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Clinical Medicine 2 > Exam 4: Pituitary Disorders > Flashcards

Exam 4: Pituitary Disorders Flashcards

1
Q

What does ACTH do?

A

Stimulates production and release of cortisol by the adrenal cortex

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2
Q

What does LH do in females?

A

Triggers ovulation and development of the corpus luteum

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3
Q

What does LH do in males?

A

Stimulates Leydig cell production of testosterone

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4
Q

What does FSH do in females?

A

Stimulates growth of ovarian follicles

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5
Q

What does FSH do in males?

A

Stimulates formation of secondary spermatocytes

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6
Q

What does GH do?

A

Stimulates growth, cell reproduction, and cell regeneration

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7
Q

What does prolactin do in males?

A

Works with LH and Testosterone to increase reproductive function

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8
Q

What two hormones does the posterior pituitary release?

A

ADH and oxytocin

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9
Q

What does ADH do?

A

Causes the kidneys to reabsorb solute free water, resulting in concentrated urine and reduced urine volume

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10
Q

What does oxytocin do?

A
  • In a positive feedback loop, increases uterine contractions and promotes stretching of the cervix and uterus during labor
  • in breastfeeding women, it also stimulates the contraction of cells around the milk ducts causing milk to be released
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11
Q

What does the intermediate pituitary do?

A

Synthesizes and secretes melanocytes stimulating hormone, which controls skin pigmentation

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12
Q

Which part of the pituitary does no synthesize hormones, but just holds and secretes them?

A

The posterior pituitary does not synthesize any hormones

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13
Q

What is the most common place to get a sellar mass?

A

The sella Turcica

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14
Q

What is the clinical presentation of a sellar mass?

A

Visual impairment, diplopia, and headaches

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15
Q

Why do visual disturbances commonly happen with sellar masses?

A

Occurs as a result of suprasellar extension of the adenoma, leading to compression of the optic chiasm
-Commonly causes bitemporal hemianopsia

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16
Q

Are pituitary adenomas, craniopharyngioma, and meningioma usually benign or malignant?

A

Benign

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17
Q

What cancers are most likely to metastasize to the brain?

A

Breast and lung cancer

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18
Q

What accounts for over 60% of all pituitary adenomas?

A

Prolactinoma

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19
Q

What constitutes as a microadenoma?

Macro adenoma?

A

Micro: <1cm
Macro: >1cm

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20
Q

How are sellar masses diagnosed?

A
  • MRI

- check labs for hormonal hypersecretion (serum prolactin, serum IGF, 24 hours urine cortisol, and T3/T4/TSH

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21
Q

What results from GH excess?

A

Gigantism and acromegaly

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22
Q

What results from GH deficiency?

A

Short stature, adult deficiency

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23
Q

What are the clinical features of a prolactinoma in premenopausal women?

A
  • Infertility
  • Amenorrhea
  • Galactorrhea
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24
Q

What are the clinical features of prolactinoma in postmenopausal women?

