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ENRP - Exam 2 > Pituitary Adenomas > Flashcards

Pituitary Adenomas Flashcards

1
Q

Generally, what do pituitary adenomas cause?

A

Hyperpituitarism = Hormone EXCESS

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2
Q

In order for a pituitary adenoma to be a microadenoma, what size is it?

A

< 1 cm

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3
Q

In order for a pituitary adenoma to be a macroadenoma, what size is it?

A

1-4 cm

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4
Q

In order for a pituitary adenoma to be a giant adenoma, what size is it?

A

> 4 cm

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5
Q

A Lactotroph Adenoma releases?

A

Prolactin

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6
Q

Why are Lactotroph Adenomas diagnosed later in men?

A

Their initial symptoms of decreased libido and sperm count go unnoticed until a mass effect presents

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7
Q

What are the signs in a woman of a Lactotroph Adenoma?

A
  • Menstrual irregularities
  • Galactorrhea
  • Infertility
  • Decreased libido
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8
Q

If a woman is presenting with menstrual irregularities, galactorrhea and infertility, what hormone is likely in excess?

A

Prolactin

= Lactotroph Adenoma

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9
Q

Describe the histo progression with a Lactotroph Adenoma

A
  • Hyalinization with psammoma bodies
  • Dense calcification
  • Pituitary stone on imaging
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10
Q

3 treatment options for Lactotroph Adenomas?

A
  • Dopamine
  • Somatostatin analogs
  • Surgery
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11
Q

Pregnancy and Lactation cause increased prolactin. What is LAM?

A

Lactational Amenorrhea Method

– with breastfeeding, prolactin stays elevated so there is consistent ANOVULATION

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12
Q

Any drugs that block ____ can cause elevated prolactin

A

Dopamine

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13
Q

How can Hypothyroidism cause elevated prolactin levels?

A

Increased TSH stimulates prolactin production

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14
Q

A Somatotroph Adenoma releases?

A

Growth Hormone

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15
Q

What are the 2 presentations that a Somatotroph Adenoma can cause? What do they depend on?

A
  1. Gigantism - BEFORE growth plates fuse

2. Acromegaly - AFTER growth plates fuse

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16
Q

What are the 2 presentations of a Somatotroph Adenoma?

A

Gigantism

Acromegaly

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17
Q

What are the signs of Acromegaly?

A

Enlarged face, hands, nose, viscera
Thickened lips
Protruding jaw
Joint pain and immobility

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18
Q

What are the signs of Acromegaly?

A

Enlarged face, hands, nose, viscera
Thickened lips
Protruding jaw
Joint pain and immobility

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19
Q

Why do those with Somatotroph Adenomas have a decreased lifespan?

A

Cardiovascular complications

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20
Q

In order to diagnose a Somatotroph Adenoma, what do you measure?

A

IGF-1 from the liver

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21
Q

If IGF-1 is elevated, what should be done next?

A

Oral glucose tolerance test

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22
Q

Normally, what is the oral glucose tolerance test result?

A

(-) IGF-1 from the liver

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23
Q

With a Somatotroph Adenoma, what is the oral glucose tolerance test result?

A

IGF-1 from the liver STAYS HIGH

24
Q

If IGF-1 from the liver is HIGH, what is being overly secreted?

A

Growth Hormone

somatotroph adenoma

25
Q

3 treatment options for Somatotroph Adenomas?

A
  • Somatostatin analogs
  • GH receptor Antagonists
  • Surgery
26
Q

A Corticotroph Adenoma releases?

A

ACTH

27
Q

With a Corticotroph Adenoma, excess ACTH will cause what else to be in excess?

A

Cortisol from the adrenal glands

28
Q

Cushing Syndrome and Cushing’s Disease both have high cortisol levels. What is the difference?

A

Cushing Syndrome = hypercortisolism

Cushing’s Disease = CORTICOTROPH ADENOMA

29
Q

What are the signs of Cushing Syndrome and Disease?

A

Centripetal obesity
Moon facies
Striae and thin skin
Hirsutism

30
Q

What are the signs of excess cortisol with a Corticotroph Adenoma due to excess ACTH?

A

Centripetal obesity
Moon facies
Striae and thin skin
Hirsutism

31
Q

What commonly causes Cushing Syndrome?

A

Iatrogenic - exogenous glucocorticoid administration

32
Q

What neoplasms can cause Cushing Syndrome and how?

A

Small cell carcinoma of the lung, pancreatic or neural tumors

  • -> release ACTH similar substances
  • -> Hypercortisolism
33
Q

With high levels of cortisol, what should you check first when trying to find the diagnosis?

A

ACTH levels

34
Q

If the ACTH levels are low, what does that mean?

A

ACTH independent

= ADRENALS

35
Q

If the ACTH levels are high, what does that mean?

A

ACTH dependent

= Corticotroph Adenoma OR Ectopic source of ACTH

36
Q

If the ACTH levels are high, what test should be done?

A

HIGH dose Dexamethasone Suppression Test

37
Q

With the high dose dexamethasone suppression test, if the levels of ACTH are suppressed, what is the diagnosis?

A

Corticotroph Adenoma

38
Q

With the high dose dexamethasone suppression test, if there is no change in the ACTH levels, what is the diagnosis?

A

Small cell Lung Carcinoma

39
Q

If the hypercortisolism is due to the Adrenal Glands, what will the level of CRH be?

A

LOW

– negative feedback

40
Q

If the ACTH levels are high, what is another way to see if the tumor is pituitary in origin?

A

Inferior Petrosal Sinus Sampling for elevated ACTH

41
Q

High cortisol, High ACTH, (+) dexamethasone suppression test

A

Corticotroph Adenoma

42
Q

High Cortisol, High ACTH, (-) dexamethasone suppression test

A

Small cell lung carcinoma

43
Q

3 treatment options for a Corticotroph Adenoma?

A
  • Somatostatin analogs
  • Bromocriptine
  • Surgery
44
Q

What occurs with Nelson Syndrome?

A

Adrenal glands are removed to treat Cushing Syndrome
–> NO suppression of ACTH
=> Skin Hyperpigmentation

45
Q

If the Adrenal Glands are removed, ACTH is increasing alpha-MSH and CLIP, what will result and what is it called?

A

Nelson Syndrome

=> skin hyperpigmentation

46
Q

What transcription factor will be present with Cushing’s Disease but NOT with Cushing Syndrome?

A

TPIT

47
Q

If TPIT is present, what is the diagnosis?

A

Corticotroph Adenoma

48
Q

Most functioning pituitary adenomas have what transcription factor?

A

PIT-1

49
Q

Most functioning pituitary adenomas have what transcription factor?

A

PIT-1

50
Q

What somatic mutation is commonly present with Somatotroph Adenomas?

A

GNAS

51
Q

Normal GNAS gene

A

GTPase takes GTP to GDP to turn off the cascade

52
Q

Mutated GNAS gene

A

Alpha subunit of Gs LOSES GTPase activity

=> GTP causes cascade to be always on

53
Q

What somatic mutation is commonly seen with Corticotroph Adenomas?

A

USP8

54
Q

What does the USP8 mutation cause?

A

EGFR upregulation

55
Q

What familial mutation is commonly seen with Somatotroph Adenomas?

A

AIP

56
Q

If a family has a germline AIP mutation, what are they at risk for?

A

Somatotroph Adenoma

57
Q

Mutated GNAS gene

A

Alpha subunit of Gs loses its GTPase activity

=> GTP causes cascade to be always on

ENRP - Exam 2 (21 decks)

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