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Endocrine > Hyposecretory states > Flashcards

Hyposecretory states Flashcards

1
Q

What are the two nuclei in the hypothalamus that send axons down into the posterior pituitary?

A

Paraventricular

Supraoptic

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2
Q

What are the six hormones that are secreted by the anterior pituitary?

A 
ACTH
TSH
PRL
LH
FSH
GH
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3
Q

What are the two hormones released by the posterior pituitary?

A

ADH

Oxytocin

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4
Q

What is the inhibitory and promoting signals for Prolactin release?

A 
Dopamine = inhibiting
TSH = promoting
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5
Q

What does GH do in the liver? What does this do?

A

causes IGF production, which acts on target tissues

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6
Q

What is hypopituitarism?

A

Decreased secretion of anterior and/or posterior pituitary hormones resulting from pituitary, hypothalamus, or parasellar disease

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7
Q

What is the most common cause of hypopituitarism?

A

80% primary pituitary disease

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8
Q

What percent of hypopituitarism is caused by hypothalamic disease?

A

13%

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9
Q

What is the sinus that sits anterior to the pituitary?

A

Sphenoid sinus

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10
Q

What are the four major primary causes of hypopituitarism?

A
  • Tumors
  • Surgery
  • Radiation
  • Infarction
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11
Q

What type of growth can cause hypopituitarism?

A

Adenomas

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12
Q

How long does it take for hypopituitarism to present following head/neck radiation?

A

Months to years

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13
Q

What is Sheehan syndrome? SSX?

A

hypopituitarism after postpartum hemorrhage d/t infarct of the pituitary

Amenorrhea and inability to lactate following prego

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14
Q

What is pituitary apoplexy? Ssx?

A

Hemorrhage into a pituitary adenoma

Sudden onset of a headache, and diplopia from pressure on oculomotor nerves

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15
Q

What are the infiltrative diseases that can cause hypopituitarism?

A
  • Sarcoidosis
  • Hemochromatosis
  • Lymphocytic hypophysitis
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16
Q

What is lymphocytic hypophysitis?

A

Lymphocytes invade and cause destruction of pituitary cells

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17
Q

What is the genetic mutation that can cause hypopituitarism ?

A

Pit-1

prop-1

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18
Q

What is the difference between primary and secondary empty sella syndrome?

A

Primary = defect in the diaphragm sella, allowing CSF pressure to enlarge the sella

Secondary = space resulting from a pituitary adenoma that has been removed by surgery or radiation

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19
Q

What are the ssx of cortisol deficiency?

A
  • Weakness/fatigue
  • Anorexia
  • Vague abdominal pain
  • Weight loss
  • hypoglycemia
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20
Q

How do you determine ACTH deficiency?

A

Low cortisol with simultaneous low ACTH

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21
Q

Does primary or secondary adrenal insufficiency cause hyperpigmentation? Why?

A

Primary, since increased POMC production causes increased MSH (by product of its breakdown) to cause hyperpigmentation

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22
Q

Does primary or secondary adrenal insufficiency cause aldosterone deficiency? Why? What metabolic disturbance does this cause?

A

Primary, since Renin-angiotensin not regulated by ACTH

Hyperkalemia

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23
Q

How do you diagnose adrenal insufficiency?

A

Morning cortisol less than 3 or greater than 18

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24
Q

What is the cortrosyn stimulation test? What indicates a normal test?

A
  • Obtain a baseline cortisol level
  • Administer 250 mcg of ACTH
  • Check serum at 30 and 60 minutes after injection
  • If rises more than 18, abnormal
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25
Q

What is Metyrapone? Use?

A

Medication that blocks conversion of 11-deoxycortisol to cortisol.

This should increase ACTH in normal patients

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26
Q

How is insulin used to diagnose ACTH deficiency?

A

Giving insulin will cause hypoglycemia, and should increased ACTH

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27
Q

What is the treatment for ACTH deficiency?

A

Give 15-30 mg of hydrocortisone daily

2/3 dose at rising, 1/3 dose afternoon

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28
Q

When should patients with secondary ACTH deficiency administer a higher dose?

A

Under periods of illness

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29
Q

How do you assess the adequacy of treatment for ACTH deficiency?

A

Check BP, lytes, and general wellbeing

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30
Q

Do patients with secondary adrenal insufficiency (decreased ACTH production) need supplementary aldosterone? Why or why not?

A

No, because only primary adrenal insufficiency causes a loss of aldosterone

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31
Q

What are the findings of TSH deficiency?

A

Low T4 and low TSH

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32
Q

What is the treatment for TSH deficiency? Goal?

A

L-thyroxine, with the goal being normal T4 serum values

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33
Q

Why do you want to fix hypocortisolism prior to fixing low TSH?

A

Will cause an adrenal crisis if fix TSH first d/t increased clearance of cortisol

34
Q

True or false: TSH measurements in secondary hypothyroidism are useless as a guide to adequacy of L-thyroxine dosing

A

True

35
Q

What are the ssx of hypogonadotropin?

A

anovulation, infertility

36
Q

What are the lab findings of gonadotropin deficiency in women?

A
  • Low estradiol
  • Low LH
  • Low FSH
37
Q

What is the progesterone challenge for female gonadotropin deficiency?

