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ENDOCRINE > Pituitary > Flashcards

Pituitary Flashcards

1
Q

Gold standard test for Growth hormone deficiency

A

Insulin tolerance test

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2
Q

Normal subjects response to insulin induced hypoglycemia

A

Peak Gh secretions more than 5 ug/L

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3
Q

Definition of severe GHD

A

Peak Gh response to hypoglycemia of less than 3 IG/L

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4
Q

Direct precursor of testosterone

A

Androstenedione

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5
Q

Chiari frommel syndrome

A

Post partum galactorrhea
Amenorrhea
Utero ovarian aropthy

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6
Q

Inhibitors of prolactin

A

Dopamine
Endothelin
Calcitonin
Tgf B2

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7
Q

Gold standard test for GHD

A

GH deficiency

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8
Q

GH replacement dose

A

0.2-0.3 mg/day

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9
Q

When to treat with growth hormone

A

Clinical features if hyposomatotropism
Evoked GH <3 ug/L
IGF 1 low

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10
Q

How to monitor response to GH

A

Measure IGF levels after 1 month
Toteate dose to normalize IGF levels after 1 month
Stop if no clinical reaoinse aft

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11
Q

Adrenal insufficency dx

Serum cortisol morning levels

A

<3 ug/dL suggests acth deficiency

>18 ug/dL normal acth reserve

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12
Q

Normal acth values in am

A

8-25 ng/L

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13
Q

Dynamic testing for acth

A

Hypothalamic ITR
Pituitary CRH or AVP
Adrebal ACTH

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14
Q

How to do insulin tolerance test for ACTH reserve

A

Insulin 0.1-0.15 U/kg IV after an overnight fast
Achieve symptomatic hypoglycemia and glood glucose less than 40
Normal reaponse:
Cortisol more than 20 ug/dL

Venous samples collect 0.,15,30,45,60,90,120
Glucose acth and cortisol

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15
Q

Recommended dose hydrocortisone adrenal steroid replacement

A

15-20 ug/day

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16
Q

Half lifr cortisol

A

Less than 2 hrs

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17
Q

How to test for gonadotropin

A

Single bolus of GnRH 25-100 ug

Evoke LG and FSG within 20-30 mins

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18
Q

GH hormone therapy effect on lipids

A

Improved HDL and chole ratio

No change in Tg

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19
Q

Range of morning plasma ACTHlevels

A

8 to 25 ng/L

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20
Q

Cortisol values as a normal response to hupoglycemia

A

Higher than 20 ug/dL

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21
Q

Mechanism of action Metyrapone

A

Blocks 11 B hydroxylase

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22
Q

An activin binding protein (gnrh) which inhibits activin action by inhibiting activin binding to its receptor

A

Follistatin

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23
Q

Autoimmune inflammatory condition occuring during or shortly after parturition

A

Lymphocytic hypophysis

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24
Q

What is ipilimumab?

A

Antibody that blocks the cytotoxic T lymphocyte antigen 4 which is also expressed by the pituitary

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25
Q

RX lymphophtcytic hypophysis

A

Replace pit deficits spontaneous resolution of inflammatory mass followed

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26
Q

Lab findings in lymphophtcytic hypoglycemia hysis

A

ESR elevated

(+) abx to 49 kda cytosolic protein in 70%

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27
Q

Characteristic for abscess on Mri

A

Isointense central cavity with surrounding ring enhancement

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28
Q

Pituitary mass
(+) vimentiun
S100 protei.
Glial fibrillat acidic protein

A

Pituicytoma

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29
Q

Most common carcinoma that metastasizes to pituitary

A

Breast
Then
Lung, prostate, renal

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30
Q

Features of ipilimumab induced hypophysitis

A 
Central hypothyroidism in 100 
AI In 50-84
Hyponat up to 5O%
Low prolactin 
Low testosterone
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31
Q

Inability to nurse and

Post partum amenorrhea

A

Sheehans syndrome

Pituitary necrosis due to vasopasn due to hupovolemic shock

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32
Q

Gene locus MEN 4

A

CDKN 1B

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33
Q

Female to male ratio of microprolactinpmas

A

20:1

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34
Q

PRL levels steongly suggestive of a MICROPROLACTINOMA

A

> 200 ug/L

Pathognomonic >500

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35
Q

The most common potuitary tumors associated with men 1

A

Prolactinomas

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36
Q

% pf patients with acromegaly with elevated PRL

A

50%

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37
Q

AE of dopamine agonists

A

Heart valve regurgitation

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38
Q

Management of patients with prolactinomas planning pregnancies

A

MACROADENOMA ?
DC bromocriptine
Periodic visual field examinations
Post partum MRI after 6 weeks

MICROADENOMA
Surgery before pregnancy
Ensure bromocriptine sensitivity before pregnancy
Monitoring visual fields expectantly if need bromocriptine resumption
High dose steroids for threatened vision/ adenoma hemprrhage occurs

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39
Q

Anti hypertensives that cause hyperprolactinemia

A

“LVR”
Labetalol
Verapamil
Reserpine

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40
Q

What are the physiologic causes of hyperprolactinemia?

