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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
Q

What are treatment options for a prolactinoma?

A

Medical: Cabergoline, Bromocriptine

Surgical: Transsphenoidal Resection

26
Q

What is the most common etiology of Growth Hormone Excess?

A

Benign pituitary macroadenoma

27
Q

What does an increase in GH cause?

A

Release of insulin-like growth factor (IGF-1) from the liver

28
Q

What are clinical features associated with Acromegaly (growth hormone access)?

A
  • Occurs in adults with onset in 30’s

- Enlargement/Elongation of hands, feet, jaw, and internal organs

29
Q

What are individuals with Acromegaly at a higher risk for?

A

DM, HTN, and CAD

30
Q

How is Acromegaly diagnosed?

A
  • 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
Q

What is the gold standard for diagnosis of Acromegaly?

A

2-hour oral glucose tolerance test

32
Q

What is the treatment for growth hormone excess in adults?

A
  • 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
Q

What is the most common etiology of adult-onset growth hormone deficiency?

A

Pituitary adenoma* or the consequence of the treatment of the tumor (surgery/radiation)

34
Q

What are clinical features associated with adult-onset growth hormone deficiency?

A
  • Decrease in lean body mass/Increase in fat mass
  • Decrease in bone mineral density/Increase in fractures
  • Increase in CVD
35
Q

Who should be evaluated for adult-onset growth hormone deficiency?

A

Adults with known hypothalamic/pituitary disease or adults with a history of GH deficiency in childhood

36
Q

What is the treatment for adult-onset growth hormone deficiency?

A

Subcutaneous GH injections

37
Q

What is the impairment of either testosterone production or sperm production due to failure of the testis?

A

Primary hypogonadism (hypergonadotrophic hypogonadism)

38
Q

What is impairment of either testosterone production or sperm production due to defects in the HPT axis levels?

A

Secondary hypogonadism (hypogonadotrophic hypogonadism)

39
Q

Will levels of testosterone, FSH, and LH be low, high, or normal in Primary hypogonadism (hypergonadotrophic hypogonadism)?

A

Testosterone: Low

FSH/LH: High

40
Q

Will levels of testosterone, FSH, and LH be low, high, or normal in Secondary hypogonadism (hypogonadotrophic hypogonadism)?

A

Testosterone: Low

FSH/LH: Low/normal

41
Q

What are clinical features associated with Secondary hypogonadism?

A
  • Erectile dysfunction
  • Hot flashes
  • Gynecomastia
  • Infertility
  • Decreases in energy, libido
  • Decrease in muscle mass and body hair
42
Q

What are the treatment options for Secondary hypogonadism?

A
  • IM testosterone injections Q 2 weeks
  • Transdermal cream/gel/patch applied daily
  • Pellets placed SC Q 3 months
43
Q

What should you obtain prior to initiating treatment for Secondary hypogonadism?

What is a contraindication to initiating treatment for Secondary hypogonadism?

A

Obtain DRE and PSA

Contraindicated in history of prostate cancer

44
Q

What is the most common etiology of Pan-Hypopituitarism?

What is the most rare?

A

Radiation therapy is most common

Sheehan Syndrome is rare

45
Q

What is Sheehan’s Syndrome?

What is the most common initial symptom?

A

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
Q

What is the treatment for Sheehan’s Syndrome?

A

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
Q

What posterior pituitary disorder is associated with the decreased release of ADH?

A

Central Diabetes Insipidus

48
Q

What is the most common symptom/presentation of Central Diabetes Insipidus?

A

Overly dilute urine and polyuria

49
Q

The following presentation is associated with what disorder?

  • Overly dilute urine and polyuria
  • Polydipsia
  • Nocturia/Enuresis
  • Hypernatremia
A

Central Diabetes Insipidus

50
Q

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
A

Central Diabetes Insipidus

51
Q

What is the treatment for Central Diabetes Insipidus?

A

Desmopression (intranasal*, oral, SC/IV)

52
Q

What posterior pituitary disorder results from an inappropriate/increased release of ADH?

A

SIADH

53
Q

The following presentation is associated with what disorder?

  • Overly concentrated urine and decreased urine volume
  • Increased urine osmolality
  • Hyponatremia
A

SIADH

54
Q

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
A

SIADH

55
Q

What is the treatment for SIADH?

A

Fluid restriction to < 800 mL/day (focused on correcting the hyponatremia)

56
Q

What are patients at an increased risk of when undergoing testosterone treatment for secondary hypogonadism? How can this be monitored?

A

At risk for erythrocytosis; monitor with CBC

Clinical Med II (17 decks)

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