Large group 1 -Sathananthan

Question 1

What is the first line of treatment for a prolactinoma?

Answer 1

DA agonist (bromocriptine and cabergoline)

Question 2

What are some causes of elevated prolactin?

Answer 2

• pregnancy
• prolactinoma
• pituitary stalk damage (trauma, surgery, pituitary tumors)
• DA blockers (haloperidol, risperidone)
• primary hypothyroidism
• renal failure and liver cirrhosis (decreased clearance)

Question 3

What endocrine issue should be considered with elevated prolactin?

Answer 3

primary hypothyroidism

low T4–> elevated TRH –> can elevate PRL

Question 4

What physiologic changes occur due to increased IGF-1 production?

Answer 4

increased tissue growth (mm mass, soft-tissue, visceral organs)
-fibroblast proliferation (thickening of connective tissue)

Question 5

What test should be done if acromegaly or gigantism are suspected?

Answer 5

• check GH and IGF_1 levels (IGF-1 is preferred)

- oral glucose tolerance test: give glucose and GH should be decreased. if GH remains elevated–> problem –> imaging

Question 6

What is the medical treatment for acromegaly?

Answer 6

• Pegvisomant (GH receptor antagonist). binds to the GH receptor but does not activate the JAK2-STAT signaling or IGF-1 secretion
• DA agonists –>

Question 7

What can happen to blood sugar with elevated GH?

Answer 7

GH acts to increase gluconeogenesis, decrease skeletal mm glucose use and decrease adipose glucose uptake

• IGF-1 acts as insulin to decrease blood glucose
• GH effects> IGF-1 ==> elevated blood glucose

Question 8

What medication can be used to treat Diabetes Insipidus?

Answer 8

Desmopressin acetate