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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
Q

Negative feedback vs positive feedback

A

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
Q

Cushing’s disease

A

increased adrenocorticotropic (ACTH) hormone secretion (–> end up with too much cortisol= regulates bodies response to stress)

27
Q

Cushing’s disease- signs and symptoms

A

Signs-
thin skin, striae/bruising, central obesity, moon facies, plethora, glucose intolerance, neutrophilia, lymphocytopenia, eosinopenia

symptoms-
labile mood, weakness, hirsutism, decrease in libido

28
Q

Cushing’s disease- morbidity

A

diabetes mellitus
cardiac disease
osteoporosis

29
Q

Cushing’s disease- dx

A

AM cortisol, ACTH, etc cortisols

30
Q

Cushing’s disease is different from ?

A

Cushing’s syndrome (primary)

disease is secondary

31
Q

Hyperthyroidism

A

excessive TSH

32
Q

Hyperthyroidism dx

A

measure tsh,

33
Q

Neurological symptoms are more common in

A

nonfunctioning adenomas or gonadotroph adenomas compared to functioning pituitary lesions

includes headaches and vision changes

34
Q

Imaging for pituitary mass suspicion?

A

MRi with and without contrast

done with and without gadolinium enhancement

35
Q

Craniopharyngiomas

A

benign tumor

lesion can behave like a malignant lesion with recurrences and “metastases”

36
Q

Craniopharyngiomas- symptoms

A 
visual 
headaches 
sexual dysfunction- men
amenorrhea- women 
growth failure- children
37
Q

Craniopharyngiomas- dx

A

MRI and or CT- calcifications and cysts often seen

38
Q

Craniopharyngiomas - tx

A

surgical resection +/- rad therapy

39
Q

Rathke’s cleft cyst

A

benign cysts

variable course

40
Q

Causes of hypopituitarism

A

acquired from compression due to tumors, inflammation, or vascular damage (stroke, hemorrhage)

also hypothalamus

41
Q

Symptoms of hypopituitarism

A

develop gradually, often overlooked

long list slide 40

in children- stunted growth, slowed sexual development

42
Q

Anterior hypopituitarism

A 
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
Q

Hypopituitarism secondary to mass lesions

A

lesions to hypothalamus, pituitary stalk, or pituitary

44
Q

Pituitary can sometimes be a part of ?

vs. sporadic

A

multiple endocrine neoplasia type 1
usually release prolactin
more aggressive than sporadic adenomas

45
Q

Sheehan syndrome

A

hypopituitarism caused by postpartum pituitary necrosis

infarction of pituitary gland after severe postpartum hemorrhage

46
Q

Lymphocytic hypophysitis

When does it occur?

A

lymphocytes infiltrate and enlarge the pituitary which causes a destruction of pituitary cells

in late pregnancy or postpartum period

47
Q

Pituitary apoplexy

A

sudden hemorrhage into the pituitary gland

can occur in a pituitary adenoma

48
Q

Pituitary apoplexy signs and symptoms

A

severe headache, diplopia, acute development of hypopituitarism

EMERGENT! can lead to CNS hemorrhage, shock and death

49
Q

Pituitary apoplexy tx

A

Surgical decomposition of pituitary

50
Q

Sheehan syndrome can lead to

A

panhypopituitarism or partial hypopituitarism

51
Q

Hypopituitarism without mass lesion

A

congenital hypopituitarism

cranial radiation

pituitary surgery

encephalitis

hemochromatosis

autoimmunity

coronary artery bypass grafting (CABG)

52
Q

TBI and hypopituitarism

A

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
Q

Empty sella syndrome

A

benign- accidental finding

have normal pituitary function (surrounding rum tissue is functional)

hypopituitarism may develop insidiously

54
Q

Pituitary masses and empty sella

A

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
Q

Diabetes Insipidus

A

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
Q

Central- diabetes insipidus

A

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
Q

Nephrogenic- diabetes insipidus

A

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
Q

diabetes insipidus - signs and symptoms

A

polyuria (peeing a lot)
nocturia
polydipsia
dilute urine

acute: 
altered mental status 
irritability 
hyperreflexia 
spasticity
59
Q

diabetes insipidus - labs and assessment

A 
24 hour urine collection for volume 
serum electrolytes 
plasma ADH level 
urine osmolality and specific gravity, plasma osmolality 
water deprivation test 
MRI
60
Q

Central- diabetes insipidus - tx

A

low sodium and protein diet
desmopressin (dDAVP)- an ADH analog for hormone replacement
thiazide diuretics

61
Q

Nephrogenic- diabetes insipidus

A

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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