Pathogenesis and Investigation Flashcards
5 general types of pituitary-hypothalamic lesions
Acquired masses Congenital lesions Vascular lesions Granulomatous diseases Infiltrative disorders
Are malignant pituitary tumors rare or common?
Very rare
2 mass symptoms to look out for
Headaches
Vision loss
What type of vision loss are you most likely to get with a sellar mass?
Bitemporal hemianopsia
(Can’t see lateral fields)
Would lose superior before inferior
Size differential between micro and macroadenoma
Macro is above 1cm, micro is below that
3 questions to ask for a sellar mass
Are there mass symptoms
Is the mass causing pituitary deficiencies
Is the mass functioning
Order of hormone deficiencies
Go Look For The Adenoma Please
GH, LH, FSH, TSH, ACTH, Prolactin, Posterior pit hormones
From first to last
Clinical features of ACTH deficiency
Nausea, vomiting, fatigue, weight loss, headache, orthostatic hypotension
No hyperpigmentation! (Thats for hyper ACTH)
K normal because aldosterone is normal
Values for
- High cortisol
- Low cortisol
- > 350
2. < 80
Clinical features of a gonadotropin deficiency
Decreased libido, erectile dysfunction, gynecomastia, menstrual irregularities, fine facial wrinkles
Clinical features of a GH deficiency
Children: decreased growth velocity
Decreased energy, social isolation
Increased body fat, decreased muscle mass
Signs of hyperprolactinemia in 1. Women
2. Men
- Galactorrhea, decreased lbido, infertility, amenorrhea or oligomenorrhea
- Rare galactorrhea, decreased libido, decreased sperm counts, erectile dysfunction
Causes of hyperprolactinemia
Pregnancy or breastfeeding Breast stimulation, chest wall lesions Primary hypothyroidism Meds (neuroleptics) Renal insufficiency Disruption or compression of pituitary stalk Prolactinoma Macroprolactin
Stalk effect
Dopamine is blocked, prolactin is elevated
Main way to treat prolactinoma
Medical therapy: dopamine agonists
Symptoms of acromegaly
Increased ring/shoe size Arthalgias Sweating Snoring +/- apnea Carpal tunnel syndrome Menstrual irregularities Galactorrhea Headache Visual loss HTN Protrusion of lower jaw Space between teeth
How to diagnose acromegaly
IGF1 levels
OGTT
Signs and symptoms of Cushing’s
Increased weight and facial fullness Muscle weakness Thinning of skin Easy bruising Purple striae Facial plethora Hirsutism Acne Irregular menses Sexual dysfunction Psychiatric problems High BP Diabetes High cholestrol Osteoporosis
3 ways to screen for Cushing’s
24 hours urine free cortisol
Midnight salivary cortisol
Overnight dexamethasone suppression test
Central Diabetes Insipidus
Patients present with polyuria, polydipsia, have large daily urine volume output and often crave cold water
Patient is unable to concentrate urine
Central = do not produce ADH
Syndrome of Inappropriate ADH
Symptoms of hyponatremia (lethargy, nausea, vomiting, seizures/decreased LOC)
Dilutional hyponatremia, but patients are often euvolemic
Treat via fluid restriction
