Hyperpituitarism Flashcards
What is an adenoma?
Benign tumor of glandular origin
What is the most common cause of hyperpituitarism?
Pituitary adenoma
What is a pituitary macroadenoma?
Tumor >1 cm that can be seen with the naked eye
A pituitary macroadenoma can compress the optic chiasm causing ____
Bitemporal hemianopsia and loss of central vision
A pituitary macroadenoma can compress the meninges or internal carotid artery causing ____
Dizziness, severe headaches, or blindness
What is a pituitary microadenoma?
Tumor <1 cm that cannot be seen with the naked eye
How is a pituitary microadenoma diagnosed?
Changes in endocrine function
A pituitary macroadenoma can exert ____ and ____ effects
mass and stalk
What is a mass effect in regards to the pituitary?
When a pituitary macroadenoma blocks the release of all 6 anterior pituitary hormones, while it may be capable of secreting hormones itself
What is a stalk effect in regards to the pituitary?
When a pituitary macroadenoma presses on the pituitary stalk interrupting the flow of releasing hormones from the hypothalamus resulting in ^prolactin and possibly another hormone that the tumor secretes itself, while decreasing all other hormones
What is a lactotrope pituitary adenoma?
Anterior pituitary tumor secreting prolactin
What is the most common type of pituitary tumor?
Lactotrope pituitary adenoma
What neurotransmitter is always inhibiting prolactin in a normal system besides during pregnancy?
Dopamine
What is a null cell pituitary adenoma?
Pituitary adenoma that does not secrete any hormones itself
What effect will a null pituitary adenoma exhibiting mass effect have on hormone levels?
Decrease of all 6 hormones
What effect will a null pituitary adenoma exhibiting stalk effect have on hormone levels?
Increase in prolactin and a decrease in all 5 other hormones
What effect will a lactotrope pituitary adenoma exhibiting mass effect have on hormone levels?
Increase in prolactin and a decrease in all other hormones
What effect will a lactotrope pituitary adenoma exhibiting stalk effect have on hormone levels?
Increase in prolactin and a decrease in all other hormones
Ovulation is inhibited by what hormone?
Prolactin
What is amenorrhea?
complete lack of menstruation
What is the number one cause of amenorrhea in women?
Prolactinoma of the anterior pituitary
What are the signs and symptoms of a prolactinoma in females?
- amenorrhea
- galactorrhea
- depression
- infertility
What is galactorrhea?
ejection of milk-like material
What are the signs and symptoms of a prolactinoma in males?
- absent libido
- decreased testosterone
- ^weight
- gynecomastia
What is gynecomastia?
abnormal breast development in males
What is a corticotrope pituitary adenoma?
Pituitary adenoma that secretes ACTH
What is a somatotrope pituitary adenoma?
Pituitary adenoma that secretes GH
What is a gonadotrope pituitary adenoma?
Pituitary adenoma that secretes FSH and LH
What is a thyrotrope pituitary adenoma?
Pituitary adenoma that secretes TSH
What effect will a corticotrope pituitary adenoma exhibiting mass effect have on hormone levels?
Increased ACTH and a decrease in all other hormones
What effect will a corticotrope pituitary adenoma exhibiting stalk effect have on hormone levels?
Increased ACTH and PRL with a decrease in all other hormones
What effect will a somatotrope pituitary adenoma exhibiting mass effect have on hormone levels?
Increased GH and a decrease in all other hormones
What effect will a somatotrope pituitary adenoma exhibiting stalk effect have on hormone levels?
Increased GH and PRL with a decrease in all other hormones
What effect will a gonadotrope pituitary adenoma exhibiting mass effect have on hormone levels?
Increased FSH and LH with a decrease in all other hormones
What effect will a gonadotrope pituitary adenoma exhibiting stalk effect have on hormone levels?
Increased FSH, LH and PRL with a decrease in all other hormones
What effect will a thyrotrope pituitary adenoma exhibiting mass effect have on hormone levels?
Increased TSH with a decrease in all other hormones
What effect will a thyrotrope pituitary adenoma exhibiting stalk effect have on hormone levels?
Increased TSH and PRL with a decrease in all other hormones
37 year old female patient who has been your patient for a few years has recently noted an unexplained gain in adiposity. Furthermore, she reports not having her period in the past 5 months and is currently lactating despite not being pregnant. What is the most likely diagnosis?
Prolactinoma
39 year old male patient who has been your patient for a few years has recently confessed to a decrease in libido for the last 4 months. He has gained a considerable amount of weight predominantly in the area around his chest. Blood work shows low levels of testosterone for his age. What is a likely diagnosis?
Prolactinoma
What is the diagnostic lab marker for a patient suspected of having excess growth hormone?
IGF-1
Where is IGF-1 made in the body?
Liver
Growth hormone from the anterior pituitary targets the ____ to make IGF-1?
Liver
What is pituitary gigantism?
Excessive growth hormone secretion that begins in childhood before growth plates close
What is acromegaly?
