PITUITARY

Question 1

What hormones are released from the anterior pituitary?

Answer 1

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

Question 2

What hormones are released from the posterior pituitary?

Answer 2

arginine Vasopressin (ADH & AVP), oxytocin

Question 3

What does the hypothalamus do?

Answer 3

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

Question 4

What does dopamine do to prolactin?

Answer 4

dopamine inhibits prolactin release

Question 5

What is hypopituitarism and what causes it?

Answer 5

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

Question 6

What happens to LH/FSH in hypopituitarism?

Answer 6

Decreased sex hormones

Adolescence = delayed puberty

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

Question 7

What labs might you see with low FSH.LH?

Answer 7

Low testosterone & estradiol

Question 8

If hypopituitarism is congenital, what does it cause?

Answer 8

Hypogonadism

Question 9

What happens to TSH hypopituitarism?

Answer 9

decreased thyroid hormone and thus HYPOthyroidism

Question 10

What are the sxs of hypothyroidism?

Answer 10

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

Question 11

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

Answer 11

Low TSH, Low FT4

Question 12

What happens to ACTH in hypopituitarism?

Answer 12

Decreased cortisol and thus adrenal insufficiency

Question 13

What are the sxs of adrenal insufficiency?

Answer 13

Weakness, fatigue, weight loss, hypotension

Question 14

What labs might you see with ACTH deficiency?

Answer 14

Decreased cortisol, hyponatremia, and hypoglycemia

Question 15

What happens to growth hormones in hypopituitarism?

Answer 15

Adults - Obesity, asthenia, decreased cardiac output

Children – serous growth disturbance

Question 16

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

Answer 16

Panhypopituitarism

Question 17

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

Answer 17

MRI

Question 18

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

Answer 18

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

Question 19

What are the 4 forms of diabetes insipidus?

Answer 19

Central, primary, secondary, and nephrogenic

Question 20

What causes central diabetes insipidus?

Answer 20

Deficiency of AVP/ADH

Question 21

What causes primary diabetes insipidus?

Answer 21

Often autoimmune; familial/genetic

Question 22

What causes Secondary diabetes insipidus?

Answer 22

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

Question 23

What causes Nephrogenic diabetes insipidus?

Answer 23

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

Question 24

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

Answer 24

INTENSE thirst, polyuria

Labs: serum-hypernatremia, urine – low specific gravity

Question 25

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

Answer 25

DM & psychogenic polydipsia

Question 26

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

Answer 26

Vasopressin challenge – desmopressin will result in a dramatic decrease in urine volume **Use only for central DI!

Question 27

How do you treat central DI?

Answer 27

Partial = none other than fluids Complete = Desmopressin (use lowest effective dose to avoid hyponatremia!)

Question 28

How do you treat nephrogenic DI?

Answer 28

Indomethacin

Question 29

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

Answer 29

Acromegaly

Question 30

What is acromegaly?

Answer 30

When excessive growth hormone is released

Question 31

What causes acromegaly?

Answer 31

Almost always from a pituitary adenoma

Question 32

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

Answer 32

Prolactin

Question 33

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

Answer 33

Hypogonadism

Question 34

What is specific about the adenoma of gigantism?

Answer 34

Develops BEFORE closure of epiphyses

Question 35

What is specific about the adenoma of acromegaly?

Answer 35

Develops AFTER closure of epiphyses

Question 36

What are some associated findings of acromegaly?

Answer 36

Hypertension, dilated cardiomyopathy, insulin resistance/diabetes

Question 37

Why is it that diabetes occurs with acromegaly?

Answer 37

GH counteracts the actions of insulin

Question 38

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

Answer 38

IGF-I in the liver

Question 39

How elevated would the IGF-I be in acromegaly?

Answer 39

5x normal

Question 40

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

Answer 40

Suggests additional pituitary pathology

Question 41

What diagnostic study must we do to confirm acromegaly?

Answer 41

MRI

Question 42

How do you treat Acromegaly?

Answer 42

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

Question 43

What does prolactin do?

Answer 43

Induces lactation during pregnancy

Question 44

What controls prolactin?

Answer 44

Always being inhibited by dopamine

Question 45

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

Answer 45

Hyperprolactinemia

Question 46

What causes hyperprolactinemia?

Answer 46

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

Question 47

Why would a patient have oligo/amenorrhea with hyperprolactinemia?

Answer 47

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

Question 48

How would a male present with hyperprolactinemia?

Answer 48

Decreased libido, erectile dysfunction, and gynecomastia

Question 49

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

Answer 49

>250

Question 50

How do you treat hyperprolactinemia?

Answer 50

D/C offending drug, microprolactinolmas grow very slowly and patients can be followed without intervention If large = dopamine agonists then do transphenoidal surgery