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ENRP Exam 2 > Pituitary > Flashcards

Pituitary Flashcards

1
Q

most common form of primary endocrine hyperfunction

A

neoplasia!!

*except thyroid

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2
Q

pituitary embryologic origin

A

Rathkes pouch

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3
Q

posterior pituitary histo

A 
axonal neurons
supportive pituicytes (neuroglial cells)
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4
Q

anterior pituitary histo

A

acidophils (GH, prolactin)
basophils (TSH, LH/FSH, ACTH)
chromophobe

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5
Q

mass effect of pituitary lesions

A 
increased ICP resulting in:
headaches
N/V
HTN
bradycardia
resp depression
papilledema
bilateral temporal hemianopsia
pituitary apoplexy (hemorrhage)
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6
Q

types of pituitary adenomas

A

non-functional - cause mass effect

functional - cause hormone excess

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7
Q

most common functional pituitary adenoma

A

lactotroph adenoma/prolactinoma

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8
Q

prolactinoma presentation in females

A 
menstrual irregularities
galactorrhea
diminished libido
infertility
mass effect
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9
Q

prolactinoma presentation in males

A

decreased libido
decreased sperm count
mass effect

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10
Q

classification of prolactinomas

A

sparsely granulated - most common

densely granulated - rare

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11
Q

histo progression of prolactinomas

A

stromal hyalinization with psammoma bodies

dense calcifications = pituitary stone

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12
Q

prolactinoma tx

A

dopamine agonists - bromocriptine, cabergoline

surgery

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13
Q

causes of hyperprolactinemia in absence of adenoma

A 
pregnancy
lactation
loss of dopamine (damage or drugs)
renal failure
hypothyroidism
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14
Q

somatotroph adenoma presentation

A

gigantism (children)

acromegaly (adults)

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15
Q

features of acromegaly

A 
enlargement of face and hands
protruding jaw
enlarged nose
thickened lips
joint pain/limited mobility
enlarged viscera
cardio complications shorten lifespan
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16
Q

acromegaly diagnostic testing

A

get serum IGF-1

if elevated, oral glucose tolerance test for GH response (glucose should inhibit GH release)

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17
Q

corticotroph adenoma

A

causes hypercortisolism and Cushing syndrome

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18
Q

Cushing syndrome

A 
hypercortisolism resulting in:
obesity
DM
hirsutism
adrenal hyperplasia
moon face
buffalo hump
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19
Q

Cushing disease

A

increased secretion of pituitary ACTH secondary to adenoma

results in hypercortisolism

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20
Q

causes of Cushing syndrome

A

exogenous cortisol (glucocorticoid administration)
small cell carcinoma
pancreatic CA
neural tumors

21
Q

Cushing syndrome diagnostic testing

A

check ACTH level:
if low –> get CT/MRI of abdomen
if high –> get MRI of brain

22
Q

dexamethasone suppression test

A

diagnostic test to determine corticotroph adenoma vs ectopic tumor vs adrenal hyperplasia

23
Q

pituitary adenoma response to dexamethasone suppression test

A

elevated urine/serum cortisol
elevated corticotropin
low dose dexamethasone does not suppress
high dose dexamethasone DOES suppress

24
Q

ectopic corticotropin response to dexamethasone suppression test

A

elevated urine/serum cortisol
elevated corticotropin
low does dexamethasone does not suppress
high dose dexamethasone does not suppress

25
Q

adrenal tumor/hyperplasia response to dexamethasone suppression test

A

elevated urine/serum cortisol
suppressed corticotropin
low does dexamethasone does not suppress
high dose dexamethasone does not suppress

26
Q

hypercortisolism tx

A

somatostatin analogs
bromocriptine
surgical excision

27
Q

typical presentation of gonadotroph adenoma

A

mass effect!

also called “silent” or “null cell” adenomas

28
Q

which transcription factor is associated with most functioning pituitary adenomas?

A

PIT-1

29
Q

which transcription factor is associated with corticotroph adenoma?

A

TPIT

30
Q

which somatic gene mutation is associated with most pituitary adenomas?

A

GNAS

*cAMP driven cell proliferation

31
Q

which somatic gene mutation is associated with corticotroph adenomas

A

USP8

*EGFR upregulation

32
Q

which familial gene mutation predisposes individuals to pituitary adenomas?

A

AIP (FIPA)

33
Q

rathke’s cleft cyst

A

cystic mass derived from Rathke’s pouch
can expand and compress normal pituitary
can rupture and cause inflammation/infection

34
Q

adolescent craniopharyngioma

A

most often adamantinomatous

growth retardation and hypopituitarism

35
Q

adult craniopharyngioma

A

papillary

increased ICP and hypopituitarism

36
Q

etiology of craniopharyngioma

A

derived from Rathke’s pouch remnants

37
Q

histo of craniopharyngioma

A

squamous epithelium
“wet” keratin
calcified cyst

38
Q

primary empty sella syndrome

A

CSF leaks into the sella and compresses the pituitary

39
Q

secondary empty sella syndrome

A

pituitary expands and infarcts within the sell, leaving an empty space

40
Q

common causes of hypopituitarism

A

tumors (craniopharyngioma, rathke’s cyst, gliomas)
empty sell syndrome
sheehan syndrome

41
Q

pathophysiology of sheehan syndrome

A

pituitary enlarges during pregnancy which makes it susceptible to compression, ischemia and avascular necrosis

42
Q

what predisposes pregnant women to sheehan syndrome?

A

small sella turcica
autoimmunity
coagulation abnormalities
severe postpartum hemorrhage

43
Q

diabetes insipidus

A

ADH deficiency

central vs nephrogenic

44
Q

presentation of DI

A

increased serum osmolality/hypernatremia
dilute, excessive urine
polyuria

45
Q

how do you determine central vs nephrogenic DI?

A

administer desmopressin

does the kidney respond?
yes - central
no - renal

46
Q

SIADH causes

A

small cell carcinoma of the lung
TBI/subarachnoid hemorrhage
drugs (SSRIs)

47
Q

SIADH presentation

A 
decreased serum osmolality/hyponatremia
concentrated urine (hypernaturia)
AMS
muscle weakness
seizures
48
Q

when does thirst present, DI or SIADH?

A

BOTH

DI - legit need to replace fluids

SIADH - effect of ADH on brain results in inappropriate thirst

ENRP Exam 2 (11 decks)

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