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Endo > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

clinical features of hypopituitarism in neonates

A
  • hypoglycemia (GH or cortisol defects)
  • mid-line defects (single upper central incisor (one oooh in the middle)/cleft lip/palate)
  • micropenis (testosterone deficiency)
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2
Q

clinical features of hypopituitarism in children

A
  • decreased growth
  • delayed/absent puberty
  • TSH/ACTH deficiency
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3
Q

family history of clinical features of hypopituitarism

A
  • parent heights

- history of short stature

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4
Q

birth history of clinical features of hypopituitarism

A
  • trauma
  • hypoxia

can cause infarcts

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5
Q

treatment of FSH/LH deficiency in children/adults

females

males

what do you monitor for

A

INDUCE PUBERTY

  • females: estrogen/progestin
  • males: testosterone

adults: FSH/LH for ovulation/spermatogenesis

  • estradiol/testosterone levels
  • secondary sex characteristics (breast development, pubic hair, axillary hair)
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6
Q

treatment for TSH deficiency in children/adults

what do you monitor

A
  • levothyroxine
  • normal or free T4
  • hypothyroid symptoms (fatigue, weight gain, dry skin)
  • growth/development
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7
Q

treatment for ACTH deficiency in children/adults

what do you monitor

A

GLUCOCORTICOIDS

  • hydrocortisone
  • prednisone
  • dexamethasone
  • energy
  • weight
  • BP
  • sodium
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8
Q

what is characteristic of GH deficiency in children

A
  • growth failure after a period of normal growth (acquired)
  • short stature < 2 SD
  • prominent forehead
  • depressed midface development (maxillary hypoplasia)
  • delayed dentition (when teeth come in)
  • truncal subQ fat
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9
Q

GH deficiency is associated with delayed ___ maturation

A
  • bone (Xray of left hand and wrist)

measure bone age

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10
Q

how to diagnose GH deficiency

screening

confirmatory

A
  • screen: measure IGF-1

- confirm: measure rise in GH after admin of insulin or other neuroactive stimulus (clonidine, glucagon, arginine)

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11
Q

treatment of growth hormone deficiency

how it is given

A
  • recombinant human growth hormone (hGH)

- 7x/week subQ injection

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12
Q

what is an important transcription factor associated with pituitary development

A
  • Pit-1

pituitary dwarfism and hypothyroidism

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13
Q

craniopharyngiomas arise from

A
  • remnants of Rathke’s pouch
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14
Q

craniopharyngiomas are associated with what form of hypopituitarism

A
  • panhypopituitarism
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15
Q

what is the definition of hypopituitarism

A
  • diminished or absent secretion of ONE OR MORE pituitary hormones
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16
Q

most common cause of hypopituitarism in adults

A
  • pituitary tumors (mostly prolactin)
17
Q

pituitary macroadenoma presents with

A
  • mass effect
  • CN palsies
  • headache
  • visual field defects
18
Q

symptoms of hypopituitarism develop

A
  • slowly
19
Q

in acquired hypopituitarism, how many hormones are usually affected

A
  • multiple
20
Q

GH deficiency in adults presents with

A
  • increased adiposity (because GH normally breaks down fat - lipolysis)
  • reduced strength and muscle mass
21
Q

big sign in men and women with FSH/LH deficiency (secondary hypopituitarism)

what lab test do you use

A
  • loss of sexual hair (public and axillary)
  • estradiol/testosterone low
  • FSH/LH low
22
Q

TSH deficiency (secondary hypopituitarism) in adults presents with

what lab test do you use

A
  • cold intolerance
  • dry skin
  • hair loss
  • T3/T4 low
  • TSH low
23
Q

ACTH deficiency (secondary hypopituitarism) in adults presents with

what lab test do you use

A
  • weight loss
  • postural hypotension
  • morning cortisol low
  • ACTH low
24
Q

for what hormone deficiency do you use a metyrapone test

A
  • ACTH
25
Q

is random cortisol helpful for treating ACTH deficiency

A
  • NO
26
Q

symptoms of GH deficiency in adults usually present during which decades

treatment of growth hormone deficiency in adults

A
  • 4th-5th decade
  • none really
  • treat symptoms
27
Q

what happens in Sheehan syndrome

main symptoms

when can it manifest

A
  • pituitary enlarges during pregnancy
  • prone to infarct with hypovolemia
  • failure to lactate
  • loss of menses
  • immediately to years/decades later
28
Q

what happens in pituitary apoplexy

symptoms

treatment

A
  • sudden hemorrhage into pituitary gland
  • headache
  • diplopia during to CN3/4/6 pressure
  • hypotension
  • fluids (patients likely have diabetes insipidus)
  • glucocorticoids (for adrenal insufficiency - cortisol helps kidneys retain sodium)
29
Q

gold standard for measuring ACTH deficiency

A
  • insulin-induced hypoglycemia

- expect a rise in cortisol

Endo (10 decks)

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