Lecture 9 - Clinical Disorders of Pituitary

Question 1

MRI with ______ contrast is the gold standard for Pituitary imaging.

Answer 1

Gadolinium

Question 2

Typical progression of hypopituitarism is as follows:

Loss of ___, then ____ and ____, then ____, and lastly ____ (which is essential for life).

Answer 2

GH, then LH and FSH, then TSH, and lastly ACTH

Question 3

GH deficiency can present with an increase in _______ and LDL/HDL and ______ resistance (with or without an increase in _____ levels.)

Answer 3

Cholesterol

Insulin resistance

Insulin

Question 4

_____ _____ test is the gold standard for GH deficiency diagnosis. You can also use a Glucagon + Arginine stimulation test or measure _____ levels.

Answer 4

Insulin Tolerance test

IGF-1

Question 5

The treatment for GH deficiency in children is recombinant GH called ______.

Answer 5

Nutropin

Question 6

Female gonadotropin replacement therapy should include physiological Estrogen WITH cyclical/continuous ______.

Answer 6

Progesterone

Question 7

Administration of T4 for Central Hyperthyroidism should not be performed until AFTER _____ deficiency is ruled out.

Answer 7

ACTH

Question 8

ACTH deficiency will result in low Cortisol levels. When should Cortisol be measured in patients and what measurement is indicative of deficiency?

What is the gold standard for diagnosis and what should the patient’s cortisol level be in response?

Answer 8

It should be measured in the morning (between 6am-8am). Cortisol < 3microgram/dL = ACTH deficiency.

Insulin tolerance test with blood glucose < 40mg/dL. Serum Cortisol should be > 18micrograms/dL if no pathology.

Question 9

Diabetes insipidus may be brought on by pregnancy bc the placenta may produce _________. This usually appears in the 3rd trimester, and curative treatment is delivering the child/placenta.

The vast majority of diabetes insipidus cases are ______ related.

Answer 9

Vasopressinases

Surgery related

Question 10

Diabetes insipidus is often diagnosed post surgery simply by observing ____ output. Otherwise, water deprivation test is used –> urine : plasma Osm < _____ is indicative of diabetes insipidus.

Answer 10

Urine output

2

Question 11

GH levels > _____ng/mL are considered abnormal following 2hrs of 75mg glucose load –> this is a means of testing GH levels in patients presenting with _______.

MRI is useful in diagnosis of GH secreting adenomas, bc about 75% are _______.

Answer 11

> 1ng/ML

Acromegaly

Macro ( > 1cm)

Question 12

______ is a dopamine analog, just like Cabergoline, and is used to treat Lactinomas.

Answer 12

Bromocriptine

Question 13

Look for _______ striae in patients with Cushing’s.

Answer 13

Violaceous striae

Question 14

Raised midnight _____ cortisol (> ____ng/dL) is a good indication of Cushing’s.

Answer 14

Salivary

0.35ng/dL