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Clinical Medicine II > Endocrine: Pituitary Disorders > Flashcards

Endocrine: Pituitary Disorders Flashcards

1
Q

Anterior pituitary synthesizes what hormones? (6)

A

ACTH, GH, TSH, FSH, LH, Prolactin

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2
Q

The intermediate pituitary produces ____ which has what effect?

A

MSH, skin pigmentation

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3
Q

The posterior pituitary stores which homrones?

A

oxytocin, ADH

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4
Q

Which hormone of the posterior pituitary?

stimulate water reabsorption

conc. Urine

Released in response to hypertonicity

A

ADH

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5
Q

Which posterior pituitary hormone has the following characteristics?

↑ uterine contractions

Lactation: contracts milk ducts

Positive feedback mechanism

A

prolactin

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6
Q

The following S/S should be immediately concerning for…

bitemporal hemianopsia
Visual Impairment
Diplopia
HA

A

sellar masses (adenoma)

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7
Q

Sellar masses are often identified how?

A

incidental MRI finding

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8
Q

What is the size cutoff between a micro or macroadenoma?

A

1cm

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9
Q

60% of pituitary adenomas are…

A

prolactinomas

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10
Q

pituitary adenoma of gonadotrophs would have what effect on them?

A

non-functioning

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11
Q

pituitary adenoma of thyrotrophs would have what effect on them?

A

↑ TSH

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12
Q

pituitary adenoma of corticotrophs would have what effect on them?

A

↑ ACTH

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13
Q

Prolactinomas have what effect on lactotrophs?

A

↑ prolactin → hypogonadism

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14
Q

pituitary adenoma of somatotroph would have what effect on them?

A

↑ GH → acromegaly

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15
Q

How is sellar mass/adenoma diagnosed?

A

MRI or hormonal hypersecretion

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16
Q

what lab tests can be ordered to assess a sellar mass/adenoma?

A

serum prolactin
IGF-1 (GH assessment)
T3/T4/TSH
24 hour urine cortisol (ACTH)

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17
Q

Male patient presents w.

↓ libido
impotence
infertility
gynecomastia
\+/- galactorrhea
A

Prolactinoma

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18
Q

How is prolactinoma diagnosed in men?

A

serum prolactin > 20

MRI

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19
Q

A pre-menopausal woman presents w.

infertility
oligomenorrhea/amenorrhea
Galactorrhea

A

prolactinoma

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20
Q

How is prolactinoma diagnosed in pre-menopausal women?

A

serum prolactin > 30

MRI

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21
Q

A post-menopausal woman presents w.

HA
impaired vision
+/- galactorrhea

A

Prolactinoma

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22
Q

How is prolactinoma diagnosed in post-menopausal women?

A

Serum Prolactin > 20

MRI

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23
Q

Medical tx for prolactinoma…

A

Cabergoline (prolactin antagonist)

bromocriptine (DA agonist)

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24
Q

surgical tx for prolactinoma

A

transsphenoidal resection, +/- radiotherapy

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25
Q

What is the most common cause of GH excess

A

benign pituitary macroadenoma

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26
Q

the below are less common causes of…

ectopic tumor, MEN Type I, Neurofibromatosis

A

GH excess

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27
Q

GH excess is more or less common in children or adults?

A

adults

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28
Q

What manifestation of GH excess occurs in adults?

A

Acromegaly (Hands/Feet/Jaw)

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29
Q

acromegaly confers increased risk for…

A

DM/HTN/CAD Risk

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30
Q

GH excess manifests as ____ in children, resulting in excessive long bone growth

A

gigantism

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31
Q

Increased GH corresponds with increased ______ from the liver

A

IGF-1

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32
Q

A patient presents with…

30s
DM/HTN/CAD
+/- HF w. LV dilation

A

acromegaly

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33
Q

why is random serum GH not an accurate lab test for GH excess?

A

Pulsatile GH Release Thruout Day

34
Q

What is the 1st test for GH excess?

A

serum IGF-1

35
Q

The below is the gold standard dx for…

2-hour OGTT showing failure of GH decrease to < 2mcg/L

A

GH excess

hyperglycemia should inhibit gonadotrophs

36
Q

What imaging can aid in dx of GH excess?

A

MRI showing pituitary tumor (95%)

37
Q

Surgical tx for GH excess…

A

Transsphenoidal Microsurgery

38
Q

Medical tx for GH excess

A

Octreotide/Lanreotide

Somatostatin Analogs

39
Q

In GH excess Transsphenoidal Microsurgery is indicated when?

A

GH < 50 ng/mL, tumor ≤ 2cm

40
Q

What must be monitored and when after Transsphenoidal Microsurgery for GH excess?

A

IGF-1 q 3-6 mo

directly linked to morbidity and mortality

41
Q

These GH excess drugs are inhibitory, may decrease tumor size…

A

Octreotide/Lanreotide

Somatostatin Analogs

42
Q

MC cause of GH deficiency?

A

pituitary adenoma

43
Q

rare but serious cause of GH deficiency?

A

Sheehan syndrome

44
Q

With GH deficiency, the following are increased or decreased?

Lean Body Mass
Bone Density
QOL

A

decreased

45
Q

With GH deficiency, the following are increased or decreased?

Fat Mass
Fx risk
CVD
Mortality

A

Increased

46
Q

Diagnosis for GH deficiency relies of ID of pituitary adenoma via..

