Pathophysiology of Pituitary & Adrenal Disorders

Question 1

What is the gold standard test for diagnosing hypercortisolism?

Answer 1

24-hour urinary free cortisol level

Question 2

What is the most common cause of Cushing syndrome?

Answer 2

Exogenous administration of glucocorticoids

Question 3

Bilateral renal bruits is most associated with what hyperaldosteronism?

Answer 3

Secondary hyperaldosteronism with high BP

Question 4

What is the safest test to diagnose GH deficiency?

Answer 4

Arginine infusion test (this test, however, is not the best test)

Question 5

Growth failure, hypoglycemic episodes, and adiposity are associated with this pituitary disorder.

Answer 5

Growth hormone hyposecretion

Question 6

What is Addison’s disease?

Answer 6

Primary hypocortisolism due to destruction of the adrenal gland

Question 7

Hypersecretion of growth hormone is associated with what disorders?

Answer 7

Gigantism & acromegaly

Question 8

What is the most common cause of death in patients with gigantism and acromegaly?

Answer 8

Congestive heart failure due to cardiomegaly

Question 9

This disorder is characterized by ischemia necrosis of the pituitary gland in postpartum women.

Answer 9

Sheehan Syndrome

Question 10

What is the best test to diagnose GH deficiency?

Answer 10

Insulin-induced hypoglycemia (this test, however, is not the safest)

Question 11

What is pituitary apoplexy?

Answer 11

Acute hemorrhage into a preexisting pituitary adenoma causing sudden and severe headache, CN paralysis, vision defects, hypotension, and CV collapse

Question 12

What hormone is most commonly released by pituitary adenomas?

Answer 12

Proalctin

Question 13

ACTH plays only a minor role in aldosterone release. What other molecules play an important role in release of aldosterone?

Answer 13

K+ & Angiotensin II

Question 14

True/False. Most cases of gigantism and acromegaly are due to a benign pituitary macroadenoma.

Answer 14

True

Question 15

From what adrenal zone is aldosterone released?

Answer 15

Zona glomgerulosa

Question 16

A patient is referred for refractory hypertension and hypokalemia. No edema is present. Their plasma aldosterone activity:plasma renin activity ratio is 25. What is the diagnosis?

Answer 16

Primary aldosteronism - PAA: PRA > 20

Question 17

What is the first-line treatment for hyperprolactinemia?

Answer 17

Dopamine agnost medications

Question 18

What is the difference between primary and secondary hyperaldosteronism?

Answer 18

Primary is due to an intrinsic defect in the pituitary (ex: adenoma, hyperplasia).

Secondary is response to some other chronic stimuli (renal artery stenosis, liver cirrhosis, heart failure)

Question 19

What unique clinical finding is only found with Addison’s disease and not secondary hypocortisolism?

Answer 19

Skin hyperpigmentation - due to increased ACTH that stimulates melanocytes

Question 20

What is the difference between gigantism & acromegaly?

Answer 20

Gigantism is due to GH hypersecretion before puberty and proportional longitudinal growth.

Acromegaly is associated with GH hypersecretion after puberty, with no linear growth.

Question 21

In cases of primary hyperaldosteronism, there is only slight hypernatremia and increased ECF. Why is this?

Answer 21

Aldosterone escape phenomenon - although aldosterone increases Na+ retention by the kidneys, the increase in ECF volume stimulates release of natriuretic peptides that increases Na+ excretion

Question 22

What is the confirmatory test for GH hypersecrection?

Answer 22

Oral Glucose Tolerance Test (OGTT)

Question 23

What symptoms are associated with hyperprolactinemia?

Answer 23

Galactorrhea, amenorrhea, decreased libido, infertility, osteoporosis

Question 24

What is Laron Syndrome?

Answer 24

Autosomal recessive disorder characterized by resistance to GH, increased GH secretion, and decreased insulin growth factor (IGF)

Question 25

What is the main hormone released from the adrenal zona fasciculata?

Answer 25

Cortisol

Question 26

How do primary and secondary hypercortisolism differ?

Answer 26

Primary is direct release of excess cortisol by the adrenal gland. Secondary is due to excess ACTH that stimulates adrenal release of cortisol

Question 27

What is the cause of Cushing’s disease?

Answer 27

Pituitary microadenoma - releases ACTH that stimulates excess cortisol release

Question 28

What is the difference between hypopituitarism and panhypopituitarism?

Answer 28

Hypopituitarism - partial loss of function

Panhypopituitarism - complete loss of function

Presentation is often as a sequential loss of hormone function

Question 29

Patients with GH hypersecretion are likely to present with what other clinical findings?

Answer 29

Hyperglycemia, Type 2 Diabetes, hypogonadism, obstructive sleep apnea, increased risk of colorectal polyps and cancer