Pituitary Flashcards
What are the signs/symptoms of acromegaly?
Protruding jaw (teeth start to spread)
Frontal bossing (neanderthal forehead)
Large hands and feet
Macroglossia
What are the signs/symptoms of hyperprolatinemia?
Changes in the menstrual cycle Galactorrhea Anovulation Decreased libido (men) Delayed puberty
Differential diagnosis hyperprolactinemia?
Hypothalamus: mass, infiltrate, stalk issue, drugs
Pituitary: prolactinoma, mass, hypothyroid
Ectopic (rare)
Breast: chest wall irritation
Physiologic: Pregnancy, stress, peak of pulsatile secretion
Disease: renal, liver
Clinical features of Cushing’s disease?
Muscle loss Purple striae Fat pad Moon face DM mood
Clinical features of pituitary mass?
Upwards expansion:
headaches (meninges)
vision changes (optic chiasm)
Lateral expansion:
Cranial nerve 3, 4, 6 palsies
Downwards expansion:
Post nasal drip (leaky!)
Causes of hypopituitarism?
Traumatic brain injury (Stalk shears)
Pituitary destruction* tumor, radiation
Congenital disorder
Most common type of pituitary mass?
Adenoma (can be SECRETING or NOT)
Suppression test for GH?
OGTT
Therapy acromegaly?
Surgery
Radiotherapy
Somatostatin analogue
GH receptor antagonist
When is GH highest?
During sleep- spikes (so random measurements are not useful)
When is cortisol’s peak/nadir?
In the morning, at midnight
How to asses GH secretion?
Stimualation: ITT, glucagon, GNRH
Suppression: oral glucose,
Complications acromegaly
Cardiovascular disease Arthritis Insulin resistance Sleep apnea Cancer (colon)
What stimulates GH?
Fasting
Deep sleep
Hypoglycemia
Amino acids
What suppresses GH?
Hyperglycemia, obesity, hypothyroid, igf-1
