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Clin med exam 2 > Pituitary > Flashcards

Pituitary Flashcards

1
Q

Pituitary adenomas

A

benign tumors that arise from one of the top five cells that comprise the anterior pituitary

characterized by size:
macroadenoma
microadenoma (more common)

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2
Q

Pituitary adenomas- hormones secreted

A

Prolactinomas

Non-functioning adenomas

Growth hormone-secreting adenomas

Adrenocorticotropic hormone (ACTH)

Follicle-stimulating hormone (FSH), luteinizing hormone (LH), or thyroid-stimulating hormone (TSH)

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3
Q

Pituitary adenomas- clinical presentation

A

hormone EXCESS or DEFICIENCY

neurological manifestations secondary to mass effect

incidental finding on imaging done for an unrelated issue

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4
Q

Pituitary adenomas- common hypersecretion syndromes

A

Hyperprolactinemia
Acromegaly
Cushing’s disease

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5
Q

Pituitary adenomas- common hyposecretion

A

hypogonadism

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6
Q

Why can pts have partial or incomplete hypopituitarism?

A

due to direct compression of the gland

or

inhibition of the pulsatile secretion or hormones

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7
Q

Functional (secreting) pituitary adenomas

A

prolactinomas
acromegaly
Cushing’s disease
hyperthyroidism

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8
Q

Prolactinomas

A

excessive prolactin

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9
Q

Prolactinomas signs and symptoms

A 
Symptoms:
men- 
gynecomastia
impotence
erectile dysfunction infertility 
women- 
oligomenorrhea or amenorrhea 
galactorrhea 
decrease in libido
infertility

Signs- hypogonadism

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10
Q

Prolactinomas- morbidity

A

Osteoporosis

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11
Q

Prolactinomas- dx

A

serum prolactin level

mri of pituitary to look for a mass lesion

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12
Q

Prolactinomas - tx

A

Dopamine agonist therapy- decrease prolactin secretion and shrink tumor

  • cabergoline (not in pregnancy or breast feeding)
  • bromocriptine (not in pregnancy or breast feeding)
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13
Q

Non-functional (non-secreting) pituitary adenomas

A 
craniopharyngiomas 
Rathke's cleft cyst 
hypopituitarism 
pituitary apoplexy 
sheehan's syndrome
empty sella syndrome 
diabetes insipidus
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14
Q

Acromegaly

A

excessive growth hormone

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15
Q

Gigantism vs Acromegaly

A

Gigantism occurs when growth hormone hypersecretion occurs before the fusion of the long bone epiphysis and is characterized by tall stature.

Acromegaly occurs when GH hypersecretion occurs after the fusion of the epiphysis leading to large extremities and characteristic facies

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16
Q

Acromegaly signs and symptoms

A

signs-
hypertension, coarse facial features, left ventricle hypertrophy, goiter

symptoms-
increased hand and foot size, change in facial features (large mandible), carpal tunnel symptoms, hyperhidrosis, decrease in libido

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17
Q

Acromegaly morbidity

A 
cardiac disease 
diabetes
sleep apnea 
increased risk for colon cancer 
osteoporosis
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18
Q

Acromegaly dx

A

IGF-1 levels
Growth hormone is not a reliable test, pulsatile (diff times being released)

oral glucose suppression test followed by growth hormone measurement after two hours
(normally increased glucose would stop GH production but does not stop it in pts with acromegaly)

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19
Q

Anterior pituitary (adenohypophysis)

A

regulates several physiological processes (including stress, growth, reproduction, and lactation)

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20
Q

Anterior pituitary hormones

A

TSH- regulate the body’s metabolism

ACTH- increases production and release of cortisol by the adrenal glands in response to stress

GH- causes bone and tissue growth, raises BG, controls balance of fat and muscle tissue in the body

LH- triggers ovulation and development of corpeus luteum in females, in males triggers Leydig cells to produce testosterone

FSH- growth of ovarian follices, in males acts on sertoli cells to simulate sperm production

LH and FSH work together

Prolactin- controls breast development, stimulates lactation

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21
Q

Posterior pituitary hormones

A

Oxytocin- uterine contractions in childbirth, milk letdown reflex, bonding between sexual activity and mom/baby

Vasopressin (ADH)- reabsorption of free water, increases BP by constricting arterioles

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22
Q

Primary disease

A

impaired function at the level of the target endocrine gland

  • ACTH secreted by pituitary gland increases as well as CRH from hypothalamus to try to get the adrenal gland to secrete CORT
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23
Q

Secondary disease

A

defect at the level of the pituitary

-hypothalamus is secreting normally, pituitary is not and adrenal cortex is also secreting normally

