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Endocrine Fellowship Board Review > Pituitary > Flashcards

Pituitary Flashcards

1
Q

most common types of pituitary adenomas

A

1 - prolactinoma

2 - nonfunctional gonadotroph adenoma

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2
Q

incidence of central DI in pituitary adenomas

A

essentially zero

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3
Q

pituitary lesion with DI should raise concern for what

A

metastatic lesion
craniopharyngioma
hypophysitis
sarciodosis

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4
Q

postpartum female with agalactia, fatigue

A

Sheehan syndrome

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5
Q

T value below this should prompt MRI pituitary central hypogonadism

A

< 150 pg/dL

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6
Q

typical order of pituitary hormone deficiency after cranial irradiation

A

GH
FSH/LH
ACTH
TSH

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7
Q

cause of Sheehan syndrome

A

typically massive uterine hemorrhage/hypovolemia

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8
Q

treatment of pituitary apoplexy

A

empiric hydrocortisone

neurosurgical consult

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9
Q

cause of empty sella syndrome

A

intrasellar herniation of the suprasellar subarachnoid space with compression of the pituitary gland producing a remodeling of the sella

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10
Q

cause of mild prolactin elevation in empty sella syndrome

A

stalk stretching

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11
Q

functional causes of pituitary insufficiency

A 
exogenous steroids
exogenous testosterone
hypothalamic amenorrhea due to exercise, anorexia
critical illness
opiates
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12
Q

antiepileptics increase catabolism of which steroids?

A

dexamethasone/prednisone > hydrocortisone

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13
Q

immunohistochemical staining for corticotroph tumors

A

T-Pit

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14
Q

immunohistochemical staining for gonadotroph tumors

A

SF-1

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15
Q

immunohistochemical staining for thyrotrophs, somatotrophs, and lactotroph tumors

A

Pit-1

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16
Q

what is the significance of silent or plurihormonal pituitary tumors?

A

aggressive behavior
invasive
high rates of recurrence
can progress to functional tumors over time

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17
Q

are pituitary tumors heritable

A

< 5% are heritable
MEN1, MEN4
FIPA
Succinate dehydrogenase mutations (SDH)

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18
Q

conditions that can cause “pseudotumor” of the pituitary gland

A

severe hypothyroidism
puberty
pregnancy

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19
Q

medical therapy for nonfunctional adenomas

A

cabergoline

Not FDA approved but some studies that show it may be beneficial

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20
Q

rate of growth of pituitary adenomas

A

typically 1-2mm per year

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21
Q

in what percentage of patients with pituitary insufficiency related to NFA will there be improvement or normalization of pituitary hormone function postoperatively?

A

15-30%

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22
Q

how long after surgery to re-test pituitary function?

A

6-12 weeks

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23
Q

equivalent doses of subq/IV, nasal, and oral desmopressin

A

1mcg
10mcg
100mcg

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24
Q

most common sodium abnormality after pituitary surgery

A

SIADH

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25
Q

management of postoperative DI

A 
free water (by mouth if thirst mechanism intact)
PRN desmopressin (usually transient)
rarely permanent - if so, will need to go home on desmopressin
26
Q

nadir of SIADH post surgery

A

5-9 days

27
Q

fluid restriction instructions for post pituitary surgery patients on discharge

A

1-1.5L of fluids/day

sodium level in 7 days

28
Q

ddx of post TSS hyponatremia

A

SIADH
hypothyroidism
adrenal insufficiency

29
Q

typical pattern of pituitary hormone deficiency

A 
GH
FSH/LH
TSH
ACTH
Prolactin
30
Q

how common are pituitary carcinomas

A

extremely rare. < 0.2% or pituitary carcinomas

31
Q

most common manifestation of pituitary metastatic disease

A

DI

32
Q

only pituitary hormone primarily regulated by negative feedback

A

prolactin (constant negative feedback via dopamine)

33
Q

effect of estrogen on prolactin level

A

increases

34
Q

physiologic states with elevated prolactin

A

pregnancy, lactation

stress, exercise, nipple stimulation

35
Q

how high can prolactin levels go in pregnancy

A

200-300 ng/mL

36
Q

definition of galactorrhea

A

discharge of milk from the breast not associated with pregnancy or lactation

37
Q

can cabergoline be used in pregnancy

A

probably safe, but stop if possible

38
Q

when to re-image macroprolactinoma after starting cabergoline

A

3 months

39
Q

how long for prolactin to normalize on dopamine agonist therapy?

A

weeks-months

40
Q

how long is medical therapy required for prolactinomas?

A

usually lifelong, but can try to stop as ~20% of patients will be cured

41
Q

rhinorrhea in a pt with macroprolactinoma after starting on cabergoline

A

CSF leak from rapid shrinkage

42
Q

indications for surgery on macroprolactinoma

A

intolerance to medical therapy
unresponsive to medical therapy
young female desiring pregnancy (to avoid medical therapy while pregnant)

43
Q

normal function of GH in children and adults

A

children - linear growth

adults - metabolic effects

44
Q

does GH directly affect peripheral tissues?

A

Very little. Most effects are mediated thru IGF-1.

45
Q

single biggest clue in examining a patient suspected of having acromegaly?

A

old photographs

46
Q

metabolic effects of acromegaly

A 
HTN
DM
cardiomyopathy
OSA
30% higher mortality rate
47
Q

which pituitary hormones are glycoproteins

A

FSH
LH
TSH

48
Q

Ddx for transient increase in serum T4 and normal/elevated TSH

A

Took Lt4 right before lab test (noncompliant)
other meds (amiodarone, amphetamines, heparin, NSAIDS)
Acute psychiatric illness
Acute liver disease

49
Q

Ddx for patients with permanent increase in serum T4 and normal/elevated TSH

A 
TSHoma
thyroid hormone resistance
HAMA antibodies (heterophile antibodies)
FDH (familial dysalbuminemic hyperthyroidism)
excessive TBG
50
Q

how to differentiate between TSHoma and resistance to thyroid hormone

A

elevated alpha subunit - TSHoma
elevated SHBG - TSHoma
T3 suppression test - TSHoma won’t suppress

51
Q

treatment of choice for TSHoma

A

surgery

52
Q

medical therapies for TSHoma

A

octreotide

thionamides/bblockers preoperatively

53
Q

what can happen to the pituitary gland in longstanding hypothyroidsm

A

pseudotumor due to pituitary hyperplasia

54
Q

is thyroid hormone resistance typically de novo or hereditary

A

hereditary, autosomal dominant

55
Q

in functional pituitary gonadotropinomas, is the FSH or LH typically higher

A

FSH

56
Q

which pituitary hormones are commonly elevated in ESRD patients

A

prolactin (avg 65 ng/mL, range 48-195)

GH (increased peripheral tissue resistance)

57
Q

pt with panhypopit is started on GH. Free t4 concentration drops. Reason?

A

GH increased conversion from T4 to T3.

58
Q

effect of testosterone supplementation on TBG

A

decreased TBG (and subsequent increase in free t4)

59
Q

female with panhypopit on oral estradiol and GH who wants to change to transdermal estradiol. what to do with GH dose?

A

decrease by 50%. women on oral e2 require 2-3x dose of GH replacement, so changing to transdermal requires dose reduction

60
Q

female pt with hx of metastatic breast ca who presents with adrenal crisis and then gets hypotensive with brisk UOP after steroid replacement. Cause?

A

unmasking of central DI after starting on glucocorticoids

Endocrine Fellowship Board Review (11 decks)

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