Pituitary and Adrenal Dz

Question 1

bitemporal hemianopsia

◐◑

Answer 1

pituitary adenoma (ususally anterior pit) 
or crainopharyngioma

Question 2

galactorrhea, amenorrhea, infertility, ↓libido

dx? tx?

Answer 2

prolactinoma

Dx ↑PRL + β-HCG/TSH (r/o 2° causes)

Tx bromocriptine or cabergoline (<1 cm), transsphenoid hypophysectomy (≥1 cm)

Question 3

overgrowth of brow, jaw,
hands, and feet; MCC death is
CV disease

Answer 3

Acromegaly ( ↑GH )

Dx oral glucose test

Tx transsphenoid hypophysectomy + octreotide (suppress GH)

Question 4

truncal obesity, abd striae, buffalo hump, hyperglycemia, osteoporosis, HTN, immunosuppression

dx? tx?

Answer 4

Pituitary Cushings

• Dx ↑ACTH + dexa suppression test (pituitary Cushing is suppressable)
• Tx transsphenoid hypophysectomy

Question 5

embryological remnant of
Rathke pouch → bitemporal
hemianopsia (◐◑), headache,
papilledema, ∆MS

dx? tx?

Answer 5

crainopharyngioma

• Dx MRI (supracellar calcified cysts)
• Tx transsphenoid hypophysectomy

Question 6

pathophys and presetation of diabeties incipidus? how to make dx? tx?

Answer 6

central = dec ADH secretion 
nephrogenic = dec response to ADH 

polyuria and polydypsia

Dx water deprivation test (normal pts increase urine osm >280, central DI <280 and don’t normalize w/ ADH)

tx: central: DDAVP
perih = HCTZ

Question 7

Pathophys of SIADH + presentation + how to make dx + tx?

Answer 7

↑ADH secretion from posterior pituitary → volume expansion, hyponatremia (coma/sz/death if acute, asx if chronic)

Dx Na <270

Tx water restriction

Question 8

what is central ponitine myelinolysis

Answer 8

Central pontine myelinolysis: rapid correction of hyponatremia will cause demyelination and locked-in syndrome, so replace Na at a max of 0.5/hr

Question 9

work up for suspected cushing syndrome (to deterime etiology)

Answer 9

get ACTH and cortisol levels. If elevated cortisol but dec ACTH then know it is adrenal source. If both are elevated need dexamethasone suppression test

Question 10

dexamethasone suppresion test used to distinguish between

Answer 10

pituitary source for cushings vs ectopic cushings

(both have elevated ACTH and cortisol)

suppress elevated ACTH and cortisol by > 50% = pit source

suppress elevated ACTH and cortisol by <50% = ectopic source (get chest/abd CT bc likely SCLC)

Question 11

5 Ps – Pressure (BP), Pain
(HA), Perspiration, Palpitations,
Pallor

dx? tx?

Answer 11

Pheochromocytoma (episodic catecholamine excess)

Dx 24 hr urinary VMA/metanephrines

Tx α-blockers (phenoxybenzamine) then β-blockers then adrenalectomy

Question 12

What is Conn’s syndrome? present?

cause?
dx?
tx?

Answer 12

1° hyperaldosteronism

↑aldosterone → ↑Na (HTN), ↓K, ↓H (metabolic alkalosis)

67% adenoma, 33% hyperplasia

Dx abd CT scan

Tx adrenalectomy (adenoma), spironolactone (hyperplasia)

Question 13

hypoglycemia, HTN, fatigue,
hyperpigmentation, weight
loss, abd pain

dx?

Answer 13

adrenal insuff w/ ↓cortisol/↓aldosterone

Dx ↓cortisol + ACTH levels

Question 14

how to distinguish between 1/1 and 2/2 adrenal insuff

what is the etiology of 1/1 vs 2/2
how is each treated?

Answer 14

↑ACTH if primary, ↓ACTH if secondary

ETIOLOGIES:
1/1 (addisons): : autoimmune (MC US), TB (MC 3rd world), Waterhouse-Friderichsen syndrome (N. meningitidis)

2/2: due to abrupt cessation of steroid use

TREATMENT
1/1: • Tx glucocorticoid (prednisone) + mineralocorticoid (fludrocortisone)

2/2: Tx glucocorticoid (prednisone) only

Question 15

hirsutism, virilization, ↓Na/↑K/↑H

Cause?
how to dx?
tx?

Answer 15

CAH
congenital deficiency of
21α-hydroxylase (MC) or 11β-
hydroxylase

Dx w/ ↑17-OHP

Tx glucocorticoid (prednisone) + mineralocorticoid (fludrocortisone)

Question 16

what is an incidentaloma? tx?

Answer 16

adrenal tumor found incidentally on CT scan

tx:
5 cm → Tx resection + check other organs since adrenals are common site of metastasis

Question 17

What is the rule of 10s?

Answer 17

Pheochromocytomas are…

10% malignant
10% bilateral
10% extraadrenal
10% calcify
10% kids
10% familial (MEN2A/2B)