A
  • Headache
  • impaired vision
  • Galactorrhea
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25
What is the clinical presentation of prolactinoma in men?
Decreased libido, impotence, infertility, gynecomastia, and galactorrhea
26
How is a prolactinoma diagnosed in premenopausal women?
Serum prolactin >30ng/mL
27
How is a prolactinoma diagnosed in postmenopausal women and men?
Serum prolactin >20ng/mL
28
What are the possible causes of hyperprolactinemia?
Pregnancy, lactation, stress, exercise, drugs (phenothiazine, haloperidol, and benzos), or pathologic (prolactinoma and hypothyroid)
29
How is a prolactinoma treated?
Pharmacologic: Bromocriptine, cabergoline Surgical: transsphenoidal resection, radiotherapy
30
What is the most common etiology of growth hormone excess?
Benign pituitary macroadenoma
31
Increase in GH causes an increase in **** from the liver.
Insulin like growth factor (IGF-1)
32
What are the clinical features of GH excess?
- occurs in adults, enlargement/elongation of hands, feet, and jaw - increased risk of DM, HTN, and CAD
33
How is growth hormone excess diagnosed?
- serum IGF - serum prolactin - 2 hour oral glucose tolerance test - MRI will reveal pituitary tumor in 95% of patients
34
What is the gold standard to diagnose GH excess and what will it show?
-2 hour oral glucose tolerance test, will show failure of GH to decrease to less than 2mcg *** random serum GH is not accurate as levels fluctuate
35
How is GH excess treated?
- somatostatin analogs are inhibitory and may decrease tumor size - transsphenoidal microsurgery is most successful in patients with GH levels below 50 and pituitary tumors <2cm - IGF should be measured every 3-6 months, as this is directly linked to morbidity and mortality
36
Is gigantism or acromegaly more common in adults?
Acromegaly
37
What is the most common etiology of GH deficiency?
Pituitary adenoma
38
What is the rare etiology of GH deficiency?
Sheehan syndrome
39
What are the clinical features of GH deficiency?
Decrease in lean body mass, decrease in bone mineral density, decrease in QOL, increase in fat mass, increase in rate of fractures, increase in mortality
40
What is the #1 cause of GH deficiency in adults?
Tumors
41
What is the recommended therapy for GH deficiency in patients who have childhood onset of GH deficiency?
GH therapy
42
What are the side effects of supplemental GH therapy?
Peripheral edema, arthralgia, paresthesias, and worsening of glucose tolerance
43
What is the difference between primary and secondary hypogonadism?
Primary: due to failure of the testes Secondary: due to defects in the HPT axis
44
What will labs show in primary hypogonadism?
Low testosterone, high FSH and LH
45
What will labs show in secondary hypogonadism?
Low testosterone, low to normal FSH and LH
46
What are the clinical features of secondary hypogonadism?
ED, hot flashes, gynecomastia, infertility, decreased energy, libido, muscle mass, and body hair
47
How is secondary hypogonadism diagnosed?
Free and total serum testosterone, LH, and FSH - prolactin, TSH, CBC, CMP, possibly semen analysis - MRI
48
What are the testosterone treatment options for secondary hypogonadism?
- IM injections Q 2 weeks - Transdermal cream/gel/patch applied daily - pellets placed SC Q3 months
49
Before initiating treatment for secondary hypogonadism, what should be done?
-DRE and PSA as history of prostate cancer is contraindicated in testosterone therapy
50
What should be done to monitor treatment for secondary hypogonadism?
-Free and total testosterone, CBC (risk of erythrocytosis, free estradiol, and annual DRE and PSA
51
What is it called when a patient has global anterior pituitary dysfunction, resulting in decreased anterior pituitary hormones?
Pan hypopituitarism
52
What are the etiologies of Pan-hypopituitarism?
Radiation therapy, pituitary tumors, Sheehan syndrome, and extrapituitary syndrome
53
What is Sheehan syndrome?
Postpartum pituitary gland necrosis, due to blood loss and hypovolemia shock during and after childbirth
54
What is the most common initial symptom of Sheehan syndrome?
Agalactorrhea/ difficulties with lactation
55
How is pan-hypopituitarism diagnosed?
Extensive history and physical exam, full hormone work up, brain MRI, and stimulation tests as indicated to exclude primary disease
56
What is the treatment for pan-hypopituitarism?
- Extensive hormone replacement for life (Levothyroxine, dexamethasone, testosterone, estrogen-progestin, and GH) - 1500 mg Ca with 800 IU of Vit D per day to protect the bones
57
What are the two disorders of the posterior pituitary?
Central DI, and SIADH
58
What is it called when there is decreased release of ADH from the posterior pituitary?
Central DI
59
What are the common etiologies of central DI?
- Most are idiopathic | - second most common is tumor of the posterior pituitary
60
What is the clinical presentation of Central DI?
- Overly dilute urine and polyuria - dehydration - polydipsia - ice water craving - nocturnal/enuresis - hypernatremia in late stages
61
How is central DI diagnosed?
- 24 hour urine collection - serum electrolytes - simultaneous serum and urine osmolality - glucose
62
What will the urine osmolality be in central DI?
<250 mOsm/kg
63
What is the treatment for central DI?
-Desmopressin (available intranasal)
64
What is it called when there is inappropriately high release of ADH from the posterior pituitary?
SIADH
65
What is the clinical presentation of SIADH?
- Overly concentrated urine and decreased urine volume - increase urine osmolality - decreased serum osmolality - hyponatremia
66
How is SIADH diagnosed?
- 24 hour urine collection - serum electrolytes - simultaneous serum and urine osmolality
67
What is the treatment for SIADH?
- focused on correcting the hyponatremia - fluid restriction to <800mL/day - consider oral salt intake - consider vasopressin receptor antagonist

Clinical Medicine 2 (22 decks)

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