release as well as GH release?

A

Dopamine

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16
Q

Manifestations of prolactinoma in women

In men?

A

Women
-Hypogonadism: amenorrhea, infertility, galactorrhea, local compression (headache and visual changes)

Men
-Hypogonadism: ED, decreased libido, infertility, gynecomastia, local compression

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17
Q

What is one symptom that should be remembered with all pituitary tumors?

A

Can compress the optic chiasm: leading to bitemporal hemianopsia

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18
Q

What do endocrine studies (labs) show in a prolactinoma?

A

Increased prolactin
decreased FSH and LH

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19
Q

What is the imaging study of choice to look for pituitary tumors?

A

MRI

20
Q

Treatment for a prolactinoma

A

-Dopamine agonists (Cabergoline, Bromocriptine)
-Transsphenoidal resection if refractory or in women who wish to become pregnant

21
Q

A somatotroph adenoma is a pituitary adenoma that secretes ________ leading to ______ or _______

A

Growth-hormone

Gigantism or Acromegaly

22
Q

Explain the pathophysiology of growth hormone, glucose, and insulin-like growth factor

A

-Growth hormone (GH) increases glucose
-Increased growth hormone stimulates increased hepatic production of Insulin-like growth factor

23
Q

Symptoms of a somatotroph adenoma

A

-DM or glucose intolerance
-Enlargement of soft tissues, cartilage and bone: hands, feet, skull, increased ring, shoe, and hat size
-Headache
-Bitemporal hemianopsia
-Hypertension
-Colonic polyps

24
Q

What is the initial test of choice for a somatotroph adenoma?

Confirmatory?

What is the imaging study of choice for this?

A

Initial: Insulin-like growth factor

Confirmatory: oral glucose suppression test - increased growth hormone levels seen in acromegaly (normal response is GH suppression)

MRI

25
Q

Treatment for a somatotroph adenoma (both surgical and medical)

A

-Transsphenoidal resection is treatment of choice

-Octreotide or Lanreotide is used, first line, if surgery not possible. They inhibit GH release.
-Cabergoline or Bromocriptine: dopamine inhibits GH

26
Q

What is a corticotroph adenoma?

What is this also known as?

A

ACTH-secreting pituitary adenoma that leads to hypercortisolism (Cushing’s Syndrome)

Cushing’s Disease

27
Q

Symptoms of a corticotroph adenoma?

A

Proximal muscle weakness
Weight gain
Osteoporosis
ED
Polyuria
Oligomenorrhea
Headache
Mental changes

28
Q

How do you differentiate Cushing’s Disease from other causes of Cushing’s Syndrome?

A

-Increased ACTH + suppression of cortisol on high-dose Dexamethasone suppression test

29
Q

Where is growth hormone made?

A

Anterior Pituitary

30
Q

Symptoms of growth hormone deficiency?

A

-Short stature
-Growth delays
-Dwarfism
-Fasting hypoglycemia
-Dyslipidemia
-Decreased bone mass
-Decreased cardiac output

31
Q

What test is done to determine if hypopituitarism is the cause of GH deficiency?

A

Arginine stimulation test: Pituitary should secrete GH in response to arginine

32
Q

There are many causes of hyperprolactinemia. What are some of them?

A

-Prolactinoma (MCC)
-Hypothyroidism (increased TRH stimulates prolactin)
-Dopamine Antagonists (Risperidone, Haloperidol)
-SSRI’s, TCA’s, Verapamil, Estrogen
-Pregnancy, Stress, Exercise

33
Q

How does prolactin work with gonadotropin-releasing hormone?

A

Prolactin inhibits gonadotropin-releasing hormone –> hypogonadism

34
Q

Symptoms of hyperprolactinemia

A

-Oligomenorrhea
-Amenorrhea
-Infertility
-Vaginal dryness
-Galactorrhea
-ED, Decreased libido
-Gynecomastia in males

35
Q

Treatment for hyperprolactinemia

A

-Discontinue offending drugs
-Dopamine agonists (Cabergoline or Bromocriptine) inhibit prolactin

36
Q

Hypogonadism is a decrease in either or both of the primary function of the testes (testosterone and sperm production). In primary, there is a decrease in function of the ______ cells. This means there is decreased __________

A

Leydig

Testosterone synthesis

37
Q

What diagnostic should be done for hypogonadism?

A

Morning serum total testosterone: decreased

Normal FSH if primary.

38
Q

Metabolic syndrome is also known as Syndrome X or Insulin Resistance Syndrome.

What is the key component in this condition?

Explain the pathology of this.

A

Insulin resistance

Free fatty acids are released which causes and increase in TG’s and glucose production and reduction in insulin sensitivity.

High levels of insulin can cause sodium reabsorption, leading to hypertension.

39
Q

To be diagnosed with metabolic syndrome, you need 3 of the 5 criteria. Name the 5.

A

1) Low HDL: < 40 in men and < 50 in women
2) High BP: >135 or > 85 (or on meds for htn)
3) High fasting TG’s: >150 (or on meds)
4) High fasting sugar: >100 (or on meds)
5) High abdominal obesity: waist circumference > 40 in men and > 35 in women

40
Q

Initial management for metabolic syndrome

A

-Lifestyle: weight reduction, exercise, activity, diet

41
Q

Name some medications used for weight loss that can be used in metabolic syndrome.

A

-Phentermine (only used for 3 months)
-Phentermine/Topiramate (no restriction on usage)
-Lorcaserin: induces satiety
-Orlistat: inhibits fat absorption

42
Q

Multiple Endocrine Neoplasia I (MEN I) is a rare inherited disorder of 1 or more overactive endocrine gland tumors. Most tumors are benign with this condition. Where are the clinical manifestations with this condition (3 P’s).

A

Parathyroid: hyperparathyroidism
Pancreatic Tumors: Gastrinomas (ZES), Insulinomas, etc.
Prolactinomas

43
Q

What labs should you order to screen patients who have MEN I

A

PTH + Calcium
Gastrin
Prolactin

44
Q

With multiple endocrine neoplasia II, what are some manifestations you should watch for?

A

-Medullary Thyroid Carcinoma
-Pheochromocytoma
-Neuroma: mucosal (lips, tongue, eyelids, nasal)
-Marfanoid Habitus (scoliosis, high arched palate, pectus excavatum)

45
Q

What should you screen in patients you suspect with MEN II?

A

-Calcitonin
-Epinephrine
-PTH
-Calcium

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