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FA17 Endocrine > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

1
Q

hypothalamus is controlled by

A

controlled by cortical centers in brain and responds to emotions and sensory inputs

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2
Q

pituitary location

laterally and superiorly

A

laterally: cavernous sinuses
superiorly: optic chiasm

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3
Q

optic chiasm

A

crossing of the optic nerves

superior to pituitary

pituitary tumors lead to loss of peripheral vision

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4
Q

anterior pituitary hormones list (7)

A 
TSH 
ACTH 
FSH
LH
GH
PRL 
Endorphins
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5
Q

hypothalamus/pituitary

anterior communication

A

hypothalamus and transported to anterior lobe by pituitary portal circulation

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6
Q

posterior pituitary hormones list (2)

A

oxytocin

vasopressin (ADH_

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7
Q

posterior pituitary/hypothalamus communication

A

transported directly by neural network to the stalk and posterior lobe

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8
Q

products of hypothalamus

A 
CRH 
GnRH 
GHRH
Somatostatin 
TRH 
Dopamine
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9
Q

hypothalamus function

A

affects appetite, sleep, activity of autonomic NS and pituitary hormone secretions

hormones cause growth + release of hormones

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10
Q

HPA/Pituitary/Target:

Thyroid

A

TRH -> TSH -> T3/T4

thyroid gland

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11
Q

HPA/Pituitary/Target:

growth axis

A

GHRH -> GH -> IGLF-1

Liver

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12
Q

HPA/Pituitary/Target:

adrenal

A

CRH -> ACTH -> cortisol

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13
Q

HPA/Pituitary/Target:

gonadal

A

GnRH -> LH/FSH -> Testosterone/Progesterone, Estradiol/Inhibin

ovary, testes

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14
Q

functioning pituitary tumors

A

produce hormones

GH and prolactin

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15
Q

pituitary tumor effects depends on

A
  1. amount and kind of hormones produced
  2. location and size of tumor
  3. age/gender of patient
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16
Q

microadenomas

A

pituitary gland tumor

<10 mm

non cancer

prolactin producing

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17
Q

macroadenomas

A

pituitary gland tumor

> 10mm

growth hormone producing

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18
Q

carniopharyngioma

A

benign tumor arising from squamous cell nests

pediatric intracranial neoplasm

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19
Q

meningioma

A

typically benign and non functional pituitary gland

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20
Q

how do you screen for pituitary adenomas

A

screens for functionality by obtaining serum levels of prolactin, GH, TSH, ACTH, LH, FSH

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21
Q

symptoms of prolactinomas in women

A

menstrual irregularities or amenorrhea

vaginal dryness, pain with intercourse, and osteoporosis, galactorrhea

LH/FSH suppression and increased prolactin

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22
Q

symptoms of prolactinomas in men

A

typically present with macroadenoma and compression

decreased libido, erectile dysfunction, infertility

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23
Q

DDX of prolactinemia

A

drugs that inhibit dopamine

pregnancy***

ESRD/cirrhosis

endocrine disorder

pituitary or hypothalamic pathology

24
Q

prolactinoma workup

A

prolactin level, TSH, and pregnancy test

MRI with contrast, thin cuts

25
Q

prolactinoma treatment

A

yearly MRI + observation

can be treated with dopamine agonists(bromocriptine, stimulate DA r., surpasses prolactin and shrinks)

transsphenoidal pituitary adenomactomy

26
Q

macroadenomas (children v. adults)

A

secrete growth hormone

child- epiphyses (growth plates) open and susceptible to GH, gigantism

adult - epiphyses are closed, bones larger not longer, acromegaly

27
Q

GH normal function

A

secreted by somatotropin in anterior pituitary

pulsatile fashion

induces ILGF-1 secretion in liver

regulate muscle and bone growth + gluconeogenesis

28
Q

GH secretion inhibited by

A

somatostatin and ILGF-1, hyperglycemia, leptin, multiple other peptides

29
Q

GH secretion stimulated by

A

hypoglycemia
fasting or starvation
ghrelin

30
Q

GH excess (macroadenomas)

