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NYCC Visceral Pathology > Hyperpituitarism > Flashcards

Hyperpituitarism Flashcards

1
Q

What is an adenoma?

A

Benign tumor of glandular origin

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2
Q

What is the most common cause of hyperpituitarism?

A

Pituitary adenoma

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3
Q

What is a pituitary macroadenoma?

A

Tumor >1 cm that can be seen with the naked eye

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4
Q

A pituitary macroadenoma can compress the optic chiasm causing ____

A

Bitemporal hemianopsia and loss of central vision

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5
Q

A pituitary macroadenoma can compress the meninges or internal carotid artery causing ____

A

Dizziness, severe headaches, or blindness

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6
Q

What is a pituitary microadenoma?

A

Tumor <1 cm that cannot be seen with the naked eye

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7
Q

How is a pituitary microadenoma diagnosed?

A

Changes in endocrine function

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8
Q

A pituitary macroadenoma can exert ____ and ____ effects

A

mass and stalk

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9
Q

What is a mass effect in regards to the pituitary?

A

When a pituitary macroadenoma blocks the release of all 6 anterior pituitary hormones, while it may be capable of secreting hormones itself

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10
Q

What is a stalk effect in regards to the pituitary?

A

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

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11
Q

What is a lactotrope pituitary adenoma?

A

Anterior pituitary tumor secreting prolactin

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12
Q

What is the most common type of pituitary tumor?

A

Lactotrope pituitary adenoma

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13
Q

What neurotransmitter is always inhibiting prolactin in a normal system besides during pregnancy?

A

Dopamine

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14
Q

What is a null cell pituitary adenoma?

A

Pituitary adenoma that does not secrete any hormones itself

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15
Q

What effect will a null pituitary adenoma exhibiting mass effect have on hormone levels?

A

Decrease of all 6 hormones

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16
Q

What effect will a null pituitary adenoma exhibiting stalk effect have on hormone levels?

A

Increase in prolactin and a decrease in all 5 other hormones

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17
Q

What effect will a lactotrope pituitary adenoma exhibiting mass effect have on hormone levels?

A

Increase in prolactin and a decrease in all other hormones

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18
Q

What effect will a lactotrope pituitary adenoma exhibiting stalk effect have on hormone levels?

A

Increase in prolactin and a decrease in all other hormones

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19
Q

Ovulation is inhibited by what hormone?

A

Prolactin

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20
Q

What is amenorrhea?

A

complete lack of menstruation

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21
Q

What is the number one cause of amenorrhea in women?

A

Prolactinoma of the anterior pituitary

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22
Q

What are the signs and symptoms of a prolactinoma in females?

A
  • amenorrhea
  • galactorrhea
  • depression
  • infertility
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23
Q

What is galactorrhea?

A

ejection of milk-like material

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24
Q

What are the signs and symptoms of a prolactinoma in males?

A
  • absent libido
  • decreased testosterone
  • ^weight
  • gynecomastia
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25
Q

What is gynecomastia?

A

abnormal breast development in males

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26
Q

What is a corticotrope pituitary adenoma?

A

Pituitary adenoma that secretes ACTH

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27
Q

What is a somatotrope pituitary adenoma?

A

Pituitary adenoma that secretes GH

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28
Q

What is a gonadotrope pituitary adenoma?

A

Pituitary adenoma that secretes FSH and LH

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29
Q

What is a thyrotrope pituitary adenoma?

A

Pituitary adenoma that secretes TSH

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30
Q

What effect will a corticotrope pituitary adenoma exhibiting mass effect have on hormone levels?

A

Increased ACTH and a decrease in all other hormones

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31
Q

What effect will a corticotrope pituitary adenoma exhibiting stalk effect have on hormone levels?

A

Increased ACTH and PRL with a decrease in all other hormones

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32
Q

What effect will a somatotrope pituitary adenoma exhibiting mass effect have on hormone levels?

A

Increased GH and a decrease in all other hormones

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33
Q

What effect will a somatotrope pituitary adenoma exhibiting stalk effect have on hormone levels?

A

Increased GH and PRL with a decrease in all other hormones

34
Q

What effect will a gonadotrope pituitary adenoma exhibiting mass effect have on hormone levels?

A

Increased FSH and LH with a decrease in all other hormones

35
Q

What effect will a gonadotrope pituitary adenoma exhibiting stalk effect have on hormone levels?

A

Increased FSH, LH and PRL with a decrease in all other hormones

36
Q

What effect will a thyrotrope pituitary adenoma exhibiting mass effect have on hormone levels?

A

Increased TSH with a decrease in all other hormones

37
Q

What effect will a thyrotrope pituitary adenoma exhibiting stalk effect have on hormone levels?

