HP Disorders Flashcards
Disorders of excess require a
suppression test
Disorders of deficiency require a
stimulatory test
Secondary organs
pituitary and hypothalamus
Primary organs
thyroid, adrenal, gonads, etc.
Patient complains of ptosis, which area is the tumor extended
Cavernous sinus
tumor compressive effects areas
dorsal sellar diaphragm
cavernous sinus (cn 3, 4, 5, 6)
temporal and frontal lobe
hypothalamus
types of pituitary gland disorders
“too much too little or tumor”
excess, deficiency, or mass
possible scenarios in pituitary gland disorders
deficiency of all hormones, hypersecretion of one hormone and deficiency of others, normal secretion of some and deficiency of some
scenarios regarding clinical presentations of primary/secondary disorders
different clinical presentation, similar lab and organ hormone levels
similar clinical presentation and end organ hormone levels
t/f the presence of a pituitary mass and hyperprolactinemia confirms the presence of a pituitary-secreting adenoma
false
clinical manifestations of prolactin excess in females
galactorrhea
menstrual irregularities
sexual dysfunction
hot flashes
clinical manifestations of prolactin excess in males
decreased libido erectile dysfunction tumor mass effects galactorrhea bigger tumor
clinical manifestations of prolactin excess in both sexes
infertility
osteoporosis
bone fractures
pathologic reasons for prolactin excess
medications
prolactinoma
stalk effect
serum prolactin levels
<200 mcg/L - stalk interruption
>200 mcg/L - micro/macroprolactinoma
>500 mcg/L - prolactinoma
prolactin excess treatment
first line: dopamine agonists
>
surgery indicated for dopamine agonist resistance and large prolactinoma
>
radiation indicated for partial tumor removal or adjust to surgery
bromocriptine vs cabergoline
see table 1
highly discriminatory features for cushing’s syndrome
easy bruisability
muscle weakness
facial plethora
broad, red striae
screening/confirmation tests for cushing’s syndrome
24 h urine free cortisol
dexamethasone overnight suppression test
low dose dexamethasone suppression test
midnight salivary cortisol (elevated = cushing’s)
dexamethasone overnight suppression test procedure and result
give dexamethasone at 11 pm, get serum cortisol at 8 am
normal: decreased cortisol (due to negative feedback)
cushing’s: increased cortisol
t/f any cortisol can be used in dexamethasone overnight suppression test
false, prednisone and hydrocortisone are read as cortisol. dexamethasone is not converted and can be distinguished from endogenous cortisol
(search) plasma acth values for cushing’s
acth dependent (pituitary cause): normal or >15 pg/ml
acth independent (adrenal cause): < 5 pg/ml
imaging for cushing’s
acth is high (dependent) = pituitary mri
acth is low (independent) = adrenal ct
treatment for cushing’s
surgery > radiation > medical
clinical manifestation of growth hormone excess
prognathism, large lips and nose, frontal bossing, spade-like hands, arthralgia and arthritis, organomegaly, diabetes, hypertension
gh excess screening test and normal gh levels
igf-1 levels
5-20 yo: 6 ng/ml
29-40 yo: 3 ng/ml
40-70 yo: 1.6 mg/ml
gh excess confirmatory test
oral glucose suppression test
normal: gh suppressed
gh excess: gh increased
(search) causes for gh excess
most common: gh secreting pituitary adenoma ectopic sites (MRI with contrast with pituitary protocol)
gh excess treatment
surgery (endoscopic transsphenoidal) > medical (somatostatin receptor ligands, dopamine agonists, gh receptor antagonists) > radiation
(confirm and search)
expected results for:
primary hyperthyroidism
secondary hyperthyroidism
primary: low tsh, high ft4 and ft3
secondary: high tsh, ft4, and ft3
treatment for excess thyroid
surgery (debulking)
>
radiation / medical
iodine therapy moa
inhibits ft4 (relieves hyperthyroid symptoms) –> negative feedback –> increase TSH –> pituitary tumor grows
best time for screening of cortisol when suspecting insufficiency?
early morning
cortisol levels for acth deficiency
< 3 mcg/dl (low): sure
>18 mcg/dl (high): not AI
confirmatory tests for acth deficiency
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
causes for acth deficiency
primary adrenal insufficiency: low cortisol, high acth
secondary adrenal insufficiency: low acth, low cortisol
treatment for acth deficiency
emergency: IV hydrocortisone, IV normal saline, supportive treament
replacement therapy: steroids in the morning 7-8 am (and 4-5 pm)
confirmatory tests for gonadotropin deficiency
primary: low testosterone, high lh and fsh
secondary: low lh and fsh, low testosterone
treatment for gonadotropin deficiency
fertility: pulsatile gnrh
males: testosterone (IM)
females: estrogen
confirmatory test for gh deficiency
insulin tolerance test
gh deficiency treatment
somatotroopin at night time
causes of hypothyroidism
primary: high tsh, low t4 and t3
secondary: low tsh, t4, and t3
hypothyroidism treatment
levothyroxine
