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ENDO > PITUITARY > Flashcards

PITUITARY Flashcards

1
Q

What hormones are released from the anterior pituitary?

A

Growth hormone, prolactin, ACTH, TSH, LH, FSH

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2
Q

What hormones are released from the posterior pituitary?

A

arginine Vasopressin (ADH & AVP), oxytocin

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3
Q

What does the hypothalamus do?

A

Releases regulatory hormones, most of which stimulate the release of pituitary hormones

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4
Q

What does dopamine do to prolactin?

A

dopamine inhibits prolactin release

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5
Q

What is hypopituitarism and what causes it?

A

Hormone deficiencies – genetic defects, tumors, autoimmune, stroke, trauma/shock

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6
Q

What happens to LH/FSH in hypopituitarism?

A

Decreased sex hormones

Adolescence = delayed puberty

Adult = loss of secondary sex characteristics, decreased libido, amenorrhea, infertility, and low testosterone/estrogen

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7
Q

What labs might you see with low FSH.LH?

A

Low testosterone & estradiol

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8
Q

If hypopituitarism is congenital, what does it cause?

A

Hypogonadism

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9
Q

What happens to TSH hypopituitarism?

A

decreased thyroid hormone and thus HYPOthyroidism

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10
Q

What are the sxs of hypothyroidism?

A

Weakness, cold intolerance, constipation, skin/hair changes, weight gain, dyslipidemia

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11
Q

What labs might you see in TSH deficiency due to hypopituitarism?

A

Low TSH, Low FT4

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12
Q

What happens to ACTH in hypopituitarism?

A

Decreased cortisol and thus adrenal insufficiency

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13
Q

What are the sxs of adrenal insufficiency?

A

Weakness, fatigue, weight loss, hypotension

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14
Q

What labs might you see with ACTH deficiency?

A

Decreased cortisol, hyponatremia, and hypoglycemia

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15
Q

What happens to growth hormones in hypopituitarism?

A

Adults - Obesity, asthenia, decreased cardiac output

Children – serous growth disturbance

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16
Q

What is it known as when all of the anterior pituitary hormones are lacking?

A

Panhypopituitarism

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17
Q

What is the diagnostic study of choice to R/O any neoplasms of the pituitary or other CNS pathology?

A

MRI

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18
Q

: If there is a tumor on the pituitary gland, how do you treat it?

A

Transphenoidal pituitary surgery – followed by endocrine replacement therapy (L-thyroxin, testosterone or estrogen, cortisol, hGH

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19
Q

What are the 4 forms of diabetes insipidus?

A

Central, primary, secondary, and nephrogenic

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20
Q

What causes central diabetes insipidus?

A

Deficiency of AVP/ADH

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21
Q

What causes primary diabetes insipidus?

A

Often autoimmune; familial/genetic

22
Q

What causes Secondary diabetes insipidus?

A

Damage to pituitary or pituitary stalk via tumor, surgery, or anoxia

23
Q

What causes Nephrogenic diabetes insipidus?

A

Inability of kidneys to respond to ADH; lack ADH receptors; acquired (pyelo, post-obstructive, tubular interstitial); drug induce; hypercalcemia

24
Q

How does someone present with diabetes insipidus & what would you see on labs?

A

INTENSE thirst, polyuria

Labs: serum-hypernatremia, urine – low specific gravity

25
Q

If a patient has polyuria and polydipsia, what other diagnosis might you be thinking of?

A

DM & psychogenic polydipsia

26
Q

How do you confirm diagnosis of DI? How does it work?

A

Vasopressin challenge – desmopressin will result in a dramatic decrease in urine volume

**Use only for central DI!

27
Q

How do you treat central DI?

A

Partial = none other than fluids

Complete = Desmopressin (use lowest effective dose to avoid hyponatremia!)

28
Q

How do you treat nephrogenic DI?

A

Indomethacin

29
Q

If a patient presents with enlargement of hands, jaw, and feet what is this known as?

A

Acromegaly

30
Q

What is acromegaly?

A

When excessive growth hormone is released

31
Q

What causes acromegaly?

A

Almost always from a pituitary adenoma

32
Q

What does the pituitary adenoma often produce along with excessive GH?

A

Prolactin

33
Q

How would the patient present if prolactin & GH are being secreted?

A

Hypogonadism

34
Q

What is specific about the adenoma of gigantism?

A

Develops BEFORE closure of epiphyses

35
Q

What is specific about the adenoma of acromegaly?

A

Develops AFTER closure of epiphyses

36
Q

What are some associated findings of acromegaly?

A

Hypertension, dilated cardiomyopathy, insulin resistance/diabetes

37
Q

Why is it that diabetes occurs with acromegaly?

A

GH counteracts the actions of insulin

38
Q

IF there is lots of GH being released, what would we see a lot of in the body?

A

IGF-I in the liver

39
Q

How elevated would the IGF-I be in acromegaly?

A

5x normal

40
Q

IF we see low TSH/FT4 along with high amounts of IGF-I, what does that mean?

A

Suggests additional pituitary pathology

41
Q

What diagnostic study must we do to confirm acromegaly?

A

MRI

42
Q

How do you treat Acromegaly?

A

Transphenoidal microsurgery

Give octreotide – suppresses GH if it continues to secrete post-op

43
Q

What does prolactin do?

A

Induces lactation during pregnancy

44
Q

What controls prolactin?

A

Always being inhibited by dopamine

45
Q

If a pre-menopausal woman has galactorrhea and oligo/amenorrhea, what should you consider to be a cause?

A

Hyperprolactinemia

46
Q

What causes hyperprolactinemia?

A

Pituitary microadenoma, drugs (SSRI’s & thiazides), hypothyroidism, renal failure, and cirrhosis

47
Q

Why would a patient have oligo/amenorrhea with hyperprolactinemia?

A

Because the excess prolactin suppress GnRH thus, decreasing LH/FSH

48
Q

How would a male present with hyperprolactinemia?

A

Decreased libido, erectile dysfunction, and gynecomastia

49
Q

What would the prolactin level be to be highly suspicious of a prolactinoma?

A

> 250

50
Q

How do you treat hyperprolactinemia?

A

D/C offending drug, microprolactinolmas grow very slowly and patients can be followed without intervention

If large = dopamine agonists then do transphenoidal surgery

ENDO (7 decks)

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