A

Increased TSH and PRL with a decrease in all other hormones

38
Q

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?

A

Prolactinoma

39
Q

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?

A

Prolactinoma

40
Q

What is the diagnostic lab marker for a patient suspected of having excess growth hormone?

A

IGF-1

41
Q

Where is IGF-1 made in the body?

A

Liver

42
Q

Growth hormone from the anterior pituitary targets the ____ to make IGF-1?

A

Liver

43
Q

What is pituitary gigantism?

A

Excessive growth hormone secretion that begins in childhood before growth plates close

44
Q

What is acromegaly?

A

Excessive growth hormone secretion that begins in adulthood after growth plates close

45
Q

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?

A

Pituitary gigantism

46
Q

Pituitary gigantism will present with a ____ increase in body size?

A

Proportional

47
Q

What are 2 consequences of gigantism?

A
  • early arthritis
  • cardiovascular compromise
48
Q

What are some distinct features of a patient with acromegaly?

A
  • 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
49
Q

Name 3 consequences of Acromegaly

A
  • visceromegaly
  • HTN
  • headaches
50
Q

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?

A

Acromegaly with an increase in IGF-1

51
Q

Acromegaly can be caused iatrogenically (TRUE/FALSE)?

A

TRUE

52
Q

What is the number one cause of Cushing’s Syndrome?

A

Exogenous long term corticosteroid use

53
Q

What is the number one cause of Cushing’s Disease?

A

Corticotrope pituitary adenoma

54
Q

What is the main hormone level seen in high amounts used to diagnose Cushing’s syndrome?

A

Cortisol

55
Q

A patient with a hypothalamus SOL will have what trends in TRH, TSH, and T3/T4?

A

Decreased TRH, Decreased TSH, Decreased T3/T4

56
Q

A patient with a pituitary thyrotrope adenoma will have what trends in TRH, TSH, and T3/T4?

A

Decreased TRH, ^TSH, ^T3/T4

57
Q

A patient with Grave’s disease will have what trends in TRH, TSH, and T3/T4?

A

Decreased TRH, Decreased TSH, ^T3/T4

58
Q

A patient with a hypothalamic tumor hypersecreting TRH will have what trends in TRH, TSH, and T3/T4?

A

^TRH, ^TSH, ^T3/T4

59
Q

Thyroid tumors are usually (Cold/Hot)?

A

Cold

60
Q

What two hormones are stored/secreted by the neurohypophysis?

A

Oxytocin and ADH (Vasopressin)

61
Q

What hormones are produced in the posterior pituitary?

A

NONE!!!!!

62
Q

What are two disorders of ADH secretion?

A

Diabetes insipidus and SIADH

63
Q

What can cause diabetes insipidus?

A

unknown, adjacent tumor, head trauma/surgery

64
Q

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?

A

Diabetes insipidus with low ADH

65
Q

A patient with diabetes insipidus will present with (High/Low) ADH

A

Low

66
Q

A patient with diabetes insipidus will present with (Increased/Decreased) water reabsorption in the collecting duct of the kidney

A

Decreased

67
Q

A patient with diabetes insipidus will have (Increased/Decreased) serum osmolarity

A

Increased

68
Q

ADH acts on the ____ of the kidney

A

Collecting ducts

69
Q

Aldosterone acts on the ____ of the kidney

A

Distal convoluted tubule

70
Q

A patient with diabetes insipidus will present with (Hypotension/Hypertension)? Why?

A

Hypotension due to low blood volume from decreased ADH

71
Q

What is SIADH?

A

Syndrome of Inappropriate ADH Secretion

72
Q

What is the main etiology of SIADH?

A

Small cell carcinoma of the lungs / paraneoplastic syndromes

73
Q

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?

A

SIADH caused by a small cell (oat cell) carcinoma of the lung

74
Q

A patient with SIADH will have (Increased/Decreased) ADH

A

Increased

75
Q

A patient with SIADH will have (Increased/Decreased) water absorption in the collecting ducts of the kidney

A

Increased
(^aquaporins)

76
Q

A patient with SIADH will have (Polyuria/Oliguria)

A

Oliguria

77
Q

A patient with diabetes insipidus will have (Polyuria/Oliguria)

A

Polyuria

78
Q

A patient with SIADH will have (Increased/Decreased) serum osmolarity

A

Decreased

79
Q

A patient with SIADH will present with (Hypernatremia/Hyponatremia)

A

Hyponatremia

80
Q

A patient with SIADH will present with (Hypotension/Hypertension)

A

Hypertension (due to ^blood vol)

NYCC Visceral Pathology (40 decks)

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