Pituitary Disorders

Question 1

what is the function of the hypothalamus

Answer 1

homeostasis
regulates body temp
regulates pituitary
responds to hormonal autonomic and environmental effects
located in the wall third ventricle

Question 2

what are the purpose of the endocrine glands

Answer 2

secrete hormones directly into the blood stream

Question 3

what is the purpose of exocrine glands

Answer 3

secrete substances into ducts

Question 4

ADH is also called

Answer 4

AVP, arginine vasopressin

Question 5

what is the most common cause of hyper/hypo secretion of pituitary hormone

Answer 5

pituitary adenomas

Question 6

what is an adenoma less than 10cm is called what

Answer 6

microadenomas

Question 7

what is an adenoma greater than 10cm is called what

Answer 7

macroadenoma

Question 8

what are some clinical features of pituitary adenomas

Answer 8

headache, visual loss, bitemporal hemianopsia
ptosis, decreased facial sensation
excess hormones

Question 9

what causes pituitary apoplexy

Answer 9

from a hemorrhage into a pre-existing adenoma

Question 10

what are the clinical feature of pituitary apoplexy

Answer 10

headache, biltateral visual changes, opthaloplegia, LOC, hypoglycemia, CNS hemmorage

Question 11

what is the treatment for pituitary apoplexy

Answer 11

glucocorticoids if no visual loss

if visual loss then sx decompression

Question 12

what does dopamine inhibit

Answer 12

prolactin

Question 13

what is the function of prolactin

Answer 13

stimulates production of breast milk, metabolism and immune function

Question 14

what is hyperprolactinemia

Answer 14

elevated prolactin levels

Question 15

what is the most common cause of amenorrhea in premenstrual women

Answer 15

hyperprolactinemia

Question 16

what is the most common pituitary hormone hypersecretion in men and women

Answer 16

hyperprolactinemia

Question 17

prolactin inhibits what

Answer 17

decreased reproductive function and drive

Question 18

what does prolactin inhibit

Answer 18

GnRH which decreases the sex hormones

Question 19

what are the clinical features of hyperprolactinemia in women

Answer 19

menstrual changes
stopped period of infrequent period
galactorrhea (spontaneous milk flow)
infertility
nipple discharge

Question 20

what are the clinical features of hyperprolactinemia in men

Answer 20

hypogonadism
decreased libido
ED
Infertility
gyneocmastia
galactorrhea

Question 21

how is hyperprolactinemia diagnosed

Answer 21

fasting and morning prolactin levels

Question 22

what is the treatment for hyperprolactinemia

Answer 22

discontinue med if cause

or MRI of pituitary

Question 23

how do you treat a prolactinoma

Answer 23

dopamine agonist

trans-sphenoid resection

Question 24

what is galactorrhea

Answer 24

inappropriate lactation
not breast feeding
not post partum

Question 25

how is galatorrhea diagnosed

Answer 25

persistent discharge unilateral limited to one duct serous, sanguinous, serosanguinous

Question 26

what drugs can cause galatorrhea

Answer 26

methlydopa phenothiazines, tricyclics

Question 27

what is the treatment for galatorrhea

Answer 27

correct underlying cause medication side effect surgical removal of intraductal papilloma

Question 28

what is gigantism

Answer 28

extreme linear growth mandifesting in height occurs prior to closure of epiphysial plates leading to long bone growth. Inhibition of GnRH delays puberty further delaying epiphysial closure and leading to increased height

Question 29

what is acromegaly

Answer 29

bony and soft tissue over begins post pubertal thus linear growth does not occur

Question 30

characteristic of gigantism

Answer 30

arises from pituitary adenoma producing GH | there is an increase in GH, IGF-1 (screening test)

Question 31

how do you treat gigantism

Answer 31

tanssphenoidal sx bromocriptine, octretide radiation therapy

Question 32

what is the physiology of acromegaly

Answer 32

growth hormone may be produce by microadenoma local invasion can occur, disruption of other anterior pituitary hormones systemic effects mediated by final common denominator IFG-1 largely made in the liver

Question 33

what are the clinical presentations of acromegaly

Answer 33

systemic fatigue, weight gain, lethargy enlarged nose, jaw, lips, hands, feet, brow, acne cardiac hypertrophy, nerve entrapment (carpel tunnel), arthritis, hyperlipidemia HTN, CAD, atherosclerosis hypogonadism, decreased libido changes in visual field

Question 34

how is acromegaly diagnosed

Answer 34

clinical suspicion, enlarging hat , shoe/glove size | GH level not reliable

Question 35

what is the gold standard for acromegaly

Answer 35

OGTT: 80 glucose load over 5 min then GH levels are obtained at 0, 30, 60, 90, 120, post, lack of supression of GH to <1ng/ml diagnostic

Question 36

what is the treatment of acromegaly

Answer 36

surgery or radiotherapy control tumor mass without remaining pituitary being disrupted restore life expectancy via cardiovascular management, DM control

Question 37

what is the most common form of hypopituitarism

Answer 37

neoplastic

Question 38

how is hypopituitarism diagnosed

Answer 38

8am cortisol level, TSH, FT4, IGF-1, testosterone in men

Question 39

what is the treatment for hypopituitarism

Answer 39

hormone replacement

Question 40

what regulates ADH

Answer 40

CRH and barorecptors

Question 41

what is the pathophysiology behind central diabetes insipidus

Answer 41

often no identifiable pituitary/hypothalmus lesions | due to trauma, familial, genetic

Question 42

what is the pathophysiology behind nephrogenic diabetes insipidus

Answer 42

ADH resistance in kidneys

Question 43

what is the clinical presentation of DI

Answer 43

``` polydipsia, especially ice water, polyuria, Enuresis (bed wetting) nocturia day time fatigue hypernatermia dehydrated ```

Question 44

how do you monitor a person with DI

Answer 44

24hr urine collection check volume, osmolarity Serum glucose, urea nitrogen, calcium, uric acid, potassium, sodium, osmolarity increased due to excess water excretion

Question 45

how do you differentiate central from nephrogenic DI

Answer 45

vasopressin challenge test

Question 46

what would it mean if there was decreased urine output after administering vasopressin

Answer 46

central diabetes

Question 47

what would it mean if there was no decrease in urine output

Answer 47

nephrogenic diabetes

Question 48

what is the treatment for central DI

Answer 48

demopression

Question 49

what is the treatment for nephrogenic DI

Answer 49

hydrochrolothiazide causes excretion of more water than sodium

Question 50

What is SIADH

Answer 50

excess ADH interferes with water excretion, even when there is normal water intake, resulting in a imbalance of input vs output there is an increase in ADH results in increased water reabsorption by the kidneys, decreased aldosterone secretion