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Endocrinology Exam 3 > Hypothalamic-Pituitary Disorders > Flashcards

Hypothalamic-Pituitary Disorders Flashcards

1
Q

Pea-sized Endocrine gland
attached to the base of brain
with anatomically,
physiologically distinct anterior
& posterior lobes

A

Pituitary gland

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2
Q

Inferior floor of the sella turcica is the
posterior superior roof of the
_____

A

sphenoid sinus

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3
Q

Anterior Pituitary: FLAT PeG

A

● Follicle Stimulating Hormone (FSH)
● L uteinizing Hormone (LH)
● A drenocorticotropic Hormone
(ACTH)
● T hyroid Stimulating Hormone (TSH)
● Prolactin (PRL)
● Growth Hormone (GH)

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4
Q

Posterior Pituitary:

A

● Antidiuretic Hormone (ADH)
○ (AKA Vasopressin)
● Oxytocin

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5
Q

Hypopituitarism

A

Partial or complete deficiency of one or any combination of
the anterior pituitary hormones.

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6
Q

Usually hypopituitarism is
secondary to____ or other
conditions affecting the pituitary
gland or hypothalamus.

A

mass lesions

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7
Q

This causes hypopituitarism by compression or displacement of the
gland itself or the infundibulum (Mass Effect)

A

Mass Lesions

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8
Q

most common sellar mass

A

Pituitary Adenoma

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9
Q

Other Etiologies of Hypopituitarism

A

○ Congenital syndromes (genetic disorders, etc.)
○ Status post cranial radiation therapy
○ Status post Circle of Willis aneurysm rupture
○ Status post traumatic brain injury

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10
Q

Hormone Deficiencies seen in Hypopituitarism

A

○ Adrenocorticotropic Hormone deficiency
○ Growth Hormone deficiency
○ Prolactin deficiency
○ Thyroid Stimulating Hormone deficiency
○ LH and FSH deficiency

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11
Q

Deficiencies in ALL anterior pituitary hormones is known as
_____

A

Panhypopituitarism

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12
Q

If several deficiencies (but not all) are present, we call this _____

A

Combined Pituitary Hormone Deficiency (CPHD)

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13
Q

Imaging recommended if hypopituitarism

A

MRI of Pituitary

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14
Q

Pituitary insufficiency often requires ____

A

lifetime hormone replacement therapy

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15
Q

Diabetes Insipidus

A

Deficiency of or ineffective Antidiuretic Hormone (ADH) from the posterior pituitary

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16
Q

We classify Diabetes Insipidus as one of the following

A

○ Central DI (Neurogenic)- decreased ADH production
■ ADH deficiency/absence.
■ Can be due to autoimmune posterior pituitary destruction,
trauma, pituitary surgery, CNS infections, etc.
○ Nephrogenic DI- decreased response to ADH.
■ The problem is at the kidney (intrinsic renal disease).
■ ADH is present, but ineffective receptors. Far less common.

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17
Q

ADH Normal action

A

ADH acts on renal tubules à reduce
water loss (antidiuresis), retaining water and producing concentrated urine

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18
Q

ADH in Diabetes insipidus

A

aquaporins are not placed in the membrane so
water reabsorption does not occur.
■ Results in excretion of large amounts of dilute urine

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19
Q

Children with DI often have
____ (unexpected urination).

A

enuresis

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20
Q

Diagnosing DI

A

○ Urinalysis reveals very dilute urine (SG < 1.010).
○ Often (but not always) these patients are hypernatremic.
24 hour urine collection.
■ If < 2 L in 24 hours and normal serum sodium, DI is ruled out

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21
Q

High serum ADH levels suggests ___

A

nephrogenic cause. Pituitary working fine

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22
Q

How do we Treat DI?

