Pituitary Cases

Question 1

Anterior Pituitary Hormones

FLATPIG

Answer 1

FSH
LH
ACTH
TSH
Prolactin
GH

Question 2

Temporal visual field is recognized by the

GnRH stimulates release of

Prolactinomas always require

Dx

Cabergoline

Bromocriptin

Answer 2

medial aspect of eye

LH/FSH, stimulating ovaries/testes

Medical Tx

Very high prolactin level/imaging

Better tolerated

Nausea, more often, less effective

Question 3

Surgical indications for prolactinoma

Other sx of hyperprolactinemia in woman

male

Answer 3

Huge tumor w CSF leak

Tumor not responding to DA agonist

Tumor during/prior to pregnancy

Hirsutism, acne, osteopenia

dec potency, loss of pubic hair/muscle mass, gynecomastia

Question 4

Panhypopituitarism indicates

Mass effect can also cause

Temporal hemaniopsia

Diminished _____ fields
____ eye affected
Occurs ______

Junction Scotoma
Visual defects ______
_____ chiasmatic lesion
Presnets w

Answer 4

all hormones low

CSF leak

temporal
One/both
Gradually

vary
Anterior
Central blind spot & lack of superior temporal field

Question 5

Functional adenomas

Nonfunctional adenomas usually

Answer 5

Prolactin, GH, ACTH, TSH

gonadotrophs (FSH/LH), do not inc hormones

Question 6

Stalk effect caused by

such as

prolactin levels, due to

NF Adenomas hormone treatment

Answer 6

suprasellar lesions/damage to infundibulum

NF macroadenoma

inc slightly, lack of DA

Testosterone/Estrogen, Glucocorticoids, Synthetic T4

Question 7

Meningismus triad

Mass effect in cavernous sinus

6th nerve palsy

3/4 nerve palsy

V1 (ophthalmic)

Oculosympathetic fibers

manifestations

Answer 7

nuchal rigidity, photophobia, HA

Horizontal diplopia (esotropia)

Dilated, down&out, vertical diplopia, lack of intorsion

pain/numb

Horners syndrome

Question 8

Pituitary apoplexy hypopituitarism caused by

dramatic presentation

tx

less severe clinical finding tx

Medical therapies

Answer 8

Secondary AI

Rapid onset visual/mental status change, hypopituitarism

NS evaluation

surgery wait, evaluate hormones, treat medically

high does CS for visual changes, AI
DA if prolactinoma

Question 9

Primary disease look for

Secondary dz look for

Hormone def, pt ____

Hormone excess, pt _____

Answer 9

opposite changes

same direction changes

fails stimulation test

fails suppression test