A

MRI

47
Q

What labs can be helpful in identifying GH deficiency? (5)

A 
CBC
CMP
Lipid Panel
Fasting insulin
IGF-1
48
Q

In addition to MRI, what imaging modality is helpful for GH deficiency?

A

DEXA scan

49
Q

Who should be evaluated for GH deficiency?

A

Known hypothalamic/pituitary disease

hx of GH deficiency in childhood

50
Q

What is the tx for GH deficiency?

A

If Childhood Onset

GH SC QD

51
Q

The below are SFx of…

peripheral edema
arthralgia
paresthesia
worsening glucose tolerance

A

GH therapy

52
Q

What type of male hypogonadism?

↓ T
↑ FSH/LH

(hypergonadotrophic hypogonadism)

A

primary

53
Q

What type of male hypogonadism?

↓ T, FSH, LH

(hypogonadotrophic hypogonadism)

A

secondary

54
Q

What causes primary male hypogonadism?

hypergonadotrophic hypogonadism

A

failure of testis

55
Q

What causes secondary male hypogonadism?

hypogonadotrophic hypogonadism

A

defects in HPT axis

56
Q

A patient presents w.

ED
hot flash
gynecomastia
infertility

↓ energy, libido, muscle mass, body hair

A

Male hypogonadism

sxs of estrogen excess

57
Q

What 4 labs help diagnose male hypogonadism? What information do these labs give you about etiology?

A

Free & Total Serum Testosterone, LH, FSH

determines primary vs secondary

58
Q

what f/u tests should be ordered if you determine secondary male hypogonadism?

A

Serum Prolactin, TSH, CBC, CMP, semen analysis, MRI

59
Q

What tx regimen is recommended to treat male hypogonadism?

A

Testosterone IM q 2 weeks, transdermal Testosterone QD

THEN

SC Testosterone Pellets Q 3 mo

60
Q

What 2 screenings should be done before initiating testosterone therapy, and what is contraindicated?

A

DRE & PSA (annual if T therapy initiated)

Prostate CA C/I

61
Q

the below tests should be used for monitoring before or during T therapy?

Free & Total T
CBC (erythrocytosis)
Free Estradiol
DRE/PSA

A

during

62
Q

what should always be considered with a traumatic birth?

A

Sheehan’s syndrome/Pan-hypopituitarism

63
Q

This disease is postpartum pituitary necrosis after hypovolemia during/after childbirth

A

sheehan’s syndrome/pan-hypopituitarism

64
Q

What is the initial sx of sheehan’s syndrome/pan-hypopituitarism?

A

agalactorrhea/difficulty lactating

65
Q

What does the workup for pan-hypopituitarism/sheehan’s look like? (4)

A

H&P

full hormone workup

brain MRI

stimulation tests to exclude primary disease

66
Q

What is the tx for pan-hypopituitarism/sheehan’s?

A

Extensive hormone replacement

1500 mg Ca2+ + 800 IU Vit. D. QD

67
Q

What hormones should be administered with sheehan’s as part of extensive hormone replacement?

A

Levothyroxine

dexamethasone

T (for males)/Estrogen-Progestin (for females)

GH

68
Q

Presentation:

Dilute Urine
Polyuria
Polydipsia, Nocturnia/Enuresis

A

central DI

69
Q

What is a late stage finding in central DI?

A

hypernatremia

70
Q

Central DI is most commonly by…

A

idiopathic ↓ ADH Release

71
Q

The below is the workup for…

24 hr Urine Collection
Urine SG
Serum/Urine Osmolality

Serum Lytes
Serum Glucose (r/o DM)

Desmopressin Testing

MRI

A

Central DI

72
Q

The following test results indicate…

24 Hr. Urine Collection: > 3L/day (elevated)

Urine Osmolality: < 250 mOsm/kg (low)

Serum Osmolality: Normal to High

Serum Sodium: Normal to High

A

Central DI

73
Q

What is 1st line tx for central DI?

A

Desmopressin, IN, PO, SC/IV

74
Q

The below drugs can be used after 1st line drugs to treat…

Chlorpropamide
carbamazepine
thiazides
NSAIDs

A

Central DI

75
Q

↑ ADH Release

Caused by:
Trauma, CNS Disorders, Malignancy

A

SIADH

76
Q

4 hallmark S/S for SIADH?

A

Concentrated Urine
↓ Urine Volume
High Urine Osm.
Hyponatremia

77
Q

The below is the workup for…

24 hr Urine Collection
Urine Sodium

Serum/Urine Osm.
Serum Lytes

CT/MRI Head
CXR ( r/o paraneoplastic syndrome)

A

SIADH

78
Q

The below lab results indicate…

24 Hr. Urine Collection: < 2000 mL/Day (Low)

Urine Osmolality: > 1200 mOsm/Kg (High)

Serum Osmolality: Low
Serum Sodium: Low

Urine Sodium: > 40 mmol/L

A

SIADH

79
Q

What is the 1st line tx for SIADH and with what goal?

A

Fluid Restriction (< 800 mL/Day)

correcting hyponatremia

80
Q

In addition to fluid restriction, what can be added to tx SIADH?

A

PO Salt
Vasopressin receptor agonists

IV Hypertonic Saline (if severe/resistant)

81
Q

What role does prolactin have in males?

A

work with T for increased repro

Clinical Medicine II (31 decks)

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