A

○ Mild cases simply require adequate fluid intake.
○ In severe, acute cases, aggressive “IV Fluid chasing” with an isotonic fluid is required.
○ Desmopressin (DDAVP) is a synthetic Vasopressin

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23
Q

Desmopressin (DDAVP) MOA

A

At very low doses, activation of V2
receptors on collecting ducts of the
nephron, triggering water reabsorption
(Antidiuretic).

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24
Q

How to treat Nephrogenic DI

A

Nephrogenic DI is difficult to treat.
■ Mainly focus on salt restriction in diet and hydration

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25
Desmopressin (DDAVP) Indications
○ Central Diabetes Insipidus ○ Nocturnal Enuresis (works for bedwetting) ○ Surgical preparation for those with Hemophilia A or von Willebrand Disease (give 30 min before surgery)
26
Contraindications of Desmopressin
Psychogenic polydipsia
27
Side effects of Desmopressin
○ Flushing and headaches ○ Nasal irritation and epistaxis with nasal form
28
Adverse reactions of Desmopressin
○ Dilutional Hyponatremia ○ Hypotension or Hypertension(with IV administration) ○ Seizures
29
Desmopressin Follow up and Monitoring
○ Caution advised during pregnancy, although likely safe. ○ Probably safe with lactation; limited data. ○ Check Creatinine at baseline; periodically if chronic use. ○ Watch serum sodium throughout treatment. ○ If administering by IV, watch BP and HR closely
30
SIADH
Syndrome of Inappropriate Antidiuretic Hormone.
31
Essentially the opposite of Diabetes Insipidus
SIADH
32
Most common causes of SIADH
Stroke, meningitis, brain tumors, brain surgery Other causes: ○ Small cell lung cancer ○ Some drugs (ex: carbamazepine) ENDO-HPD-1
33
Clinical Presentation of SIADH
■ Weakness/anorexia ■ Nausea with or without vomiting ■ Headaches ■ Muscle cramps ■ In SEVERE hyponatremia: Lethargy, confusion, seizures, coma and eventually death
34
Physical Exam Signs of SIADH
○ Mild edema may be present, but usually not severe. ○ Mental status changes or behavior changes
35
Diagnosis of SIADH
○ Hyponatremia (<135 mEq/L). Severe is <125 or Sxs. ○ Low serum osmolality. ○ High urine specific gravity (concentrated urine). ○ Elevated circulating vasopressin
36
Treatment of SIADH
○ Mainstay of treatment is water restriction! This may be enough if patient is stabel and Na between 125 and 134 ○ If severe disease, can administer Hypertonic (3% saline) IV infusion in the ICU
37
What happens if we correct hyponatremia too quickly?
Central Pontine Myelinolysis!
38
GH stimulates _____
IGF-1 synthesis in the liver and various tissue. ○ IGF-1 = Insulin Like Growth Factor (Somatomedin C)
39
GH and IGF-1 stimulate ____ in children
Linear Growth Work on epiphyseal cartilage and promote bone and muscle growth
40
Acromegaly
Excessive amounts of GH that occurs AFTER puberty.
41
Most common cause of acromegaly
By far, the most common cause is a GH secreting adenoma (tumor of the anterior pituitary)
42
Signs and Symptoms of Acromegaly
○ Acral overgrowth ○ Hypertrophic arthropathy of major joints ○ Bone density increases in spine and hip areas ○ Other Pituitary dysfunction due to enlarging tumor ○ Skin thickening and increased hair growth ○ “Soft, doughy, sweaty handshake” ○ Macroglossia (leading to deeper voice and OSA=apnea) ○ ~10% will develop a malignancy (often GI)
43
Most patients with Acromegaly will have ______
hyperglycemia; 25% will have overt Type 2 Diabetes
44
Cardiomyopathy
Enlargement of the heart, goes along with excessive GH
45
Diagnosing Acromegaly
○ Elevated serum IGF-1 (Somatomedin-C) is the best single test for Acromegaly. (IGF-1 doesn’t fluctuate like GH) ○ OGTT GH Suppression test ○ MRI of Pituitary à pituitary adenoma
