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ENDO 1 MOD > pituitary d/o & ED > Flashcards

pituitary d/o & ED Flashcards

1
Q

name the two hormones secreted by POST pit

A

Oxytocin and ADH

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2
Q

negative feedback loop

A

causes a decrease in function
more common feedback

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3
Q

positive feedback loop

A

increases a function till outcome is reached or stimulus is removed
ex. oxytocin production

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4
Q

how is oxytocin production controlled

A

positive feedback mechanism
causes milk release or labor contractions which signals more production of oxytocin and continues till delivery or feeding is done

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5
Q

what symptom is caused by excess prolactin hormone

A

galactorrhea/amenorrhea
hypogonadism in men & women

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6
Q

what is galactorrhea

A

milky nipple discharge unrelated to normal milk production

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7
Q

condition of excess ACTH

A

Cushing Disease

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8
Q

condition of excess TSH w/ normal T4

A

hyperthyrotropinemia

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9
Q

condition of excess LH/FSH

A

hypergonadotropinemia

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10
Q

general rule of what causes hyperprolactinemia

A

anything that disrupts the pituitary stalk and blocks dopamine inhibition

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11
Q

what is the most common pituitary tumor

A

prolactinoma

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12
Q

what controls prolactin secretion

A

dopamine. presence of dopamine inhibits the secretion of prolactin

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13
Q

causes of hyperprolactinemia

A

physiologic (stress, pregnancy, etc)
pharmacologic (anti-depressants, H2 blockers, opiods, etc)
pathologic (prolactinoma, renal failure, etc)

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14
Q

drugs that induce hyperprolactinemia

A

anti depressant/anti-psychotics
estrogen
H2 blockers

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15
Q

what is a prolactinoma

A

most common functioning adenoma; can cause hyperprolactinemia

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16
Q

mass effect of prolactinomas result in… (2 things)

A

visual changes (bitemporal hemianopsia)
headache

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17
Q

treatment for prolactinoma

A

dopamine agonist
surgery (transphenoidal resection)
XRT (radiation)

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18
Q

what are the two dopamine agonists that can be used to treat prolactinomas? what are their ADR?

A

bromocriptine & cabergoline
ADR- nausea, lightheadedness, congestion

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19
Q

what labs are needed if a pituitary tumor is suspected?

A

1 Prolactin

TSH, LH, GH, FSH
Estrogen, pregnancy test

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20
Q

what are normal prolactin levels

A

men <20, women <25 pregnant is up to 400

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21
Q

what would be seen on an MRI if theres pituitary tumor

A

stellar mass

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22
Q

acromegaly vs gigantism

A

acromegaly– growth plates closed so they are not super tall
gigantism– before epiphyses close so they get very tall

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23
Q

etiology of gigantism and acromegaly

A

GH secreting adenoma

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24
Q

sx of GH excess

A

increased growth of distal parts (spade like hands, phalangeal bony overgrowth)
macroglossia, enlarged sinus/frontal bossing (lantern jaw)
organomegaly (liver, spleen, kidneys)
prominent nasolabial folds

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25
Q

diagnostics if suspecting excess GH

A

serum GH
IGF-1
MRI

26
Q

what must you do before collecting serum GH

A

give insulin first– glucose suppresses GH levels so give it clear up glucose and see true GH levels

27
Q

tx for excess GH

A

1 surgery (transphoenoidal resection)

#2 pharm: (dopaminergic drug or GH blocker- octreotide or pegvisomant)
#3 XRT

28
Q

ADR of surgical or XRT

A

hypopituitarism

29
Q

effect of cortisol on hypothalamus & pituitary

A

inhibitory effects via negative feedback
reduces CRH from hypothalamus & ACTH from pituitary

30
Q

what is Sheehan’s syndrome

A

hypopituitarism d/t postpartum hemorrhage causing pituitary gland necrosis

31
Q

classic signs of sheehans syndrome

A

fatigue
inability to lactacte
low BP
irregular or amenorrhea
thinning of vaginal lining
loss of pubic hair & wt gain

32
Q

sequalae of sheehans syndrome

A

adrenal insufficiency
hypothyroidism
amenorrhea
DI
inability to breast-feed

33
Q

diagnostics for sheehans syndrome

A

serum pituitary hormone levels (would be low)
MRI/CT

34
Q

how is sheehans syndrome treated?