A

Failure to bleed

38
Q

What is the treatment for male hypogonadotropism? (if seeking fertility vs not)

A

Testosterone if not seeking

LH/FSH if pituitary disease

GnRH if hypothalamic disease

39
Q

What is the treatment for female hypogonadotropism? (if seeking fertility vs not)

A

Estrogen/progestin replacement

FSH/LH if pituitary disease
Pulsatile gonadotropin GnRH in hypothalamic disease

40
Q

What are the ssx of GH deficiency in children?

A

Short stature /growth failure

41
Q

What are the ssx of GH deficiency in adults?

A
  • Diminished muscle mass
  • Increased fat mass
  • Increased LDL
  • Decreased bone mass
42
Q

Why are random GH levels not helpful?

A

No standarized ranges, and peaks at night

43
Q

What is the hormone that is most commonly measured for GH deficiency? How can you determine if there is disease present?

A

IFG-1

Age and gender ranges

44
Q

How is insulin used to diagnose GH deficiency?

A

Give insulin, measure GH. Normal response should be an increased in more than 10 ng/ml

45
Q

How is arginine + GH releasing hormone used to diagnose GH deficiency?

A

Given, then measure at 0, 30, 60 etc

46
Q

True or false: when 3-4 pituitary deficiencies exist, one can assume GH deficiency exists as well

A

True

47
Q

What is the order of the likelihood of hypopituitarism (most to least likely)?

A

GH
LH/FSH
TSH
ACTH

48
Q

What is the treatment for GH deficiency? How do you monitor this?

A

Recombinant GH preps

Monitor with IGF-1 levels

49
Q

What is the primary sign of prolactin deficiency?

A

Inability to lactate

50
Q

How do you diagnose and treat prolactin deficiency?

A

Typically not done since hard to distinguish low from normal levels

No treatment

51
Q

What are the two stimuli for ADH release?

A
  1. Increased plasma osmolality

2. Decreased plasma volume

52
Q

What is the MOA of ADH? (what does binding to each of its receptors do)?

A
  • Binds to V1 receptors on the kidneys to vasoconstrict

- Binds to V2 on renal tubules to insert aquaporins

53
Q

What is central diabetes insipidus?

A

Deficiency in vasopressin d/t damage of hypothalamus-posterior pituitary region

54
Q

What are the common causes of central diabetes insipidus?

A
  • Head trauma
  • Neurosurgery
  • Tumors/aneurysms
  • Infiltrative disease
55
Q

What is the primary sign of central diabetes insipidus?

A

Hypotonic polyuria

56
Q

What are the electrolyte disturbances in diabetes insipidus?

A

Hypernatremia

57
Q

What is the MRI change with diabetes insipidus?

A

Loss of bright spot on MRI for the potuitary

58
Q

What is the treatment for central diabetes insipidus?

A
  • ins=outs

- Desmopressin

59
Q

When is desmopressin indicated for central diabetes insipidus?

A

If urine volumes is greater than 4 L per day

60
Q

What is desmopressin?

A

Synthetics vasopressin analogue that binds to V2 receptors on the kidney

61
Q

How long does desmopressin take to work?

A

30-60 minutes

62
Q

What is transient ADH deficiency? When is it seen?

A

Swelling on the posterior pituitary causes a lack of ADH

Commonly seen after pituitary surgery/removal of pituitary tumor

63
Q

What is the most common secretory pituitary tumor?

A

Prolactinoma

64
Q

High prolactin decreases the secretion of what other hormones?

A

GH and FSH

65
Q

Prolactin level less than 100, but elevated, is most indicative of what pituitary pathology?

A

Stalk compression, NOT a prolactinoma

66
Q

True or false: with prolactinomas, there is a direct correlation between size of a tumor, and prolactin levels

A

True

67
Q

Why does stalk compression cause an increase in prolactin?

A

Interruption of the dopamine inhibition

68
Q

If T4 is very low, but TSH is only mildly elevated, then what should you suspect?

A

Pituitary disease

69
Q

True or false: women with primary hypothyroidism tend to have heavy menstrual flows.

A

True

70
Q

What are the prolacin levels that may indicate a prolactinoma less than 1 cm in size? 1-2 cm in size? More than 2 cm in size?

A
  • Less than 1, less than 200 ng/ml
  • 1-2 cm, 200-1000 ng/ml
  • More than 2 cm, more than 1000 ng/mL
71
Q

What is Addison’s disease? What are ACTH levels with this?

A

Primary adrenal insufficiency where the adrenal glands fail to make cortisol. ACTH are elevated with this

72
Q

What happens to estrogen, LH, and FSH levels with menopause? How is this different than hypogonadotropism?

A

Lower estrogen, but increased FSH and LH

all low in hypogonadotropism

73
Q

What is the progesterone challenge?

A

Give a woman progesterone, then take it away suddenly should cause menstruation. If it does not, then there is not a high enough estrogen level

74
Q

What do low LH and FSH cause in men (respectively)?

A

Low LH = lower testosterone

Low FSH = low sperm count

75
Q

What is the classic facial finding with GH deficiency?

A

Fine facial wrinkling

76
Q

Where are osmoreceptors located? Baroreceptors?

A 
Osmoreceptors = CNS
Baroreceptors = atrium of the heart and vaculature
77
Q

What is the difference between micro and macroadenomas?

A 
Micro = less than 1 cm
Macro = more than
78
Q

Only a slight elevation in TSH when the free T4 is very low suggests what?

A

Pituitary disease

79
Q

Women with primary hypothyroidism tend to have what type of menstrual flows?

A

Heavy

80
Q

What is the way to stimulate GH?

A

Arginine + GhRH

Endocrine (32 decks)

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