A 
Exercise 
Coitus 
Stress
Sleep 
Suckling 
Pregnancy

ECSSSP

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41
Q

Reason why prolactin is moderately elevated in patients with chronic renal failure and those on HD
Mean 28

A

Decreased glomerular filtratoon rate

This may cause sexual dysfunction

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42
Q

Weight of the adult pituitary

A

600 mg (rang 400-900)

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43
Q

5 distinct hormone secreting cell types in the mature anterior pituitary gland

A 
Corticotroph cells 
Somatotroph cells
Thyrotroph cells
Gonadotroph cells
Lactotroph cells
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44
Q

Blood supply of hypothalamus

A

Superior hypophyseal arteries (branch of ICA)

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45
Q

Blood supply of anterior pituitary gland

A

Long and short hupophyseal portal arteries (from infundibar plexuses and stalk)

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46
Q

Blood supply of posterior pituitary

A

Inferior hypophyseal arteries

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47
Q

Rathke’s pouch formation

A

4-5th week gestation

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48
Q

Where is the pituitary formed from?

A

Anterior - rathke’s puth

Posterior neural ectoderm assoc with 3rd ventricle development

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49
Q

Required tor the initial pouch invagination for pituitary morphoenesis

A

BMP4

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50
Q

When does the anterior pituitary under major cell differentiation?

A

12 wks

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51
Q

When are corticotrophs identifiables

A

6 wks

Somatotroph- 8 wks
Thyrotroph- 12 weeks
Lactotroph-24 weeks

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52
Q

Directs corticotroph cell commitment

A

Tpit protein

53
Q

Determines subsequent developemebt if POUF1F1 and gonadotroph cell lineages

A

PROP1

54
Q

Major determinant of pituitary cell lineage

A

PROP1

55
Q

Corticotrop cell devt occurs earliest and is independent of PROP1 determined lineages. What is a prerequisite for POMC expression

A

T pit protein

56
Q

Effect of VIP and serotonin pn prolactin secretion

A

Stimulates PRL

57
Q

Share a common a subunit expression under developmental control of Gata2

A

TSH

Gonadotropin expressing cells

58
Q

Transfeiption factors

Detemines gonadotroph development

A

SP1 and DAX1

59
Q

Effect of opiates on PRL

A

Acutely induce PRL release

60
Q

Effect of cyproheptadine on PRL

A

Attenuatea noctirnal prl secretion

61
Q

Side effects of pituitary irradiation

A
  • hypopituitarism
  • second brain tumors
  • cerebrovascular doseases
  • visual damage
  • brain necrosis
62
Q

To minimize visual damage what is recommended dose od radiation

A

Less than 200 rads

63
Q

Second brain tumors reported after pituitary irradiation

A

Glioma

64
Q

3 phases of post op diabetes insipidus

A
  1. Transient disorder
  2. Interphase 6-11
  3. 3rd phase return to DI
65
Q

Rathke’s pouch is where thne ___ is derived

A

Anterior and intermiediate lobes of the pituitary

66
Q

Parasellar masses
Locally invasive
From midline notochord remnants
Mucin rich matrix

A

Chordomas

67
Q

Critical neuroectodermal sugnal
Dorsal gradient of pituitary devt
Needed for initial puch invagination

A

BMP4

68
Q

Pituitary stem cell progeniyors that express this marker can regenerate in times of stress

A

Sox 1 and sox 2

69
Q

Rieger syndrome

Mutation in eye umbilicL cord defect in…

A

Pitx2

70
Q

Sequence of hormone loss

Pituitary compression

A

GFLTA

Radiation

GFLAT

71
Q

Stimulates PRL secretion

A

TEVS

TRH
Estrogen
VIP
Serotonin

72
Q

Inhibits prolactin

A 
DECT 
dopamine 
Endothelin 1 
Calciyonin 
TGF B
73
Q

Anti psychotic drug with minimal effect on PRL levels so you may shift to this to rule out drug induced hyperprolactinemia (short of stopping the meds)

A

Olanzapine

74
Q

Hallmarks of pathologic prolactinemia

A

Galactorrhea

Reporxuctive dysfunxction

75
Q

Chiari frommel syndrome

A

Pathologic hyper prolactinemia

Post partim galactorrhe
Amenorrhea
Ureteo ovarian atrophy

76
Q

Time frim discontinuation of nursing continued milk production is abnormal

A

6 months

77
Q

How come 50% of patients with actomegaly have galactorrhea despite normal prolactin levels

