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Endocrine > Hypersecretory states > Flashcards

Hypersecretory states Flashcards

1
Q

What are the two pituitary hormones that are absolutely essential for life?

A

Corticotropin (cortisol)

TSH (T4)

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2
Q

What are the two major effects that pituitary tumors can have on the endocrine system?

A

Hormone excess or deficiencies

Impingement of nearby structures

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3
Q

What is pituitary apoplexy?

A

Hemorrhage into the pituitary

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4
Q

What are the two different types of tumors that can have an effect on the HPA axis?

A

Hypothalamic

Pituitary

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5
Q

What are the major inflammatory diseases that can cause hypopituitarism?

A

Granulomatous diseases

Lymphocytic hypophysitis

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6
Q

What is lymphocytic hypophysitis?

A

Autoimmune attack against the pituitary, causing a variety of different symptoms

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7
Q

What are the granulomatous diseases that can have an effect on the pituitary? (3, two are infectious)

A

Sarcoid
TB
Syphilis

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8
Q

What is Sheehan’s postpartum necrosis?

A

hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth. The pituitary is more susceptible to ischemia d/t increased lactotrophs, so hypovolemia will more often result in infarction

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9
Q

What are the usual first ssx of Sheehan’s syndrome?

A

Agalactorrhea, and amenorrhea

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10
Q

Aneurysm of what artery can cause pituitary damage?

A

Internal carotid

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11
Q

What are the three major infiltrative diseases that can cause pituitary dysfunction?

A

Hemochromatosis
Amyloidosis
Sarcoidosis

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12
Q

ACTH excess leads to what?

A

Cushings

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13
Q

TSH excess leads to what?

A

Hyperthyroidism

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14
Q

FSH/LH excess leads to what?

A

Hypogonadism

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15
Q

What three pituitary hormones have simple end organ feedback?

A

ACTH
TSH
FSH/LH

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16
Q

Which two anterior pituitary hormones lack a simple feedback loop?

A

PL

GH

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17
Q

PL excess leads to what?

A

Galactorrhea

Hypogonadism

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18
Q

GH excess leads to what?

A

Gigantism/acromegaly

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19
Q

What CNs can be affected with large pituitary tumors?

A

2, 3, 4, 5, and 6

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20
Q

Why is it that prolactin levels increase with otherwise panhypopituitarism?

A

Loss of inhibitory dopamine

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21
Q

What percent of the pituitary function does prolactin represent normally? What about in pregnancy?

A

10-25% normally

70% with prego

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22
Q

What is the normal serum concentration of prolactin?

A

2-15 ng/mL

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23
Q

What is prolactin inhibitory factor also known as?

A

Dopamine

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24
Q

What, besides pregnancy, stimulates the production of prolactin? (4)

A

Stress
Estrogens
Opiates
Diseases

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25
Q

What are the two main presentations of hyperprolactinemia? Why?

A
  • Hypogonadism d/t inhibition of GnRH release

- Galactorrhea

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26
Q

Why is it that hyperprolactinemia is harder to detect in postmenopausal women?

A

They’re already hypogonadal, and do not as readily produce milk

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27
Q

What are the causes of hyperprolactinemia, besides a pituitary adenoma that secretes prolactin? (4)

A
  • Stalk compression
  • Decreased dop/dop inhibitory action
  • Increased stimuli (e.g. estrogen excess)
  • Decreased PL clearance from CKD
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28
Q

What are the two major types of stimuli that can cause hyperprolactinemia?

A

Excess estrogen

Hypothyroidism

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29
Q

Why can CKD cause hyperprolactinemia?

A

Decreased clearance of prolactin

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30
Q

Hyperprolactinemia with a prolactin level less than 30 is suspicious for what etiology?

A

Stress induce

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31
Q

Hyperprolactinemia with a prolactin level greater than 300 is suspicious for what etiology?

A

Pituitary adenoma

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32
Q

Hyperprolactinemia with a prolactin level greater than 100 (without pregnancy) is suspicious for what etiology?

A

adenoma

33
Q

What is the use of ordering an hCG level with hyperprolactinemia?

A

prolactin levels with increase if prego

34
Q

What is the use of ordering a TSH level with hyperprolactinemia?

A

TSH inhibits prolactin release. Thus if low, may be a secondary effect.

35
Q

What are the 4 most common drugs that can cause prolactinemia?

A

Verapamil
Metoclopramide (Reglan)
Risperidone
Haldol

36
Q

What is the most common type of functional pituitary adenoma?

A

Prolactinomas

37
Q

True or false: the size of prolactinomas correlates well with hormonal output

A

True

38
Q

Which is more common: micro or macro prolactinomas?

A

Maco

39
Q

When in particular do prolactinomas usually arise?

