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Clinical Med II > Exam 4 - Pituitary Disorders > Flashcards

Exam 4 - Pituitary Disorders Flashcards

1
Q

What is the function of the anterior pituitary?

A

Synthesizes and secretes hormones in response to negative feedback from adrenals, thyroids, and gonads.

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2
Q

What stimulates production and release of cortisol by the adrenal cortex?

A

ACTH

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3
Q

What stimulates the thyroid gland to produce T4 and T3?

A

TSH

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4
Q

What stimulates ovulation in females and Leydig cell production of testosterone in males?

A

LH

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5
Q

What stimulates ovarian follicles in females and formation of secondary spermatocytes in males?

A

FSH

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6
Q

What stimulates growth, cell reproduction and cell generation?

A

GH

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7
Q

What stimulates milk production in females and helps increase reproductive function in males?

A

Prolactin

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8
Q

What two hormones are released from the posterior pituitary?

Where are these hormones synthesized?

A

ADH and Oxytocin

Synthesized in the hypothalmus

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9
Q

What hormone is synthesized and secreted from the intermediate pituitary? What is the function of this hormone?

A

MSH which controls skin pigmentation

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10
Q

What hormone stimulates the kidneys to reabsorb solute-free water, resulting in concentrated urine?

A

ADH

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11
Q

What hormone stimulates uterine contractions and the release of breast milk?

A

Oxytocin

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12
Q

Where does the pituitary sit within the skull?

A

Sella Turcica

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13
Q

What are common neurological symptoms associated with sellar masses?

A
  • Visual impairment
  • Diplopia
  • Headaches
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14
Q

What causes visual impairment with sellar masses?

A

Suprasellar extension of the adenoma, leading to compression of the optic chiasm

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15
Q

What is the most common visual complaint with sellar masses?

A

Bitemporal hemianopsia

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16
Q

What is the most common etiology of sellar masses?

A

Benign pituitary adenomas

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17
Q

What are the most common pituitary adenomas?

A

Prolactinomas

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18
Q

What distinguishes a microadenoma from a macroadenoma?

A

Microadenoma: < 1 cm

Macroadenoma: > 1 cm

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19
Q

What are clinical features associated with prolactinoma in premenopausal women?

A
  • Infertility
  • Oligomenorrhea/Amenorrhea
  • Galactorrhea
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20
Q

How is prolactinoma diagnosed in premenopausal women?

A

Serum prolactin > 30, MRI

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21
Q

What are clinical features associated with prolactinoma in post-menopausal women?

A
  • Headache

- Impaired vision

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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

What are clinical features associated with prolactinoma in men?

A
  • Decreased libido
  • Impotence, infertility
  • Gynecomastia
24
Q

How is prolactinoma diagnosed in men?

