HP Disorders

Question 1

Disorders of excess require a

Answer 1

suppression test

Question 2

Disorders of deficiency require a

Answer 2

stimulatory test

Question 3

Secondary organs

Answer 3

pituitary and hypothalamus

Question 4

Primary organs

Answer 4

thyroid, adrenal, gonads, etc.

Question 5

Patient complains of ptosis, which area is the tumor extended

Answer 5

Cavernous sinus

Question 6

tumor compressive effects areas

Answer 6

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

Question 7

types of pituitary gland disorders

Answer 7

“too much too little or tumor”

excess, deficiency, or mass

Question 8

possible scenarios in pituitary gland disorders

Answer 8

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

Question 9

scenarios regarding clinical presentations of primary/secondary disorders

Answer 9

different clinical presentation, similar lab and organ hormone levels

similar clinical presentation and end organ hormone levels

Question 10

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

Answer 10

false

Question 11

clinical manifestations of prolactin excess in females

Answer 11

galactorrhea
menstrual irregularities
sexual dysfunction
hot flashes

Question 12

clinical manifestations of prolactin excess in males

Answer 12

decreased libido
erectile dysfunction
tumor mass effects
galactorrhea
bigger tumor

Question 13

clinical manifestations of prolactin excess in both sexes

Answer 13

infertility
osteoporosis
bone fractures

Question 14

pathologic reasons for prolactin excess

Answer 14

medications
prolactinoma
stalk effect

Question 15

serum prolactin levels

Answer 15

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

Question 16

prolactin excess treatment

Answer 16

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

Question 17

bromocriptine vs cabergoline

Answer 17

see table 1

Question 18

highly discriminatory features for cushing’s syndrome

Answer 18

easy bruisability
muscle weakness
facial plethora
broad, red striae

Question 19

screening/confirmation tests for cushing’s syndrome

Answer 19

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

Question 20

dexamethasone overnight suppression test procedure and result

Answer 20

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

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

Question 21

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

Answer 21

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

Question 22

(search) plasma acth values for cushing’s

Answer 22

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

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

Question 23

imaging for cushing’s

Answer 23

acth is high (dependent) = pituitary mri

acth is low (independent) = adrenal ct

Question 24

treatment for cushing’s

Answer 24

surgery > radiation > medical

Question 25

clinical manifestation of growth hormone excess

Answer 25

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

Question 26

gh excess screening test and normal gh levels

Answer 26

igf-1 levels 5-20 yo: 6 ng/ml 29-40 yo: 3 ng/ml 40-70 yo: 1.6 mg/ml

Question 27

gh excess confirmatory test

Answer 27

oral glucose suppression test normal: gh suppressed gh excess: gh increased

Question 28

(search) causes for gh excess

Answer 28

``` most common: gh secreting pituitary adenoma ectopic sites (MRI with contrast with pituitary protocol) ```

Question 29

gh excess treatment

Answer 29

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

Question 30

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

Answer 30

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

Question 31

treatment for excess thyroid

Answer 31

surgery (debulking) > radiation / medical

Question 32

iodine therapy moa

Answer 32

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

Question 33

best time for screening of cortisol when suspecting insufficiency?

Answer 33

early morning

Question 34

cortisol levels for acth deficiency

Answer 34

< 3 mcg/dl (low): sure | >18 mcg/dl (high): not AI

Question 35

confirmatory tests for acth deficiency

Answer 35

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

Question 36

causes for acth deficiency

Answer 36

primary adrenal insufficiency: low cortisol, high acth secondary adrenal insufficiency: low acth, low cortisol

Question 37

treatment for acth deficiency

Answer 37

emergency: IV hydrocortisone, IV normal saline, supportive treament replacement therapy: steroids in the morning 7-8 am (and 4-5 pm)

Question 38

confirmatory tests for gonadotropin deficiency

Answer 38

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

Question 39

treatment for gonadotropin deficiency

Answer 39

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

Question 40

confirmatory test for gh deficiency

Answer 40

insulin tolerance test

Question 41

gh deficiency treatment

Answer 41

somatotroopin at night time

Question 42

causes of hypothyroidism

Answer 42

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

Question 43

hypothyroidism treatment

Answer 43

levothyroxine