A

During pregnancy

40
Q

Who usually has macroprolactinomas: men or women? Why?

A

Men

Thought is that men do not seek medical attention as quickly as women

41
Q

When is it appropriate to treat a microprolactinoma? What is the treatment?

A

If symptomatic

Bromocriptine (dopamine agonist)

42
Q

When is it appropriate to treat a macroprolactinoma? What are the two medical treatment options? Surgical?

A

Most always require treatment

Bromocriptine and/or tamoxifen

Transsphenoidal resection

43
Q

What is the MOA of bromocriptine? Use?

A

Dopamine agonist for treating prolactinomas

44
Q

What is the main symptom of hyperprolactinemia?

A

Failure to lactate

45
Q

What is the major cause of hyperprolactinemia?

A

Sheehan syndrome

46
Q

How do you diagnose Hyperprolactinemia? What is the normal response?

A

Stimulation test with TRH or chlorpromazine

Normal increase is 200%

47
Q

What is the MOA of Chlorpromazine? Use?

A

Dopamine antagonist

Typical antipsychotic, but also sometimes used to treat hyperprolactinemia

48
Q

GH usually accounts for what percent of anterior pituitary function? How is GH released?

A

50%

Pulsatile fashion

49
Q

What are the two hormones that control GH release? Which does inhibition/secretion?

A
  • GRH stimulates release

- Somatostatin inhibits release

50
Q

If there is GH excess before the epiphyseal plates close, what is the outcome? After they close?

A 
Before = gigantism
After = acromegaly
51
Q

What is the sleep disturbance that can happen with acromegaly d/t GH?

A

OSA secondary to macroglossia

52
Q

What happens to the hands and feet with GH excess?

A

Enlargement and carpal tunnel syndrome

53
Q

What can excess GH cause that causes a pt to smell?

A

Hyperhidrosis

54
Q

What is the GI pathology that can happen with GH excess?

A

Colon polyps

55
Q

How do you diagnose GH excess?

A

GH inhibition test with standard glucose load

56
Q

Pts with large pituitary adenomas should always be screened for what pathology?

A

GH excess

57
Q

What are the goal of treatment for excess GH? (3)

A
  • Decrease GH levels back to normal
  • Decrease tumor size
  • Preserve normal function
58
Q

What is the treatment for GH excess?

A
  • Surgery
  • Radiation
  • Bromocriptine
59
Q

What is the role of bromocriptine in the treatment of GH excess?

A

Adjunct

60
Q

What are the labs that are commonly elevated with GH excess? (5)

A
  • Hyperglycemia
  • Hypercalciuria
  • Hypercalcemia
  • Hyperphosphatemia
  • Hyperprolactinemia
61
Q

What is the most common cause of GH excess?

A

Ptuitary adenomas (75% of the time)

62
Q

What are the two rare causes of GH excess?

A

GRH induced

Ectopic

63
Q

What is the first pituitary hormone to be lost d/t pituitary/hypothalamus problems?

A

GH

64
Q

How do you diagnose GH deficiency?

A

Stimulation test for GH release

65
Q

If an adult has DM, how will a GH deficiency present?

A
  • Decreased insulin requirements

- Hypoglycemia

66
Q

What percent of the anterior pituitary function is dedicated to the thyroid function?

A

10%

67
Q

What is the normal serum concentration of TSH?

A

0.5 - 3.5 micro units/mL

68
Q

If a patient has panhypopituitarism, will they ever have normal TSH levels? If not, what should be measured?

A

N

T3/T4 levels instead

69
Q

What are the two secondary causes of hypothyroidism?

A

TSH or TRH deficiency

70
Q

What are the two secondary causes of hyperthyroidism?

A

TSH excess

Resistance to T3/T4

71
Q

What percent of the anterior pituitary function is used for ACTH secretion?

A

15%

72
Q

What is the normal serum concentration of ACTH?

A

10-80 pg/mL

73
Q

What is the difference between Cushing’s disease, and Cushing’s syndrome?

A

Disease = secondary/tertiary cause (brain)

Syndrome = primary

74
Q

ACTH deficiency is also known as what?

A

Secondary Addison’s disease

75
Q

What percent of anterior pituitary function is dedicated to gonadotrophs?

A

10%

76
Q

What are the non-endocrine functions of the hypothalamus?

A
  • Caloric intake
  • Temp
  • Sleep/wake
  • memory/behavior
  • thirst
  • ANS
77
Q

Which are more common: slow or fast growing hypothalamic tumors?

A

Slow

78
Q

What are the usual ssx of slow growing hypothalamic tumors? (3)

A

Dementia
Disturbances in food intake
Endocrine dysfunction

79
Q

What is the usual presentation of rapid growing hypothalamic tumors?

A

Coma

ANS dysfunction

Endocrine (32 decks)

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