A

lifelong HRT

35
Q

hormones incharge of testosterone & spermatogenesis

A

LH–> Leydig cells–> testosterone
FSH–> Sertoli cells–> Spermatogenesis/Inhibin B
negative feedback

36
Q

first test to check for male reproductive potential

A

semen analysis
2-3 separate counts at least 2-4 weeks apart

37
Q

normal semen analysis

A

volume: 2-6 mL
sperm conc: 20-100 mill/mL
>50% motility w/ forward progression
>12% normal forms
<1 mill/mL WBC

38
Q

factors contributing to male infertility

A

varicocele (cause 44% of time)– bag of worms; too hot
trauma– torsion, tumor
infections, high fever/heat
drugs– chemotherapy, ETOH, marijuana, tobacco, steroids, pesticides

39
Q

Kleinfelters syndrome

A

47 XXY
low testosterone, reduced muscle mass, facial & body hair
breast enlargement
little or no sperm

40
Q

Kleinfelters syndrome

A

47 XXY
low testosterone, reduced muscle mass, facial & body hair
breast enlargement
little or no sperm

41
Q

diagnostics for kleinfelters syndrome

A

genetic test

42
Q

treatment for kleinfelter syndrome

A

testosterone replacement & fertility treatment

43
Q

____% of infertility amongst couple is traced back to the male

A

30%

44
Q

workup for infertility

A

semen analysis & ovulation

45
Q

mechanism of erections

A

increased arterial flow to penis
relaxation of smooth muscle of trabeculae whereby blood is shunted into corpora cavernosa

46
Q

if a young male presents with ED, it could be a hallmark sign for CV dz, what should you do to check?

A

lipid panel
A1C
they have risk of major cardiac even in 7-10 yrs

47
Q

Organic vs Psychogenic ED

A

organic: gradual, have RF, consistent dysfx, no sleep erections, can have orgasms
psychogenic: sudden, No RF, situational & varying dysfx, no orgasm, have sleep erections

48
Q

RF for ED

A

obesity
HTN, DM
smoking
dyslipidemia
sedentary
age

49
Q

ED tx options

A

1 PDE-5 inhibitors

intracavernosal injections
intraurethral suppository (can use w/ PDE-5)
vacuum
penile prosthesis (highest patient & partner satisfaction)

50
Q

MOA of PDE5 inhibitors

A

potentiate effects of cGMP to prolong erections and increase sexual satisfaction

51
Q

ADR of PDE5 inhibitors

A

blue tinges in vision & muscle pain (most common)
HA, nausea
Rhinitis
flushing
dyspepsia

52
Q

if you’re going to prescribe PDE5i what should you make sure of?

A

that pt isn’t taking alpha blocker– risk of hypotension from double smooth muscle dilation
that pt isnt taking nitrate– absolute contraindication

53
Q

list the four PDEi meds (-afil)

A

sildenafil (viagra)
vardenafil
tadalafil– longer half life & enhanced erectile fx (the weekender)
avanafil– shorter onset of action

54
Q

what is Alprostadil

A

a prostaglandin E1 analog; vasodilator
penile injection that increases cAMP

55
Q

what is hypogonadism and how do you test for it?

A

low testosterone
#1 measure total testosterone
bioavailable testosterone if needed

56
Q

“total” testosterone vs bioavailable testosterone

A

Total: free T + albumin bound T + sex hormone binding globulin (SHBG) bound T
bioavailable: free T + albumin bound T

57
Q

sx of hypogonadism (not signs)

A

decreased libido, energy & muscle mass
increased body fat
cognitive changes & depressed mood

58
Q

Signs of hypogonadism

A

truncal obesity, anemia, decreased bone density

59
Q

Tx for hypogonadism

A

testosterone
gel & patch- daily; gel has risk of transference
IM q 3 wks
SQ pellets q 3 months
nasal

60
Q

when would you not want to give testosterone

A

male of reproductive age who wants to have kids

ENDO 1 MOD (4 decks)

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