A

Human GH is a potent lactogen

78
Q

The most frequent cause of galactorrhea

A

Normoprolactinemic galactorrhea

79
Q

PRL deficiency with central hypothyroidism

A

Immunoglubulin superfamily member 1 defficiency syndrome

80
Q

Side effect CRH stimulation test

Table

A

Flushing

81
Q

Side effect metyrapone test

A

Nausea insomnia adrenal crisis

82
Q

Effect of norepinephrine to GH secretion

A

A adrenergic increases release

B adrenergic inhibits

83
Q

These substances account for GH release during exercise and stress

A

Endorphins and enkephalins

84
Q

These STIF teceptor subtypes mediate GH secretion

A

2 and 5

85
Q

Effect of ghrelin

A

Binds growth hormone secretagogue receptor to release GHRH and pituitary GH

86
Q

70% of GH secretion in its diurnal rhythm occurs when

A

Slow wave sleep

87
Q

The signature property of GH

A

Protein anabolism, reducing urea synthesis and urea secretion

88
Q

Effect of GH on glucose metabolism

A

Insulin like effects: enhanced glucose uptake in cells

Whole body: suppresses glu oxidation while enhancing hepatic glu production

89
Q

Critical factor for corticotroph cell differentiation

A

Tpit

90
Q

Where are corticotrophs clustered

A

Central medial pituitary wedge

91
Q

Weight of pituitary gland

A

600 mg

92
Q

GH uses

A

Osteoporosis

HIV cachexia

93
Q

Melanocortin receptor for melanocyte stimulation

A

MCR1

Mcr2 adrenals
Mcr 3 Nd 4 leptin

94
Q

MOA metyrapone

A

Inhibits adrenal 11 B hydroxylase

95
Q

Most common endocrine deficit encountered with ipilimumab induced hypophysitis

A

Secondary adrenal insuffiency

96
Q

Median onset of ipilimumab induced hupophysitis

A

CTLA4

97
Q

Isolated in prolactinomas

A

PTTG

98
Q

MEN1 gene

A

Chromosome 11q13

99
Q

MEN 4 gene

A

CDKN1B

100
Q

Mutations seen in patients with gigantism

A

AIP mutations

101
Q

Rx DI

A

Vasopressin
Desmopressin
Chlorpropamide
Indomethacin

Not recomended:
Carbamazepine
Clofibrate

102
Q

Natriuretic agents for DI

A

Thiazide
Amiloride
Indapamide

103
Q

Target bp alpha blockadr

A

<120/80 seared

>90 sbp standing

104
Q

Losnsger duration of alpha blockade needed

A

Cathecholamine cardiomyopathy

Cathecholamine induced vasculitis

105
Q

When to start alpha blockade

A

7-10 days pre op

106
Q

When to start beta blocked

A

2-3 days pre op

107
Q

Target HR beta blockade

A

60-80 bpm

108
Q

Anaesthesia to use in pheo

A

Propofol
Etomidate
Barbiturates

109
Q

Inhibits aldosterone

A

Heparin
ANP
Dopamine

“HAD”

110
Q

MC cause of hyperaldosteronism

A

Bilateral idopathic hyperplasia

111
Q

When to test hyperaldo

A 
Hypertension and hypokalemia
Resi hrn 
Icidentaloma and htn 
Onset of HTN at young age <20 
Sever htn >150/100 
Whenever considering secondary HTN
112
Q

Positive result for hyperaldosteronism screening

A

PAC> 15
Renin < 1
20 ratio

113
Q

High renin high aldo

A

Renovascular disease

114
Q

Diff liddle from AME

A

Give amiloride /traimtene (corrects liddle)

115
Q

How to diagnose SAME

A

24 h urine cortisol and cortisone

Increase ratio in the 24h urine

116
Q

Age risk foctors fot DM

A

Unite age over 40

Williams 45

117
Q

prevalence of DM

A
  1. 8% IDF

7. 2% Unite

118
Q

Criteria for diagnosis of atypical pituitary adenomas

A 
Invasion 
Rapid growth 
Recurrenc 
Diameter more than 4 cn
Resistance to medical therapy
Carcinoma, if extracranial metastasis
119
Q

WHO 2004 diagnosis attpical adrenocorticotrophic hormone

A 
Aggressive invasive 
Pleomorphic 
Increased mitotic activity 
Ki 67 >3%
P53 immunoreactivity
120
Q

Genes assic wifh familial pituitary tumor syndromes

A

Men1
Men4
Carney complex
Familial isolated pit adenomas

121
Q

Used to treat aggresisve pituitrytumors that failed to respond to other therapy or if with evidence of carcinoma

A

Temozolomide

122
Q

Interferes with drug efficacy of temozolomide

A

O MGMT

123
Q

Radiation Dose for irradiation pituitary mass

A

Max 5000 rads

180 rad 5-6 weeks

124
Q

Indications for pituitary ireadiation

A 
P242 
Adjuvant to surgical therapy
1) pit adenoma
2) craniopharyngioma
3) nelson syndrome
4) nonadenomatous sellar mass
5) tumor recurrence 
6) hormone hypersecretion recurrence
125
Q

Second brain tumors implicated post pituitary irradiation

A

Gliomas

Astrocytonas

126
Q

Acromegaly treatment which emgances insulin sensitivity hence suited for patients with co existing diabetes

A

Pegvisomant

127
Q

Marker of responsiveness to pegvisomant

A

IGF-1

Because action is on peripheral receptor and levels of GH rise as IGF1 negative feedback is lost

128
Q

Monitoring of patients on pegvisomant

A

Hepatic transaminases every 6 mos

Monitoring tumor growth

ENDOCRINE (12 decks)

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