Pathogenesis and Investigation

Question 1

5 general types of pituitary-hypothalamic lesions

Answer 1

Acquired masses
Congenital lesions
Vascular lesions
Granulomatous diseases
Infiltrative disorders

Question 2

Are malignant pituitary tumors rare or common?

Answer 2

Very rare

Question 3

2 mass symptoms to look out for

Answer 3

Headaches

Vision loss

Question 4

What type of vision loss are you most likely to get with a sellar mass?

Answer 4

Bitemporal hemianopsia
(Can’t see lateral fields)
Would lose superior before inferior

Question 5

Size differential between micro and macroadenoma

Answer 5

Macro is above 1cm, micro is below that

Question 6

3 questions to ask for a sellar mass

Answer 6

Are there mass symptoms
Is the mass causing pituitary deficiencies
Is the mass functioning

Question 7

Order of hormone deficiencies

Answer 7

Go Look For The Adenoma Please
GH, LH, FSH, TSH, ACTH, Prolactin, Posterior pit hormones
From first to last

Question 8

Clinical features of ACTH deficiency

Answer 8

Nausea, vomiting, fatigue, weight loss, headache, orthostatic hypotension
No hyperpigmentation! (Thats for hyper ACTH)
K normal because aldosterone is normal

Question 9

Values for

1. High cortisol
2. Low cortisol

Answer 9

1. > 350

2. < 80

Question 10

Clinical features of a gonadotropin deficiency

Answer 10

Decreased libido, erectile dysfunction, gynecomastia, menstrual irregularities, fine facial wrinkles

Question 11

Clinical features of a GH deficiency

Answer 11

Children: decreased growth velocity
Decreased energy, social isolation
Increased body fat, decreased muscle mass

Question 12

Signs of hyperprolactinemia in 1. Women

2. Men

Answer 12

1. Galactorrhea, decreased lbido, infertility, amenorrhea or oligomenorrhea
2. Rare galactorrhea, decreased libido, decreased sperm counts, erectile dysfunction

Question 13

Causes of hyperprolactinemia

Answer 13

Pregnancy or breastfeeding
Breast stimulation, chest wall lesions
Primary hypothyroidism
Meds (neuroleptics)
Renal insufficiency
Disruption or compression of pituitary stalk
Prolactinoma
Macroprolactin

Question 14

Stalk effect

Answer 14

Dopamine is blocked, prolactin is elevated

Question 15

Main way to treat prolactinoma

Answer 15

Medical therapy: dopamine agonists

Question 16

Symptoms of acromegaly

Answer 16

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

Question 17

How to diagnose acromegaly

Answer 17

IGF1 levels

OGTT

Question 18

Signs and symptoms of Cushing’s

Answer 18

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

Question 19

3 ways to screen for Cushing’s

Answer 19

24 hours urine free cortisol
Midnight salivary cortisol
Overnight dexamethasone suppression test

Question 20

Central Diabetes Insipidus

Answer 20

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

Question 21

Syndrome of Inappropriate ADH

Answer 21

Symptoms of hyponatremia (lethargy, nausea, vomiting, seizures/decreased LOC)
Dilutional hyponatremia, but patients are often euvolemic
Treat via fluid restriction