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ClinMed exam III > Pituitary > Flashcards

Pituitary Flashcards

1
Q

How do exocrine glands secrete substances

A

via ducts

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2
Q

How do endocrine glands secrete substances

A

through the cells and rich capillary system

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3
Q

What control the anterior pituitary

A

hypothalamus

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4
Q

What is the best imaging to see the pituitary gland

A

MRI

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5
Q

What is the pituitary close to in the brain

A
  • optic chiasm
  • cranical nerves III,IV, VI
  • trigeminal ganglion
  • ophthalmic division V
  • carotid artery
  • cerebral circulation
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6
Q

What hormones does the anterior pituitary produce

A
  • GH
  • prolactin
  • ACTH
  • TSH
  • LH
  • FHS
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7
Q

What hormones are stored in the posterior pituitary

A
  • ADH

- oxytocin

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8
Q

What does somatostatin inhibit

A

growth hormone release

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9
Q

What does dopamine inhibit

A

prolactin release

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10
Q

What is a pituitary ademona? two types?

A

benign mass of the pituitary gland

can be functional or nonfunctional

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11
Q

What are the malignant masses of the pituitary gland

A
  • germ cell tumor
  • sarcoma
  • chordoma
  • pituitary carcinoma
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12
Q

What are the cell types of pituitary adenomas

A
  • gonadotroph
  • thyrotroph
  • corticotroph
  • lactrotroph
  • somatotroph
  • lactrotroph/somatotroph
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13
Q

What is the most common cell type in pituitary adenomas

A

lactotroph

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14
Q

Which disease/disorder does each pituitary adenoma cell type cause

A
  • gonadotroph: clinically nonfunctioning
  • thyrotroph: hyperthyroidism
  • lactotroph: hyperprolactenemia
  • corticotroph: Cushing’s disease
  • somatotroph: acromegaly
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15
Q

What genes may play a role in pituitary adenomas

A
  • MEN1
  • GS aplha
  • PTTG
  • FGF receptor 4
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16
Q

What are the signs and symptoms of pituitary adenomas

A
  • neurologic sx (visual changes, headache, CFS rhinorrhea)

- hormonal abnormlaities

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17
Q

Why do people usually seek medical attention for pituitary adenomas

A

visual changes (bitemporal hemianopia)

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18
Q

What is pituitary apoplexy

A

infarct or hemorrhage into the ademona

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19
Q

What are the symptoms of pituitary apoplexy

A
  • severe, acute onset of headache
  • vomiting
  • visual field defects
  • other cranial nerve dysfunction
  • fever, neck stiffness
  • AMS
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20
Q

What lab do you check for a lactotroph

A

serum prolactin

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21
Q

What lab do you check for a somatotroph

A

IGF-1

22
Q

What labs do you check for corticotroph

A

24 hr urinary free cortisol and elevated ACTH

23
Q

What labs do you check for thyrotroph adenoma

A
  • alpha subunit
  • T4
  • TSH
24
Q

What labs do you check for gonadotroph

A
  • luteinizing hormone

- follicle stimulating hormone

25
Q

What do you do if you find an incidentaloma >10mm

A

typical hormone evaluation

26
Q

What do you do if you find an incidentaloma <10 mm

A
  • only measure serum prolactin

- MRI at 6 months and 12 months

27
Q

Treatment goals for nonfunctioning pituitary adenomas

A
  • relief of visual impairment and neurologic sx
  • removal of macroadenomas to avoid recurrance
  • management of hormonal deficiencies
28
Q

Treatment for pituitary adenoma

A
  • surgical
  • medical
  • adjuvant radiation
29
Q

What postoperative hormone deficiency are present after adenoma removal

A
  • hypocortisolism

- diabetes insipidus or SIADH

30
Q

Physiological causes of hyperprolactinemia

A
  • sleep
  • physical exertion
  • food
  • stress/trauma
  • sex
  • pregnancy/post partum
  • nursing/nipple stimulation
  • surgery
31
Q

Causes of hyperprolactinemia

A
  • prolactinoma
  • acromegaly
  • primary hypothyroidism
  • seizures
  • PCOS
  • neurogenic causes
  • renal insufficiency
  • cirrhosis
32
Q

What drugs can induce hyperprolactinemia

A
  • ranitidine
  • cocaine/amphetamines
  • metoclopramide
  • opiods
  • risperidone
  • SSRIs
  • verapamil
  • hydroxyzine
33
Q

Are prolactinomas usually macro or micro

A

MICRO

34
Q

What is associated with prolactinomas

A

MEN1

35
Q

Clinical manifestation of hyperprolactemia

A
  • galactorrhea
  • infertility
  • osteopenia
  • decreased libido
  • gynecomastia in men
36
Q

What do you need for diagnosis of a prolactinoma

A
  • significantly elevated serum prolactin level

- MRI with a pituitary lesions

37
Q

Labs to order for hyperprolactemia evaluation

A
  • prolactin
  • TFTS
  • LFTs
  • Ca
  • Cre/BUN
  • HCG
  • IGF 1 (mixed adenoma)
38
Q

When wold you treat a prolactinoma

A
  • tumor growth
  • oligo or amenorrhea/ hypogonadism
  • bothersome galactorrhea
  • infertility
39
Q

Treatment of prolactinomas

A 
-Dopamine agonist (first choice)
      carbergoline- 1st choice
      bromocriptine for pregnancy
-surgery
-radiation
40
Q

When is surgery indicated for a prolactinoma

A
  • visual field defects unresponsive to medical therapy
  • macroadenomas unresponsive to medical therapy
  • tumor growth while on medical therapy
  • intolerance to medical therapy
  • pituitary apoplexy
  • CSF rhinorrhea

-

41
Q

Presentation of acromegaly

A
  • prognathism
  • headaches
  • vision defects
  • skin tags
  • ennlarged tongue
  • frontal bossing
  • coarse features (acral enlargement)
  • enlarged hands and feet
  • osteoarthritis
  • carpal tunnel
42
Q

What are comorbidities with acromegaly

A
  • HTN/ heart disease
  • CVA
  • headache
  • arthritis
  • insulin resistant diabetes
  • sleep apnea
43
Q

Baseline evaluation labs for acromegaly

A
  • IGF 1
  • pituitary function test (if macro)
  • PRL
  • glucose
  • LFTs
  • Cr/BUN
  • MRI
  • visual field
44
Q

Medical treatment for acromegaly

A
  • somatostatin analogs (octerotide, lanreotide)
  • dopamine agonists (bromocriptine, cabergoline)
  • GH receptor antagonist (pegvisomant)
45
Q

Where do metastatic pituitary tumors come from

A

breast cancer in women

lung cancer in men

46
Q

Where does a pituicytoma arise

A

posterior pituitary

47
Q

How does a pituicytoma present

A

sellar mass, often mistaken for a pituitary adenoma but there is no hormone secretion

48
Q

Signs and symptoms of germ cell tumors

A
  • headache
  • N/V
  • lethargy
  • diplopia
  • hypopituitary
  • diabetes insipidus
  • Parinaud’s syndrome
49
Q

What is Parinaud’s syndrome

A

paralysis of disconjugate gaze seen in germ cell tumors

50
Q

Where do germ cell tumors arise

A

third ventricle

51
Q

Signs and symptoms of chordomas

A
  • headache
  • visual impairment
  • anterior pituitary hormonal def
52
Q

Symptoms of metastatic disease to pituitary

A
  • diabetes insipidus
  • visual field defects
  • anterior pituitary hormonal def
  • retroorbital pain and ophthalmoplegia

ClinMed exam III (7 decks)

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