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05 Endo > HP Disorders > Flashcards

HP Disorders Flashcards

1
Q

Disorders of excess require a

A

suppression test

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2
Q

Disorders of deficiency require a

A

stimulatory test

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3
Q

Secondary organs

A

pituitary and hypothalamus

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4
Q

Primary organs

A

thyroid, adrenal, gonads, etc.

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5
Q

Patient complains of ptosis, which area is the tumor extended

A

Cavernous sinus

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6
Q

tumor compressive effects areas

A

dorsal sellar diaphragm
cavernous sinus (cn 3, 4, 5, 6)
temporal and frontal lobe
hypothalamus

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7
Q

types of pituitary gland disorders

A

“too much too little or tumor”

excess, deficiency, or mass

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8
Q

possible scenarios in pituitary gland disorders

A

deficiency of all hormones, hypersecretion of one hormone and deficiency of others, normal secretion of some and deficiency of some

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9
Q

scenarios regarding clinical presentations of primary/secondary disorders

A

different clinical presentation, similar lab and organ hormone levels

similar clinical presentation and end organ hormone levels

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10
Q

t/f the presence of a pituitary mass and hyperprolactinemia confirms the presence of a pituitary-secreting adenoma

A

false

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11
Q

clinical manifestations of prolactin excess in females

A

galactorrhea
menstrual irregularities
sexual dysfunction
hot flashes

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12
Q

clinical manifestations of prolactin excess in males

A 
decreased libido
erectile dysfunction
tumor mass effects
galactorrhea
bigger tumor
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13
Q

clinical manifestations of prolactin excess in both sexes

A

infertility
osteoporosis
bone fractures

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14
Q

pathologic reasons for prolactin excess

A

medications
prolactinoma
stalk effect

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15
Q

serum prolactin levels

A

<200 mcg/L - stalk interruption
>200 mcg/L - micro/macroprolactinoma
>500 mcg/L - prolactinoma

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16
Q

prolactin excess treatment

A

first line: dopamine agonists
>
surgery indicated for dopamine agonist resistance and large prolactinoma
>
radiation indicated for partial tumor removal or adjust to surgery

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17
Q

bromocriptine vs cabergoline

A

see table 1

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18
Q

highly discriminatory features for cushing’s syndrome

A

easy bruisability
muscle weakness
facial plethora
broad, red striae

19
Q

screening/confirmation tests for cushing’s syndrome

A

24 h urine free cortisol
dexamethasone overnight suppression test
low dose dexamethasone suppression test
midnight salivary cortisol (elevated = cushing’s)

20
Q

dexamethasone overnight suppression test procedure and result

A

give dexamethasone at 11 pm, get serum cortisol at 8 am

normal: decreased cortisol (due to negative feedback)
cushing’s: increased cortisol

21
Q

t/f any cortisol can be used in dexamethasone overnight suppression test

A

false, prednisone and hydrocortisone are read as cortisol. dexamethasone is not converted and can be distinguished from endogenous cortisol

22
Q

(search) plasma acth values for cushing’s

A

acth dependent (pituitary cause): normal or >15 pg/ml

acth independent (adrenal cause): < 5 pg/ml

23
Q

imaging for cushing’s

A

acth is high (dependent) = pituitary mri

acth is low (independent) = adrenal ct

24
Q

treatment for cushing’s

A

surgery > radiation > medical

25
Q

clinical manifestation of growth hormone excess

A

prognathism, large lips and nose, frontal bossing, spade-like hands, arthralgia and arthritis, organomegaly, diabetes, hypertension

26
Q

gh excess screening test and normal gh levels

A

igf-1 levels

5-20 yo: 6 ng/ml
29-40 yo: 3 ng/ml
40-70 yo: 1.6 mg/ml

27
Q

gh excess confirmatory test

A

oral glucose suppression test

normal: gh suppressed
gh excess: gh increased

28
Q

(search) causes for gh excess

A 
most common: gh secreting pituitary adenoma
ectopic sites (MRI with contrast with pituitary protocol)
29
Q

gh excess treatment

A 
surgery (endoscopic transsphenoidal) 
> 
medical (somatostatin receptor ligands, dopamine agonists, gh receptor antagonists) 
> 
radiation
30
Q

(confirm and search)
expected results for:
primary hyperthyroidism
secondary hyperthyroidism

A

primary: low tsh, high ft4 and ft3
secondary: high tsh, ft4, and ft3

31
Q

treatment for excess thyroid

A

surgery (debulking)
>
radiation / medical

32
Q

iodine therapy moa

A

inhibits ft4 (relieves hyperthyroid symptoms) –> negative feedback –> increase TSH –> pituitary tumor grows

33
Q

best time for screening of cortisol when suspecting insufficiency?

A

early morning

34
Q

cortisol levels for acth deficiency

A

< 3 mcg/dl (low): sure

>18 mcg/dl (high): not AI

35
Q

confirmatory tests for acth deficiency

A

acth stimulation of cortisol (low cortisol = deficiency), peak cortisol >20 mcg/dl

insulin tolerance test to induce hypoglycemia (low acth/cortisol = deficiency), peak cortisol >18 mcg/dl

36
Q

causes for acth deficiency

A

primary adrenal insufficiency: low cortisol, high acth

secondary adrenal insufficiency: low acth, low cortisol

37
Q

treatment for acth deficiency

A

emergency: IV hydrocortisone, IV normal saline, supportive treament

replacement therapy: steroids in the morning 7-8 am (and 4-5 pm)

38
Q

confirmatory tests for gonadotropin deficiency

A

primary: low testosterone, high lh and fsh
secondary: low lh and fsh, low testosterone

39
Q

treatment for gonadotropin deficiency

A

fertility: pulsatile gnrh
males: testosterone (IM)
females: estrogen

40
Q

confirmatory test for gh deficiency

A

insulin tolerance test

41
Q

gh deficiency treatment

A

somatotroopin at night time

42
Q

causes of hypothyroidism

A

primary: high tsh, low t4 and t3
secondary: low tsh, t4, and t3

43
Q

hypothyroidism treatment

A

levothyroxine

05 Endo (16 decks)

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