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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
Q

Desmopressin (DDAVP) Indications

A

○ Central Diabetes Insipidus
○ Nocturnal Enuresis (works for bedwetting)
○ Surgical preparation for those with Hemophilia A or von Willebrand Disease (give 30 min before surgery)

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26
Q

Contraindications of Desmopressin

A

Psychogenic polydipsia

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27
Q

Side effects of Desmopressin

A

○ Flushing and headaches
○ Nasal irritation and epistaxis with nasal form

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28
Q

Adverse reactions of Desmopressin

A

○ Dilutional Hyponatremia
○ Hypotension or Hypertension(with IV administration)
○ Seizures

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29
Q

Desmopressin Follow up and Monitoring

A

○ 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

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30
Q

SIADH

A

Syndrome of Inappropriate Antidiuretic Hormone.

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31
Q

Essentially the opposite of Diabetes Insipidus

A

SIADH

32
Q

Most common causes of SIADH

A

Stroke, meningitis, brain tumors,
brain surgery
Other causes:
○ Small cell lung cancer
○ Some drugs (ex: carbamazepine)
ENDO-HPD-1

33
Q

Clinical Presentation of SIADH

A

■ Weakness/anorexia
■ Nausea with or without vomiting
■ Headaches
■ Muscle cramps
■ In SEVERE hyponatremia: Lethargy, confusion, seizures, coma and eventually death

34
Q

Physical Exam Signs of SIADH

A

○ Mild edema may be present, but usually not severe.
○ Mental status changes or behavior changes

35
Q

Diagnosis of SIADH

A

○ Hyponatremia (<135 mEq/L). Severe is <125 or Sxs.
○ Low serum osmolality.
○ High urine specific gravity (concentrated urine).
○ Elevated circulating vasopressin

36
Q

Treatment of SIADH

A

○ 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
Q

What happens if we correct hyponatremia too quickly?

A

Central Pontine Myelinolysis!

38
Q

GH stimulates _____

A

IGF-1 synthesis in the liver and various tissue.
○ IGF-1 = Insulin Like Growth Factor (Somatomedin C)

39
Q

GH and IGF-1 stimulate ____ in children

A

Linear Growth
Work on epiphyseal cartilage and promote bone and muscle growth

40
Q

Acromegaly

A

Excessive amounts of GH that occurs AFTER puberty.

41
Q

Most common cause of acromegaly

A

By far, the most common cause is a GH secreting adenoma (tumor of the anterior pituitary)

42
Q

Signs and Symptoms of Acromegaly

A

○ 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
Q

Most patients with Acromegaly will have
______

A

hyperglycemia; 25% will have overt
Type 2 Diabetes

44
Q

Cardiomyopathy

A

Enlargement of the heart, goes along with excessive GH

45
Q

Diagnosing Acromegaly

A

○ 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
Q

Acromegaly Treatment

A

Surgery: Transsphenoidal resection of tumor, +/- radiation therapy
Monitor biochemical markers
Pharmaceutical management/GH Antagonists:

47
Q

Gigantism

A

Excessive amounts of GH that occurs BEFORE puberty

48
Q

T/F Gigantism has the same pathophysiologic mechanism as
Acromegaly

A

T

49
Q

because epiphyseal plates are still “available,” this
conditions manifests itself as Tall Stature.

A

Gigantism

50
Q

If not diagnosed with Gigantism and treated, the patient will go on to develop
_____

A

Acromegaly after puberty

51
Q

Childhood GH Deficiency

A

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
Q

Acquired GH secretion defect occurs due to:

A

■ CNS infection as neonate
■ Hypothalamic lesion or mass
■ Hydrocephalus
■ Head injury as newborn

53
Q

Low levels of GH during development
can be diagnosed with _____

A

GH provocation testing
IV Arginine normally stimulates
GH secretion. If no significant rise
in GH, diagnosis is established

54
Q

Treatment for Childhood GH Deficiency

A

Subcutaneous Somatropin
■ An aqueous solution of GH
ENDO-HPD-1

55
Q

Somatropin MOA

A

GH replacement therapy

56
Q

Somatropin Indication

A

○ Pediatric growth failure secondary to GH deficiency
○ Adult GH deficiency

57
Q

Somatropin Contraindications

A

○ Malignancy
○ Intracranial tumor
○ Acute severe illness

58
Q

Common Side Effects of Somatotropin

A

○ Injection site reaction
○ Skeletal pain
○ Extremity stiffness

59
Q

Major Adverse Reactions of Somatotropin

A

○ Secondary Malignancy
○ Diabetes Mellitus

60
Q

Follow up and Monitoring of Somatotropin

A

○ Caution advised in pregnancy, limited studies.
○ Periodic blood glucose testing and Cardiac examination

61
Q

Hyperprolactinemia

A

Elevated serum Prolactin (PRL) levels

62
Q

PRL levels are normally elevated _____

A

during pregnancy

63
Q

_____ is an adverse reaction of many drugs

A

Hyperprolactinemia

64
Q

Medical conditions that can cause elevated PRL include

A

○ PRL-secreting Pituitary Adenoma (AKA Prolactinoma)
○ Pregnancy
○ Hypothyroidism
○ Cirrhosis of the liver
○ Chronic kidney disease ENDO-HPD-1,3

65
Q

Hyperprolactinemia presentation

A

● 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
Q

Treatment of Hyperprolactinemia depends on _____

A

the cause of the elevated PRL

67
Q

Galactorrhea + New Vision problems =

A

Prolactinoma until proven otherwise

68
Q

Hyperprolactinemia treatment if there is a Prolactinoma

A

○ 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
Q

Pituitary Adenomas

A

These are tumors arising from any of the cell types that make up the pituitary gland

70
Q

Secretory Pituitary Tumors cause symptoms dependent on
______

A

where the tumor is located (i.e. hormone cells affected)

71
Q

If there is any question of a Pituitary Adenoma, order_____

A

a full panel of Pituitary Hormone labs.

72
Q

Microadenoma

A

Tumor is less than 1 cm in diameter

73
Q

Macroadenoma

A

Tumor is greater than 1 cm in diameter

74
Q

Secretory and non-secretory Pituitary
Adenomas can both cause
_____

A

compression of nearby anatomic
structures

75
Q

Compression of optic chiasm by a
pituitary tumor causes _____

A

Bitemporal Hemianopsia - Classic!

76
Q

Treatment of Pituitary Adenomas

A

○ 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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