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24
Q

Tertiary disease

A

defect at the level of the hypothalamus

  • not secreting and the other two are not either
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25
Negative feedback vs positive feedback
hormone secretion (from endocrine gland) regulates pituitary and hypothalamus secretion - "once there is enough, you can stop now" positive- secretion activates pituitary and hypothalamus to secrete
26
Cushing's disease
increased adrenocorticotropic (ACTH) hormone secretion (--> end up with too much cortisol= regulates bodies response to stress)
27
Cushing's disease- signs and symptoms
Signs- thin skin, striae/bruising, central obesity, moon facies, plethora, glucose intolerance, neutrophilia, lymphocytopenia, eosinopenia symptoms- labile mood, weakness, hirsutism, decrease in libido
28
Cushing's disease- morbidity
diabetes mellitus cardiac disease osteoporosis
29
Cushing's disease- dx
AM cortisol, ACTH, etc cortisols
30
Cushing's disease is different from ?
Cushing's syndrome (primary) disease is secondary
31
Hyperthyroidism
excessive TSH
32
Hyperthyroidism dx
measure tsh,
33
Neurological symptoms are more common in
nonfunctioning adenomas or gonadotroph adenomas compared to functioning pituitary lesions includes headaches and vision changes
34
Imaging for pituitary mass suspicion?
MRi with and without contrast done with and without gadolinium enhancement
35
Craniopharyngiomas
benign tumor | lesion can behave like a malignant lesion with recurrences and "metastases"
36
Craniopharyngiomas- symptoms
``` visual headaches sexual dysfunction- men amenorrhea- women growth failure- children ```
37
Craniopharyngiomas- dx
MRI and or CT- calcifications and cysts often seen
38
Craniopharyngiomas - tx
surgical resection +/- rad therapy
39
Rathke's cleft cyst
benign cysts variable course
40
Causes of hypopituitarism
acquired from compression due to tumors, inflammation, or vascular damage (stroke, hemorrhage) also hypothalamus
41
Symptoms of hypopituitarism
develop gradually, often overlooked long list slide 40 in children- stunted growth, slowed sexual development
42
Anterior hypopituitarism
``` deficiency in one or any combo: ACTH- decreased cortisol, testosterone, & epinephrine. Aldosterone= intact GH Prolactin- postpartum lactation TSH LH and FSH- infertility ``` caused from either hypothalamic or pituitary dysfunction
43
Hypopituitarism secondary to mass lesions
lesions to hypothalamus, pituitary stalk, or pituitary
44
Pituitary can sometimes be a part of ? vs. sporadic
multiple endocrine neoplasia type 1 usually release prolactin more aggressive than sporadic adenomas
45
Sheehan syndrome
hypopituitarism caused by postpartum pituitary necrosis infarction of pituitary gland after severe postpartum hemorrhage
46
Lymphocytic hypophysitis When does it occur?
lymphocytes infiltrate and enlarge the pituitary which causes a destruction of pituitary cells in late pregnancy or postpartum period
47
Pituitary apoplexy
sudden hemorrhage into the pituitary gland can occur in a pituitary adenoma
48
Pituitary apoplexy signs and symptoms
severe headache, diplopia, acute development of hypopituitarism EMERGENT! can lead to CNS hemorrhage, shock and death
49
Pituitary apoplexy tx
Surgical decomposition of pituitary
50
Sheehan syndrome can lead to
panhypopituitarism or partial hypopituitarism
51
Hypopituitarism without mass lesion
congenital hypopituitarism cranial radiation pituitary surgery encephalitis hemochromatosis autoimmunity coronary artery bypass grafting (CABG)
52
TBI and hypopituitarism
At least one hormone deficiency develops in survivors of mod to severe TBI and in survivors of subarachnoid hemorrhage GH deficiency and hypogonadotropic hypogonadism in ischemic stroke patients
53
Empty sella syndrome
benign- accidental finding have normal pituitary function (surrounding rum tissue is functional) hypopituitarism may develop insidiously
54
Pituitary masses and empty sella
Pituitary masses also may undergo clinically silent infarction and involution with development of a partial or totally empty sella by cerebrospinal fluid (CSF) filling the dural herniation
55
Diabetes Insipidus
decreased secretion of ADH or a loss of ADH;s action ADH reabsorbs water from collecting ducts of kidneys pts have abnormal secretion of large amounts of hypotonic urine
56
Central- diabetes insipidus
posterior pituitary secretion of ADH decreases tumor head trauma brain surgery inherited/encephalitis response to desmopressin = Antidiuretic and Clotting promoter It can treat diabetes insipidus.
57
Nephrogenic- diabetes insipidus
the kidneys are not as sensitive to ADH CKD/failure inherited defect in receptor limited toxicity no response to desmopressin = Antidiuretic and Clotting promoter It can treat diabetes insipidus.
58
diabetes insipidus - signs and symptoms
polyuria (peeing a lot) nocturia polydipsia dilute urine ``` acute: altered mental status irritability hyperreflexia spasticity ```
59
diabetes insipidus - labs and assessment
``` 24 hour urine collection for volume serum electrolytes plasma ADH level urine osmolality and specific gravity, plasma osmolality water deprivation test MRI ```
60
Central- diabetes insipidus - tx
low sodium and protein diet desmopressin (dDAVP)- an ADH analog for hormone replacement thiazide diuretics
61
Nephrogenic- diabetes insipidus
low sodium and protein diet frequent and double voiding to avoid bladder dilation Thiazide diuretic (HCTZ) Amloride if urine is not reduce enough

Clin med exam 2 (12 decks)

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