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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
3 treatment options for Somatotroph Adenomas?
- Somatostatin analogs - GH receptor Antagonists - Surgery
26
A Corticotroph Adenoma releases?
ACTH
27
With a Corticotroph Adenoma, excess ACTH will cause what else to be in excess?
Cortisol from the adrenal glands
28
Cushing Syndrome and Cushing's Disease both have high cortisol levels. What is the difference?
Cushing Syndrome = hypercortisolism | Cushing's Disease = CORTICOTROPH ADENOMA
29
What are the signs of Cushing Syndrome and Disease?
Centripetal obesity Moon facies Striae and thin skin Hirsutism
30
What are the signs of excess cortisol with a Corticotroph Adenoma due to excess ACTH?
Centripetal obesity Moon facies Striae and thin skin Hirsutism
31
What commonly causes Cushing Syndrome?
Iatrogenic - exogenous glucocorticoid administration
32
What neoplasms can cause Cushing Syndrome and how?
Small cell carcinoma of the lung, pancreatic or neural tumors - -> release ACTH similar substances - -> Hypercortisolism
33
With high levels of cortisol, what should you check first when trying to find the diagnosis?
ACTH levels
34
If the ACTH levels are low, what does that mean?
ACTH independent | = ADRENALS
35
If the ACTH levels are high, what does that mean?
ACTH dependent | = Corticotroph Adenoma OR Ectopic source of ACTH
36
If the ACTH levels are high, what test should be done?
HIGH dose Dexamethasone Suppression Test
37
With the high dose dexamethasone suppression test, if the levels of ACTH are suppressed, what is the diagnosis?
Corticotroph Adenoma
38
With the high dose dexamethasone suppression test, if there is no change in the ACTH levels, what is the diagnosis?
Small cell Lung Carcinoma
39
If the hypercortisolism is due to the Adrenal Glands, what will the level of CRH be?
LOW | -- negative feedback
40
If the ACTH levels are high, what is another way to see if the tumor is pituitary in origin?
Inferior Petrosal Sinus Sampling for elevated ACTH
41
High cortisol, High ACTH, (+) dexamethasone suppression test
Corticotroph Adenoma
42
High Cortisol, High ACTH, (-) dexamethasone suppression test
Small cell lung carcinoma
43
3 treatment options for a Corticotroph Adenoma?
- Somatostatin analogs - Bromocriptine - Surgery
44
What occurs with Nelson Syndrome?
Adrenal glands are removed to treat Cushing Syndrome --> NO suppression of ACTH => Skin Hyperpigmentation
45
If the Adrenal Glands are removed, ACTH is increasing alpha-MSH and CLIP, what will result and what is it called?
Nelson Syndrome | => skin hyperpigmentation
46
What transcription factor will be present with Cushing's Disease but NOT with Cushing Syndrome?
TPIT
47
If TPIT is present, what is the diagnosis?
Corticotroph Adenoma
48
Most functioning pituitary adenomas have what transcription factor?
PIT-1
49
Most functioning pituitary adenomas have what transcription factor?
PIT-1
50
What somatic mutation is commonly present with Somatotroph Adenomas?
GNAS
51
Normal GNAS gene
GTPase takes GTP to GDP to turn off the cascade
52
Mutated GNAS gene
Alpha subunit of Gs LOSES GTPase activity | => GTP causes cascade to be always on
53
What somatic mutation is commonly seen with Corticotroph Adenomas?
USP8
54
What does the USP8 mutation cause?
EGFR upregulation
55
What familial mutation is commonly seen with Somatotroph Adenomas?
AIP
56
If a family has a germline AIP mutation, what are they at risk for?
Somatotroph Adenoma
57
Mutated GNAS gene
Alpha subunit of Gs loses its GTPase activity | => GTP causes cascade to be always on

ENRP - Exam 2 (21 decks)

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