Endocrine - Pituitary

Question 0

LH and FSH deficiency will cause?

Answer 0

#Women – amenorrhea
#Man – no testosterone or sperm

Both - decreased libido, decreased body hair

Question 1

Prolactin deficiency presents as?

Prolactin excess?

Answer 1

Inhibited lactation after childbirth (no symptoms in men)

Lactation in women and hypogonadotropic hypogonadisn in men

Question 2

Kallman syndrome?

Answer 2

#Decreased FSH and LH from decreased GnRH
#Anosmia
#Renal agenesis

Question 3

Adults with growth hormone deficiency present with?

Answer 3

#Central obesity
#Reduced muscle mass
#Increased LDL and cholesterol

Question 4

Na and K in panhypopituitarism?

Answer 4

Hyponatremia from hypothyroidism

Normal potassium because aldosterone is not affected

Question 5

Primary Hypothyroid – test and confirmatory test?

Answer 5

TSH and thyroxine levels;

decreased TSH response to thyrotropin releasing hormone

Question 6

Cushing’s disease – test and confirmatory test?

Answer 6

Increased ACTH and cortisol;

#Normal adrenal cosyntropin test
#No response to CRH

Question 7

Growth hormone deficiency – test and confirmatory test?

Answer 7

Low GH;

#No response to arginine infusion
#No response to GHRH

Question 8

Prolactin deficiency – test and confirmatory test?

Answer 8

Low prolactin;

No response to TRH

Question 9

Insulin Simulation test?

Answer 9

Insulin decreases glucose levels, causing growth hormone to rise

Question 10

Replace hormones from panhypopituitarism in this order?

Answer 10

Cortisone before thyroxine

Question 11

Drug/disease Causes of nephrogenic diabetes insipidus?

Answer 11

#Lithium
#Chronic Pyelonephritis
#Amyloidosis 
#sickle cell/myeloma

Question 12

Electrolyte abnormalities can cause nephrogenic diabetes insipidus?

Answer 12

Hypercalcemia and hypokalemia

Question 13

Treatment of Central versus Nephrogenic DI?

Answer 13

Vasopressin

Verses

#Correct underlying cause
#HCTZ, amiloride, NSAIDs

Question 14

Acromegaly is nearly always caused by? Other possible causes?

Answer 14

Adenoma

Ectopic production from lymphoma or bronchial carcinoid

Question 15

Non-bone Symptoms of acromegaly?

Answer 15

#Carpal tunnel syndrome
#increased Body odor
#Deep voice and macroglossia
#Colonic polyps
#Hypertension
#Cardiomegaly and CHF

Question 16

Best initial test for acromegaly? Most accurate test?

Answer 16

IGF-1 (increased); glucose suppression test

Question 17

Treatment of acromegaly?

Answer 17

#Transphenoidal resection
#Cabergoline - DA inhibits GH release
#Octreotide - somatostatin inhibits GH release
#Pegvisomant - GH receptor antagonist

Question 18

Only calcium channel blocker to raise prolactin level?

Answer 18

Verapamil

Question 19

Affect of DA on prolactin?

Answer 19

Inhibits

Question 20

General drugs that increase prolactin?

Answer 20

Psych (psychotics, opioids, tricyclics)

Question 21

Patient presents with elevated prolactin levels – next tests?

Answer 21

#Pregnancy test
#Thyroid function tests
#BUN/creatinine (kidney disease elevates prolactin)
#LFTs (cirrhosis elevates prolactin)

Question 22

Treatment of prolactinoma? If fails?

Answer 22

if fails, surgery

DA (carbergoline, Bromocriptine)