46
Acromegaly Treatment
Surgery: Transsphenoidal resection of tumor, +/- radiation therapy Monitor biochemical markers Pharmaceutical management/GH Antagonists:
47
Gigantism
Excessive amounts of GH that occurs BEFORE puberty
48
T/F Gigantism has the same pathophysiologic mechanism as Acromegaly
T
49
because epiphyseal plates are still “available,” this conditions manifests itself as Tall Stature.
Gigantism
50
If not diagnosed with Gigantism and treated, the patient will go on to develop _____
Acromegaly after puberty
51
Childhood GH Deficiency
Short stature in children - Several etiologies are possible, both Endocrine or Non-Endocrine in nature One possible cause of short stature is low GH levels
52
Acquired GH secretion defect occurs due to:
■ CNS infection as neonate ■ Hypothalamic lesion or mass ■ Hydrocephalus ■ Head injury as newborn
53
Low levels of GH during development can be diagnosed with _____
GH provocation testing IV Arginine normally stimulates GH secretion. If no significant rise in GH, diagnosis is established
54
Treatment for Childhood GH Deficiency
Subcutaneous Somatropin ■ An aqueous solution of GH ENDO-HPD-1
55
Somatropin MOA
GH replacement therapy
56
Somatropin Indication
○ Pediatric growth failure secondary to GH deficiency ○ Adult GH deficiency
57
Somatropin Contraindications
○ Malignancy ○ Intracranial tumor ○ Acute severe illness
58
Common Side Effects of Somatotropin
○ Injection site reaction ○ Skeletal pain ○ Extremity stiffness
59
Major Adverse Reactions of Somatotropin
○ Secondary Malignancy ○ Diabetes Mellitus
60
Follow up and Monitoring of Somatotropin
○ Caution advised in pregnancy, limited studies. ○ Periodic blood glucose testing and Cardiac examination
61
Hyperprolactinemia
Elevated serum Prolactin (PRL) levels
62
PRL levels are normally elevated _____
during pregnancy
63
_____ is an adverse reaction of many drugs
Hyperprolactinemia
64
Medical conditions that can cause elevated PRL include
○ PRL-secreting Pituitary Adenoma (AKA Prolactinoma) ○ Pregnancy ○ Hypothyroidism ○ Cirrhosis of the liver ○ Chronic kidney disease ENDO-HPD-1,3
65
Hyperprolactinemia presentation
● Men will often present with Erectile Dysfunction, decreased libido, and occasionally gynecomastia. ● Women will often present with oligomenorrhea/amenorrhea, ● Galactorrhea is a common presentation
66
Treatment of Hyperprolactinemia depends on _____
the cause of the elevated PRL
67
Galactorrhea + New Vision problems =
Prolactinoma until proven otherwise
68
Hyperprolactinemia treatment if there is a Prolactinoma
○ Dopamine Agonists (such as Cabergoline or Bromocriptine) are first line and are usually successful (ongoing Tx). ○ Second line (or first line in massive tumors causing symptoms) is neurosurgical intervention
69
Pituitary Adenomas
These are tumors arising from any of the cell types that make up the pituitary gland
70
Secretory Pituitary Tumors cause symptoms dependent on ______
where the tumor is located (i.e. hormone cells affected)
71
If there is any question of a Pituitary Adenoma, order_____
a full panel of Pituitary Hormone labs.
72
Microadenoma
Tumor is less than 1 cm in diameter
73
Macroadenoma
Tumor is greater than 1 cm in diameter
74
Secretory and non-secretory Pituitary Adenomas can both cause _____
compression of nearby anatomic structures
75
Compression of optic chiasm by a pituitary tumor causes _____
Bitemporal Hemianopsia - Classic!
76
Treatment of Pituitary Adenomas
○ Dopamine Agonists are first line treatment for Prolactinomas ○ Surgery is preferred Tx for all other Pituitary Adenomas (if secretory or symptomatic)

Endocrinology Exam 3 (6 decks)

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