Pituitary and Hypothalamic Disorders

Question 1

6 Regulatory hormones of the hypothalmus

Answer 1

TRH:  Thyrotropin releasing hormone
GnRH:  Gonadotropin releasing hormone
CRH:  Corticotropin releasing hormone
GHRH:  Growth hormone releasing hormone
GHIH:  Somatostatin
PIH:  Prolactin inhibiting hormone

Question 2

Hormones of the anterior pituitary

Answer 2

FLAT PeG
FSH
LH
ACTH
TSH
Prolactin
GH

Question 3

Most common cause of sellar masses?

Answer 3

Adenoma

Question 4

Prolactinoma

Answer 4

Most common type of pituitary adenoma
Secretes prolactin
May compress optic chiasm = bitemporal hemianopsia

Question 5

Prolactin inhibiting hormone?

Answer 5

Dopamine

If this cannot reach the pituitary because of a damaged stalk, prolactin levels will increase unchecked.

Question 6

Medications that increase serotonin may lead to?

Answer 6

Increased prolactin levels
Antidepressants
Antipsychotics

Question 7

Hypothyroidism may lead to?

Answer 7

Increased prolactin levels.

Question 8

What does prolactin block?

Answer 8

Gonadotropins FSH and LH

Question 9

Is a microadenoma more common in men or women?

Answer 9

Women

Macroadenomas (>1cm) are more common in men

Question 10

S/S of prolactinoma in women:

Answer 10

Amenorrhea
Galactorrhea (milk w/o baby)
Infertility

Question 11

S/S of prolactinoma in Men

Answer 11

Decreased Libido, gynecomastia, ED, infertility, bitemopral hemianopsia
Leads to decreased testosterone

Question 12

Best test to dx prolactinoma?

Answer 12

Prolactin level

MRI to confirm

Question 13

Tx for prolactinoma?

Answer 13

Dopamine agonists:
Cabergoline **
Bromocriptine
Surgery, chemo and radiation may be needed

Question 14

Acromegaly

Answer 14

Excess growth hormone
Almost always caused by pituitary tumor
May also be ass’d with pancreas, paraT tumors

Question 15

Acromegaly S/S

Answer 15

Skeletal changes
Prominent brow, jaw protrusion
Enlarged hands and feet
Deepening of voice
Carpal tunnel syndrome
CHF
Organomegaly
Amenorrhea

Question 16

Acromegaly Dx

Answer 16

IGF-1 level
Serum GH not suppressed following oral glucose load
MRI

Question 17

Acromegaly Tx

Answer 17

Surgery

Or oral cabergoline

Question 18

Gigantism

Answer 18

Excessive GH in children prior to closing of epiphyses

W/U and Tx same as acro…

Question 19

Pituitary Apoplexy

Answer 19

Hemorrhage into the pituitary gland
Usually secondary to adenoma
HA, N/V, AMS, low BP, low glucose

Question 20

Sheehan’s Syndrome

Answer 20

Post partum pituitary ischemic necrossi
Secondary to hypotension, emboli, HELLP syndrome.
DIfficulty breastfeeding, extended amenorrhea

Question 21

First hormone deficiency to develop with lack if functioning pituitary? 2nd, 3rd 4th?

Answer 21

1: GH
2: LH/FSH
3: TSH
4: ACTH

Question 22

S/S of LH/FSH deficiency

Answer 22

Amenorrhea, infertility, decreased pubic, axillary hair, genital atrophy, decreased libido, ED

Question 23

S/S GH deficiency

Answer 23

Clinically undectable

Question 24

S/S TSH deficiency

Answer 24

Fatigue, weight gain, weakness, decreased appetite, low BP, Low glucose

Question 25

S/S ACTH deficiency

Answer 25

Fatigue, decreased appetite, decreased pigmentation, low BP, low glucose

Question 26

Hypopituitary Dx

Answer 26

``` Test anterior hormones LH/FSH IGF-1 or GH glucose TSH ACTH (cortisol) MRI ```

Question 27

Hypopituitary tx

Answer 27

Adress underlying cause Replace needed hormone Decompression may be needed for apoplexy

Question 28

SIADH

Answer 28

``` Syndrome of Inappropriate ADH (too high) Euvolemic Hyponatremua **Elevated ADH Levels** Fluid is retained Low sodium, serum osmolarity ```

Question 29

SIADH S/S

Answer 29

If chronic: asymptomatic HA, N/ V AMS Seizures

Question 30

SIADH Causes

Answer 30

TBI Malignancy Meningitis Medications

Question 31

SIADH Dx

Answer 31

CMP Urine dip High urine sodium, low serum sodium Head CT

Question 32

SIADH Tx

Answer 32

Increase serum sodium levels Restrict fluids to 1200-1800 mL/day Hyperotonic saline (3%) for symptomatic patients 1-2 ml/kg over 3-4 hours slowly

Question 33

Diabetes Insipidus

Answer 33

``` Central:: Deficient levels of ADH Deficiency or resistance to ADH OR Nephrologic:: defect of renal tubules that interferes with water reabsorption ```

Question 34

Diabetes Insipidus S/S

Answer 34

``` Elevated plasma sodium, inability to concentrate urine. Intense thirst (2-20L/day) Polydipsia. Polyuria, Nocturia Craving for ice water Hypernatremia ```

Question 35

Diabetes Insipidus etiology

Answer 35

``` Central:: Most common: trauma or tumor Meningitis, radiation, idiopathic, cerebral anoxia Nephrogenic:: Meds: lithium, demeclyocycline Hypercalcemia, hypokalemia Sjogrens Syndrome ```

Question 36

Diabetes Insipidus Dx

Answer 36

CMP Plasma osmolarity Plasma ADH DDAVP Test

Question 37

Diabetes Insipidus Tx

Answer 37

Central: DDAVP Nephrogenic: HCTZ or amiloride Blocks reabsorption, keeps plasma sodium low