Pituitary Flashcards
Sellar mass typical neuro sxs?
HA
CSF rhinorrhea
Sellar mass typical visual sxs?
(most common sxs of mass)
bitemporal hemianopsis
diplopia
Sellar mass typical hormone sxs?
↓ LH/FSH
↑ prolactin
↑ ACTH
↑ TSH
Hormone hypersecretion labs?
Prolactin (lactotroph adenoma)
IGF1, GH (somatotroph adenoma)
TSH (thyrotropin adenoma)
ACTH, Cortisol, 24 hr urine cortisol (corticotroph adenoma)
Hormone hyposecretion labs?
Same as hyper and:
LH/FSH
Free/Total Testost
Free/Total Estradiol
Vasopressin
Pituitary mass imaging?
MRI w/ and w/o gadolinium
CT for craniopharyngioma or meningioma (calcification more visible)
Prolactin actions? (4)
Stim lactation
Provides sexual gratification
Stim oligodendrocytes (myelin)
Fetal lung surfactant
Prolactin levels highest when?
REM sleep and early a.m.
Also rise w/ exercise, food, sex, surgery
Prolactinoma signs/sxs?
(Excess prolactin)
All: Visual, HA, thyroid dysfxn
Men: ↓ libido, impotence, infert, boobs/milk
Premeno W: infert, cycle dysfxn, milk
Prolactinoma diagnositcs: clinical?
Check for:
Rx interference
Pregnancy
Renal dz
Prolactinoma diagnositcs: labs?
Prolactin levels:
hyperprolactinema = prolactin > 20
adenoma = prolactin > 200
Prolactinoma diagnositcs: imaging?
MRI w/ gadolinium
Prolactinoma tx:
Meds?
Surgery?
Radiation?
Dopamine agonists (Bromocriptine): ↓ size and S/E
Transphenoidal resection:
S/E possible vasopressin dysfxn (SIADH)
Radiation:
for large/refractory tumors
GH synth’d where?
Action?
Highest levels when?
anter pituitary
Stim growth
Stim IGF-1 prdxn
1 hr into sleep
GH release stim’d by? (5)
GHRH Sleep Exercise Protein diet Estradiol
GH release inhibited by? (4)
Neg feedback of GH/IGF1
Somatostatin
Carb diet
Glucocorticoids
GH excess caused by? (3)
1) Somatotroph pituitary adenoma
2) GHRH hypothal tumor
3) Small cell lung CA
GH excess most common when?
40-45 yo
GH excess signs/sxs?
Visual ↑ sweat, oil Sleep apnea HTN, LVH Organomegaly HA, peripheral paresthesia Arthralgia, OA, kyphosis Fatigue, cold intolerance, DM
GH excess labs?
Imaging?
(Best marker for somat adenoma is IGF1, not GH)
Full hormone
CBC, CMP, UA, rheum panel
MRI
GH labs results that EXCLUDE Acromegaly?
GH < 0.4 and normal IGF1
Or
2hr glucose tolerance:
GH levels suppress to < 1 mcg
Acromegaly ↑ risk of what? (5)
Early death Insulin resistance LVH/CHF Colon CA Musculoskeletal issues
Acromegaly tx: Rx?
Somatostatin analogues:
suppress receptors on tumor ->
↓ IGF1
GH receptor agonists
Acromegaly tx:
Surgery?
Radiology?
Most effective for rapid reduction
Best for micro tumors
Gamma Knife:
Not primary therapy
S/E hypopituit
GH deficiency etiology? (5)
Normal w/ aging Pituitary dysfxn Hypothal dysfxn Radiation/surgery Uncontrolled DM
GH deficiency signs/sxs?
Rare to have GH deficiency by itself ->
(U) present w/ signs/sxs of other pituitary issues
GH deficiency labs?
Imaging?
Full hormone
CBC, CMP, insulin, lipids
DEXA (bone scan)
GH deficiency: Next step if initial labs are abnormal?
Confirm dx with:
Arginine-growth hormone-releasing hormone test
GH deficiency tx?
DO NOT treat w/o confirmation of deficiency
Recombinant GH
Hypopituitarism from infiltrate/inflamm caused by?
Sarcoidosis
Amylodosis
Hemochromatosis
Lymphatic hypophysitis
Hypopituitarism from infiltrate/inflamm results in?
↓ GH, GnRH, AVP
Hypopituitarism from infection typically caused by?
TB
Fungus
HIV
Syphilis
Hypopituitarism from infection results in?
↓ in some or all pituitary hormones
Hypopituitarism from vascular disorders caused by?
Pituit Apoplexy:
acute infarct/hemorr/shock damaging gland
Sheehan’s Synd:
Apoplexy from severe blood loss during childbirth
Central Diabetes Insipidus is what type of pituitary disorder?
POSTERIOR Insuff AVP (ADH) prdxn
Central DI signs/sxs?
Dilute urine
High plasma osmolarity
Dehydration
Central DI tx?
Desmopressin
SIADH is what type of pituitary disorder?
POSTERIOR
Excess ADH prdxn
SIADH signs/sxs?
Tx?
Concentrated urine
HypoNa+
surgical
Panhypopituitarism is?
↓ in majority of pituitary hormones
TSH, ACTH, GH, FSH, LH, prolactin
Panhypopituitarism workup?
Full hormone
MRI w/ w/o gadolinium
Stim tests to r/o other dz
Panhypopituitarism tx?
Replace deficient hormones
Ca2+/Vit D bone protection
Hormonal HYPOsecretion is NOT caused by?
Adenoma
Cause is either hypothal or pituitary lesion of some other kind, just not adenoma