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Year 2 Endocrine > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

prolactin is chronically inhibited by what compound?

A

dopamine

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2
Q

GH is chronically inhibited by what compound?

A

somatostatin

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3
Q

what are three etiologies of hypopituitarism?

A 
pituitary disease (80%) 
hypothalamic disease (13%) 
idiopathic (7%)
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4
Q

what are the manifestations of pituitary apoplexy (hemorrhage)?

A

hemorrhage into a pituitary adenoma
sudden onset excrutiating headache
diplopia due to pressure on oculomotor nerve

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5
Q

what are the clinical signs of ACTH deficiency - secondary adrenal insufficiency?

A

low cortisol with simultaneous low ACTH

does NOT result in hyperpigmentation

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6
Q

how is secondary adrenal insufficiency different than primary?

A

secondary - no hyperpigmentation

secondary - no aldosterone deficiency

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7
Q

what test is used to diagnose adrenal insufficiency? how does it work?

A

cortrosyn stimulation test

obtain baseline serum cortisol
administer 250 mcg of ACTH
check serum cortisol 30 minutes after injection
check serum cortisol 60 minutes after injection
levels rising over 18 is normal

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8
Q

what are two tests used to diagnose ACTH deficiency?

A

metyrapone test (blocks conversion of 11-deoxycortisol to cortisol - results in reduced cortisol / compensatory increase in ACTH)

insulin induced hypoglycemia (should cause ACTH secretion)

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9
Q

what are the treatments for ACTH deficiency?

A

hydrocortisone

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10
Q

why is mineralocorticoid replacement not necessary in secondary adrenal insufficiency?

A

mineralocorticoids are mediated by renin-angiotensin system, not ACTH

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11
Q

what levels are measured in the diagnosis of TSH deficiency?

A 
serum thyroxine (T4) 
TSH
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12
Q

what are the T4 and TSH levels in secondary hypothyroidism?

A

low T4 with simultaneous low TSH

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13
Q

what is the treatment for TSH deficiency?

A

levothyroxine

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14
Q

when should T4 be given?

A

only after adrenal function is determined to be normal / treated

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15
Q

what measurement is useless in secondary hypothyroidism as a guide to adequacy of levothyroxine dosing?

A

TSH

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16
Q

what is the treatment for LH / FSH deficiency in men NOT seeking fertility?

A

testosterone replacement

17
Q

what is the treatment for LH / FSH deficiency in men seeking fertility?

A

LH / FSH if pituitary disease

GnRH in hypothalamic disease

18
Q

what is the treatment for LH / FSH deficiency in women?

A

estrogen-progesterone replacement

ovulation induction in those seeking fertility (LH / FSH if pituitary disease, GnRH in hypothalamic disease)

19
Q

what is the most common measurement used to assess GH?

A

IGF-1

20
Q

what is the relationship of likelihood of deficiencies in panhypopituitarism?

A

GH > LH / FSH > TSH > ACTH

21
Q

how are GH levels monitored in GH deficiency?

A

IGF-1 and patient well being

22
Q

what is the treatment for GH deficiency?

A

recombinant human GH preparations

23
Q

what two factors stimulate ADH release?

A

increase in plasma osmolality

decrease in plasma volume

24
Q

where are the ADH receptors?

A

V1 receptors in vasculature

V2 receptors in renal tubules

25
Q

what do the V1 receptors do?

A

vasoconstriction

26
Q

what do the V2 receptors do?

A
  • synthesis of water channels - aquaporins
  • aquaporins get inserted into the luminal surface of the collecting duct membrane
  • increased permeability of tubules
  • reabsorption of solute free water
27
Q

what is the pathogenesis of central diabetes insipidus?

A

deficiency of vasopression due to damage of hypothalamus posterior pituitary region

28
Q

what are the clinical signs of central diabetes insipidus?

A 
hypotonic polyuria 
hypernatremia 
loss of pituitary bright spot on MRI 
lethargy 
nausea 
irratability / drowsiness / confusion 
muscular rigidity / seizures / coma
29
Q

what is the primary treatment for vasopressin deficiency?

A

desmopressin (ddAVP) - synthetic vasopressin analogue

30
Q

what are the two types of ADH deficiency?

A

transient

permanent

Year 2 Endocrine (33 decks)

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