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Q3 Clin Med II Final (Endocrine) > Pituitary > Flashcards

Pituitary Flashcards

1
Q

Sellar mass typical neuro sxs?

A

HA

CSF rhinorrhea

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2
Q

Sellar mass typical visual sxs?

A

(most common sxs of mass)
bitemporal hemianopsis
diplopia

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3
Q

Sellar mass typical hormone sxs?

A

↓ LH/FSH
↑ prolactin
↑ ACTH
↑ TSH

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4
Q

Hormone hypersecretion labs?

A

Prolactin (lactotroph adenoma)

IGF1, GH (somatotroph adenoma)

TSH (thyrotropin adenoma)

ACTH, Cortisol, 24 hr urine cortisol (corticotroph adenoma)

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5
Q

Hormone hyposecretion labs?

A

Same as hyper and:

LH/FSH
Free/Total Testost
Free/Total Estradiol
Vasopressin

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6
Q

Pituitary mass imaging?

A

MRI w/ and w/o gadolinium

CT for craniopharyngioma or meningioma (calcification more visible)

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7
Q

Prolactin actions? (4)

A

Stim lactation
Provides sexual gratification
Stim oligodendrocytes (myelin)
Fetal lung surfactant

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8
Q

Prolactin levels highest when?

A

REM sleep and early a.m.

Also rise w/ exercise, food, sex, surgery

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9
Q

Prolactinoma signs/sxs?

A

(Excess prolactin)

All: Visual, HA, thyroid dysfxn

Men: ↓ libido, impotence, infert, boobs/milk

Premeno W: infert, cycle dysfxn, milk

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10
Q

Prolactinoma diagnositcs: clinical?

A

Check for:
Rx interference
Pregnancy
Renal dz

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11
Q

Prolactinoma diagnositcs: labs?

A

Prolactin levels:
hyperprolactinema = prolactin > 20
adenoma = prolactin > 200

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12
Q

Prolactinoma diagnositcs: imaging?

A

MRI w/ gadolinium

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13
Q

Prolactinoma tx:

Meds?

Surgery?

Radiation?

A 
Dopamine agonists (Bromocriptine):
↓ size and S/E

Transphenoidal resection:
S/E possible vasopressin dysfxn (SIADH)

Radiation:
for large/refractory tumors

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14
Q

GH synth’d where?

Action?

Highest levels when?

A

anter pituitary

Stim growth
Stim IGF-1 prdxn

1 hr into sleep

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15
Q

GH release stim’d by? (5)

A 
GHRH
Sleep
Exercise
Protein diet
Estradiol
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16
Q

GH release inhibited by? (4)

A

Neg feedback of GH/IGF1
Somatostatin
Carb diet
Glucocorticoids

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17
Q

GH excess caused by? (3)

A

1) Somatotroph pituitary adenoma
2) GHRH hypothal tumor
3) Small cell lung CA

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18
Q

GH excess most common when?

A

40-45 yo

19
Q

GH excess signs/sxs?

A 
Visual
↑ sweat, oil
Sleep apnea
HTN, LVH
Organomegaly
HA, peripheral paresthesia
Arthralgia, OA, kyphosis
Fatigue, cold intolerance, DM
20
Q

GH excess labs?

Imaging?

A

(Best marker for somat adenoma is IGF1, not GH)

Full hormone
CBC, CMP, UA, rheum panel

MRI

21
Q

GH labs results that EXCLUDE Acromegaly?

A

GH < 0.4 and normal IGF1

Or

2hr glucose tolerance:
GH levels suppress to < 1 mcg

22
Q

Acromegaly ↑ risk of what? (5)

A 
Early death
Insulin resistance
LVH/CHF
Colon CA
Musculoskeletal issues
23
Q

Acromegaly tx: Rx?

A

Somatostatin analogues:
suppress receptors on tumor ->
↓ IGF1

GH receptor agonists

24
Q

Acromegaly tx:

Surgery?

Radiology?

A

Most effective for rapid reduction
Best for micro tumors

Gamma Knife:
Not primary therapy
S/E hypopituit

25
Q

GH deficiency etiology? (5)

A 
Normal w/ aging
Pituitary dysfxn
Hypothal dysfxn
Radiation/surgery
Uncontrolled DM
26
Q

GH deficiency signs/sxs?

A

Rare to have GH deficiency by itself ->

(U) present w/ signs/sxs of other pituitary issues

27
Q

GH deficiency labs?

Imaging?

A

Full hormone
CBC, CMP, insulin, lipids

DEXA (bone scan)

28
Q

GH deficiency: Next step if initial labs are abnormal?

A

Confirm dx with:

Arginine-growth hormone-releasing hormone test

29
Q

GH deficiency tx?

A

DO NOT treat w/o confirmation of deficiency

Recombinant GH

30
Q

Hypopituitarism from infiltrate/inflamm caused by?

A

Sarcoidosis
Amylodosis
Hemochromatosis
Lymphatic hypophysitis

31
Q

Hypopituitarism from infiltrate/inflamm results in?

A

↓ GH, GnRH, AVP

32
Q

Hypopituitarism from infection typically caused by?

A

TB
Fungus
HIV
Syphilis

33
Q

Hypopituitarism from infection results in?

A

↓ in some or all pituitary hormones

34
Q

Hypopituitarism from vascular disorders caused by?

A

Pituit Apoplexy:
acute infarct/hemorr/shock damaging gland

Sheehan’s Synd:
Apoplexy from severe blood loss during childbirth

35
Q

Central Diabetes Insipidus is what type of pituitary disorder?

A 
POSTERIOR
Insuff AVP (ADH) prdxn
36
Q

Central DI signs/sxs?

A

Dilute urine
High plasma osmolarity
Dehydration

37
Q

Central DI tx?

A

Desmopressin

38
Q

SIADH is what type of pituitary disorder?

A

POSTERIOR

Excess ADH prdxn

39
Q

SIADH signs/sxs?

Tx?

A

Concentrated urine
HypoNa+

surgical

40
Q

Panhypopituitarism is?

A

↓ in majority of pituitary hormones

TSH, ACTH, GH, FSH, LH, prolactin

41
Q

Panhypopituitarism workup?

A

Full hormone
MRI w/ w/o gadolinium
Stim tests to r/o other dz

42
Q

Panhypopituitarism tx?

A

Replace deficient hormones

Ca2+/Vit D bone protection

43
Q

Hormonal HYPOsecretion is NOT caused by?

A

Adenoma

Cause is either hypothal or pituitary lesion of some other kind, just not adenoma

Q3 Clin Med II Final (Endocrine) (6 decks)

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