Parrot CIS 1

Question 1

What did the first girl in the case have?

• no periods
• ….. Rewatch the first part (30 min or so) of this lecture

Answer 1

Acquired PANhypopituitarism

Question 2

What should we do about it?

Answer 2

MRI to rule out masses

• the CBC was normal
• Urine and serum osmolality, 24 her urine collection volume (?)
• Assays on releasing hormones to differentiate between hypothalamic cause or pit cause
• REPLACE, re-evaluate, and keep replacing as needed*

Question 3

Congenital isolated hypogonadotropic hypogonadism

Answer 3

• Occurs in any of the many genes that cause production of GnRH, LH, and FSH
• Prader Willi Syndrome
• Kallmann syndrome
• Occurs with the syndrome of congenital adrenal hypoplasia

Question 4

Prader Willi syndrome

Answer 4

• they eat a lot

- have a child like genitalia

Question 5

Kallmann syndrome

Answer 5

-can’t smell (anosmia)… Food doesn’t taste like anything to them

Question 6

What are the only hormones that are affected by the congenital isolated hypogonadotropic hypogonadism?

Answer 6

• just GnRH, LH, andFSH

- everything else should be normal (like TSH and the other ant pit hormones)

Question 7

Kallmann syndrome

Answer 7

• 1/3 have deficiency in GH

- some have decreased sense of smell or no sense of smell

Question 8

What did that second patient present with?

Answer 8

-galctorrhea

Question 9

What did we think of when we saw the galactorrhea?

Answer 9

-lactotroph adenoma

Question 10

What are the benefits of cabergaline vs bromocriptine?

Answer 10

• better dosing schedule and less side effects

- but bromo is less expensive so watch out

Question 11

What did that guy have?

Answer 11

-prolactinoma

Question 12

What social issues did he discuss?

Answer 12

Hard to be male lactating
Financial strain, delayed marriage
Overall worry , when can I put this behind me?
Time consuming

Question 13

22 yo female and she’s thirsty as shit….and she pees a lot, thoughts?

Answer 13

• Diabetes insipid us: central vs nephrogenic
• UTI
• preggo!
• psychogenic polydipsia

Question 14

What labs would we order?

Answer 14

• urinalysis: results- completely normal except for almost clear or pale/light yellow…. And spec grav 1.002 (norm is 1.005)
• blood glucose via finger stick
• Desmopressin suppression test…. Maybe says parrot
• 24 hour urine collection test (normal is 2 liters): result is 4.7 liters
• CMP: lytes, renal, and liver function, Ca2+ and glucose
• ADH for sure!… Maybe the ant pit hormones just to cover bases

Question 15

What is that wierd thing about water temperature with ppl with DI?

Answer 15

-they like their water super cold

Question 16

What should we do for imaging?

Answer 16

-Brain MRI

Question 17

What is the imaging of choice for all things pituitary?

Answer 17

• MRI*

- not CT or plain film

Question 18

Why do we want to do an MRI?

Answer 18

• could have mass or adenoma

- on the posterior pituitary: that’s where adh

Question 19

What is the differential with this case?

Answer 19

• central DI
• nephrogenic DI
• psychogenic polydipsia

Question 20

What should we do for her?

Answer 20

• Desmopressin (DDAVP) that is the nose spray
• order the MRI
• RTC in 2-4 weeks, go to ED for any serious concerns that you think may be life threatening

Question 21

What if she were not permitted to drink water? (Plane wreck in the desert)

Answer 21

-she would get dehydrated

Question 22

Next case, guy with pain in his hips and shoulders and stuff like hands…. Can’t play guitar (that’s his income)…. He also has paresthesias and stuff… What is it?

Answer 22

-acromegaly

Question 23

What tests should we order?

Answer 23

• GH, TSH, Prolactin, ACTH, FSH, LH
• IGF-1
• Glucose
• Ionized calcium
• X-ray of hands

Question 24

What is he at risk for?

Answer 24

Diabetes
Osteoporosis
Gonadal dysfunction
Heart disease
GI cancer
Colon polyps- which may be colon cancer precursors

Question 25

If we go in an respect the tumor, what would we want to do with him in the postoperative period?

Answer 25

• replace the corticosteroids with something…. Do a taper**
• probably a test question

Question 26

Going back to the guy with prolactinoma, what would we want to do with him for replacement after done with cabergaline?

Answer 26

-give testosterone…. But it won’t always help with the symptoms