A

acromegaly or gigantism

typically due to functional pituitary adenoma

31
Q

gigantism

A

GH excess in children

dramatic linear growth acceleration

rare disorder

32
Q

acromegaly

A

insidious onset

excess of GH + IGLF-1 causes insulin resistance

but NOT change in height

33
Q

clinical manifestations of acromegaly

A

headache, visual loss

soft tissue overgrowth/skin thickening

coarsening of facial features and macroglossia

macroganthia

deepening of voice

spade hands

parasthesia/carpal tunnel

hyperhydrosis

enlargement soft tissue of tongue, larynx, pharynx

visceral enlargement

34
Q

complications of acromegaly

A

increased CV disease

obstructive sleep apnea

diabetes mellitus

increased colon cancer

35
Q

diagnosis GH macrodaenomas

A

random serum IGF-1

GOLD STANDARD: GH suppression test (if levels fall below 1 -normal)

thin slice MRI of pituitary

36
Q

macro adenoma treatment

A

transphenoidal microsurgery

can do pharmacological (octreotide- somatostatin analog)

37
Q

hypopituitarism

A

destruction of pituitary gland

rare, presents subtly

can have some or all hormone axises

symptoms, treatment depend on axis affected

38
Q

hypopituitarism etiologies

A
  1. ischemia/infarction (Sheehan’s syndrome/preg.)
  2. tumor
  3. infiltrating disease
  4. infectious disease
  5. iatrogenic
39
Q

hypopituitarism symptoms

GH loss

A

hypoglycemia

40
Q

hypopituitarism symptoms

LH/FSH

A

failure of puberty

female- amenorrhea, loss of pubic/axillary hair, breast atrophy

male - erectile disfunction, decreased muscle mass, libido

41
Q

hypopituitarism symptoms

TSH

A

hypothyroidism (cold intolerance, weight gain, myesdema, fatigue)

42
Q

hypopituitarism symptoms

ACTH

A

adrenal insufficiency

shock

43
Q

hypopituitarism treatment

ACTH

A

glugorigoid replacement only

hydrocortisone

44
Q

hypopituitarism treatment

TSH

A

administer thyroid replacement

45
Q

hypopituitarism treatment

LH/FSH

A

determine if fertility is desired

men treated with testosterone (no fertility) gonadotropins (fertility yes)

women HRT (no fertility) or gonadotropins (yes)

46
Q

acondroplasia

A

short stature, genetics

gene coding for growth factor is mutated

short limbed dwarfism (proximal), brachydactyly

47
Q

congenital GH deficiency

A

genetic mutation

patient falls off the chart by 6-12 months of age

48
Q

diabetes insipidus

A

passage of large volumes of dilute urine

via central DI (decreased ADH secretion) or Nephrogenic (decreased ability to concentrate urine)

49
Q

cardinal diabetes insipidus symptoms

A

polyuria, polydipsia, nocturia

50
Q

polyuria

A

> 3 L of urine output daily

differential:
DM, DI, Primary polydipsia (psychiatric)

51
Q

central DI etiologies

A

idiopathic

malignant or benign brain tumors

cranial surgery

head trauma

52
Q

nephrogenic DI etiologies

A

Meds (LITHIUM)

renal disease

prganncy

hypokalemia/hyper kalemia

53
Q

manifestations of diabetes insipidus

A

if free access to water, may be relatively asymptomatic

urine can be 3-20 L/day

normal physical exam

54
Q

central DI treatment

A

due to DEFICIENCY of ADH secretion

DDAVP (synthetic ADH)

low salt diet and access to water

55
Q

nephrogenic DI treatment

A

resistance of kidney to ADH

low solute diet

HCTZ +/- amiloride

56
Q

why do i give someone with DI a diuretic?

A

decreases available water in collecting tubules (so hold onto water)

therefore proximal tubule senses less water, and takes up more water

57
Q

pituitary metastases

A

very rare

present with mass effects

typically in posterior pituitary

often breast, GI, lung CA

FA17 Endocrine (10 decks)

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