Pituitary diease Flashcards
what are sites of action in 1ry, 2ry, and 3ry defects
- primary organ
- pituitary
- hypothalamus
what does T3, T4 feed back into
both hypo and pit NEGatively
what is pattern in primary defects
pit and target hormone in opposite direction
what is pattern in secondary defect
same direction
what are the 3 presentations of pit. lesions
- mass effect
- hyperfunciton
- hypofunciton
what are mass effect presentaitons
- headache
- visual field defects
- cranial nerve in sinus being crushed (3, 4, V1V2, 6)
what are hyperfunction presentations from most to least common
nil>high prolactin>high GH>high ACTH
what is order in which hormones are lost in hypofunction
- GH
- LH
- FSH
- TSH
- ACTH
- Prolactin
what is reason for bilateral hemianopsia
optic nerve being crushed where it crosses over
what are 3 main disorders of hyperfunction
- acromegaly
- prolactinoma
- cushings (ACTH)
what are clinical, measurment and supression test for prolactinoma
clinical: galactorea, hypogonadism
measures: prolactin
supression: none exists
what are clinical, measurment and supression test for acromegaly
clinical: growth and metabolic effects
measures: baseline GH and IGF-1
supression: GH
what are clinical, measurment and supression test for cushings
clinical: catabolic effect, metabolic effects, fat dist.
measures: ACTH, cortisol
supression: cortisol
what are clinical signs of hypo function in GH, LH/FSH, TSH, ACTH
GH: short stature
LH/FSH: hypogonasim
TSH: weight gain, tiredness, cold intolerance, constipation
ACTH: weight loss, hypotension, nauseas/vomiting
what is done to assess hypofunciton
measure baseline and if low-normal try to stimulate it
what is insulin tolerance test
iv insulin to induce hypoglycemia which stimulates GH and cortisol
what is stimulant test for LH/FSH
GnRH
what are Hx and 5 tests for mass effect
Hx of headache and diploplia, decreased vision
- visual acuity
- extraocular movements
- visual field testing
- pupilarry reaction to light
- Fundi
3 treatments for acromegaly
- drugs
- surgery
- radiation
what are 2 drugs used to treat acromegaly
- somatostatin
2. GH receptor blockers
what is pathway by which prolactin effects T
prolactin - > GnRH + > LH/FSH +> T
5 DDx of high prolactin
- physiological: pregancy, breatfeeding
- Pituitary: prolactinoma
- loss of dopaminergic inhib of prolactin
- hypothyroisism: high TSH > high prolactin
- renal and liver failure
what is drug treatment of prolactinoma
dopamine agonist
what is suppression test for cushings (high cortisol)
dexamethasone (synthetic cortisol)