Excessive growth hormone secretion that begins in adulthood after growth plates close
13 year old male patient presents to your office. He is 6’11 with massive hands and feet for his age. His chief complaint is bilateral knee pain. Upon ROM examination an audible crackling sound is present as the knee is moved through passive ROM tests and the patient reports increased pain. What is the likely diagnosis for this patient?
Pituitary gigantism
Pituitary gigantism will present with a ____ increase in body size?
Proportional
What are 2 consequences of gigantism?
- early arthritis
- cardiovascular compromise
What are some distinct features of a patient with acromegaly?
- Spade-like hands
- “coarsening” (thickening) of facial/body features
- ^heel pad thickness
- ^supraorbital ridge or frontal bossing
- diastema (gap teeth)
- “Lantern jaw” (remodeling of jaw)
- Visceromegaly, Hypertension and headaches
Name 3 consequences of Acromegaly
- visceromegaly
- HTN
- headaches
45 year old female patient presents to your office presenting with recurrent headaches. Her blood pressure measures 145/90. Upon palpation you notice that her teeth are gapped in the front and her lower jaw juts out. Upon inspection of cervical spine ROM you notice decreased rotation and a thickened forehead. The patient complains of pain in her hands as well, which also appear enlarged. What is the likely diagnosis? What would you expect to be heightened in the blood of this patient?
Acromegaly with an increase in IGF-1
Acromegaly can be caused iatrogenically (TRUE/FALSE)?
TRUE
What is the number one cause of Cushing’s Syndrome?
Exogenous long term corticosteroid use
What is the number one cause of Cushing’s Disease?
Corticotrope pituitary adenoma
What is the main hormone level seen in high amounts used to diagnose Cushing’s syndrome?
Cortisol
A patient with a hypothalamus SOL will have what trends in TRH, TSH, and T3/T4?
Decreased TRH, Decreased TSH, Decreased T3/T4
A patient with a pituitary thyrotrope adenoma will have what trends in TRH, TSH, and T3/T4?
Decreased TRH, ^TSH, ^T3/T4
A patient with Grave’s disease will have what trends in TRH, TSH, and T3/T4?
Decreased TRH, Decreased TSH, ^T3/T4
A patient with a hypothalamic tumor hypersecreting TRH will have what trends in TRH, TSH, and T3/T4?
^TRH, ^TSH, ^T3/T4
Thyroid tumors are usually (Cold/Hot)?
Cold
What two hormones are stored/secreted by the neurohypophysis?
Oxytocin and ADH (Vasopressin)
What hormones are produced in the posterior pituitary?
NONE!!!!!
What are two disorders of ADH secretion?
Diabetes insipidus and SIADH
What can cause diabetes insipidus?
unknown, adjacent tumor, head trauma/surgery
22 year old male patient presents to your office one week after suffering a concussion in a pickup hockey game. The patient presents with blood pressure of 110/55. The patient reports that he has been urinating upwards of 15 times a day and has gone twice in the past 20 minutes in your office. The patient also reports an unquenchable thirst. Blood tests are ordered. Blood test results show an increased serum osmolarity and high levels of sodium. What is the likely diagnosis for this patient? What would you expect the patients ADH levels to be?
Diabetes insipidus with low ADH
A patient with diabetes insipidus will present with (High/Low) ADH
Low
A patient with diabetes insipidus will present with (Increased/Decreased) water reabsorption in the collecting duct of the kidney
Decreased
A patient with diabetes insipidus will have (Increased/Decreased) serum osmolarity
Increased
ADH acts on the ____ of the kidney
Collecting ducts
Aldosterone acts on the ____ of the kidney
Distal convoluted tubule
A patient with diabetes insipidus will present with (Hypotension/Hypertension)? Why?
Hypotension due to low blood volume from decreased ADH
What is SIADH?
Syndrome of Inappropriate ADH Secretion
What is the main etiology of SIADH?
Small cell carcinoma of the lungs / paraneoplastic syndromes
55 year old female patient presents to your office with the chief complaint of chest pain, coughing, and wheezing. The patient has a 20 pack year smoking history. Upon palpation you notice purple striae, a moon shaped face, and increased hair growth on the face of the patient. Recently, the patient consulted an oncologist for a potential lung carcinoma but the results are currently inconclusive. Recently, the patient has complained of difficulty urinating. Blood tests show a low serum osmolarity with low levels of sodium, Blood pressure of the patient measures 155/115. What is the likely cause of this patients recent complaint of infrequent urination? What would you expect from the oncologist report?
SIADH caused by a small cell (oat cell) carcinoma of the lung
A patient with SIADH will have (Increased/Decreased) ADH
Increased
A patient with SIADH will have (Increased/Decreased) water absorption in the collecting ducts of the kidney
Increased
(^aquaporins)
A patient with SIADH will have (Polyuria/Oliguria)
Oliguria
A patient with diabetes insipidus will have (Polyuria/Oliguria)
Polyuria
A patient with SIADH will have (Increased/Decreased) serum osmolarity
Decreased
A patient with SIADH will present with (Hypernatremia/Hyponatremia)
Hyponatremia
A patient with SIADH will present with (Hypotension/Hypertension)
Hypertension (due to ^blood vol)