A

Serum prolactin > 20, MRI

25
What are treatment options for a prolactinoma?
Medical: Cabergoline, Bromocriptine Surgical: Transsphenoidal Resection
26
What is the most common etiology of Growth Hormone Excess?
Benign pituitary macroadenoma
27
What does an increase in GH cause?
Release of insulin-like growth factor (IGF-1) from the liver
28
What are clinical features associated with Acromegaly (growth hormone access)?
- Occurs in adults with onset in 30's | - Enlargement/Elongation of hands, feet, jaw, and internal organs
29
What are individuals with Acromegaly at a higher risk for?
DM, HTN, and CAD
30
How is Acromegaly diagnosed?
- Serum IGF-1 - 2 hour oral glucose tolerance test will show failure of GH to decrease to less than 2 - MRI will reveal pituitary tumor in most
31
What is the gold standard for diagnosis of Acromegaly?
2-hour oral glucose tolerance test
32
What is the treatment for growth hormone excess in adults?
- Somatostatin analogs (octreotide) are inhibitory and may decrease tumor size - Transsphenoidal microsurgery (best in GH < 50 and tumors < 2 cm) ***measure IGF-1 every 3-6 months as this is directly linked to morbidity and mortality
33
What is the most common etiology of adult-onset growth hormone deficiency?
Pituitary adenoma* or the consequence of the treatment of the tumor (surgery/radiation)
34
What are clinical features associated with adult-onset growth hormone deficiency?
- Decrease in lean body mass/Increase in fat mass - Decrease in bone mineral density/Increase in fractures - Increase in CVD
35
Who should be evaluated for adult-onset growth hormone deficiency?
Adults with known hypothalamic/pituitary disease or adults with a history of GH deficiency in childhood
36
What is the treatment for adult-onset growth hormone deficiency?
Subcutaneous GH injections
37
What is the impairment of either testosterone production or sperm production due to failure of the testis?
Primary hypogonadism (hypergonadotrophic hypogonadism)
38
What is impairment of either testosterone production or sperm production due to defects in the HPT axis levels?
Secondary hypogonadism (hypogonadotrophic hypogonadism)
39
Will levels of testosterone, FSH, and LH be low, high, or normal in Primary hypogonadism (hypergonadotrophic hypogonadism)?
Testosterone: Low FSH/LH: High
40
Will levels of testosterone, FSH, and LH be low, high, or normal in Secondary hypogonadism (hypogonadotrophic hypogonadism)?
Testosterone: Low FSH/LH: Low/normal
41
What are clinical features associated with Secondary hypogonadism?
- Erectile dysfunction - Hot flashes - Gynecomastia - Infertility - Decreases in energy, libido - Decrease in muscle mass and body hair
42
What are the treatment options for Secondary hypogonadism?
- IM testosterone injections Q 2 weeks - Transdermal cream/gel/patch applied daily - Pellets placed SC Q 3 months
43
What should you obtain prior to initiating treatment for Secondary hypogonadism? What is a contraindication to initiating treatment for Secondary hypogonadism?
Obtain DRE and PSA Contraindicated in history of prostate cancer
44
What is the most common etiology of Pan-Hypopituitarism? What is the most rare?
Radiation therapy is most common Sheehan Syndrome is rare
45
What is Sheehan's Syndrome? What is the most common initial symptom?
Postpartum pituitary gland necrosis due to blood loss and hypovolemic shock during and after childbirth. Agalactorrhea/difficulties with lactation is most common initial symptom
46
What is the treatment for Sheehan's Syndrome?
Extensive hormone replacement for life: - Levothyroxine for TSH - Dexamethasone for ACTH - Testosterone in males - Estrogen-progestin in females - Growth hormone - Calcium/Vitamin D daily to protect bones
47
What posterior pituitary disorder is associated with the decreased release of ADH?
Central Diabetes Insipidus
48
What is the most common symptom/presentation of Central Diabetes Insipidus?
Overly dilute urine and polyuria
49
The following presentation is associated with what disorder? - Overly dilute urine and polyuria - Polydipsia - Nocturia/Enuresis - Hypernatremia
Central Diabetes Insipidus
50
The following diagnostic studies are associated with what disorder? - 24 hour urine collection: > 3 liters/day - Serum sodium: Normal to high - Serum Osmolality: Normal to high - Urine osmolality: Low ( < 250 mOsm/kg) - Low ADH
Central Diabetes Insipidus
51
What is the treatment for Central Diabetes Insipidus?
Desmopression (intranasal*, oral, SC/IV)
52
What posterior pituitary disorder results from an inappropriate/increased release of ADH?
SIADH
53
The following presentation is associated with what disorder? - Overly concentrated urine and decreased urine volume - Increased urine osmolality - Hyponatremia
SIADH
54
The following diagnostic studies are associated with what disorder? - 24 hour urine collection: Low - Serum sodium: Low - Serum Osmolality: Low - Urine osmolality: High - High ADH
SIADH
55
What is the treatment for SIADH?
Fluid restriction to < 800 mL/day (focused on correcting the hyponatremia)
56
What are patients at an increased risk of when undergoing testosterone treatment for secondary hypogonadism? How can this be monitored?
At risk for erythrocytosis; monitor with CBC

Clinical Med II (17 decks)

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