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Clin Med II > Pituitary Disorders > Flashcards

Pituitary Disorders Flashcards

1
Q

What part of the pituitary gland synthesizes and secretes hormones?

A

Anterior pituitary

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2
Q

Does the anterior pituitary respond to negative or positive feedback?

A

Negative

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3
Q

ACTH comes from what cells?

A

Corticotrophs

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4
Q

TSH comes from what cells?

A

Thyrotrophs

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5
Q

LH and DSH comes from what cells?

A

Gonadotrophs

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6
Q

GH comes from what cells?

A

Somatorophs

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7
Q

Prolactin comes from what cells?

A

Lactotrophs

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8
Q

What 6 hormones does the anterior pituitary release?

A
  1. ACTH
  2. TSH
  3. LH
  4. FSH
  5. GH
  6. Prolactin
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9
Q

What hormones stimulates production and release of cortisol by adrenal cortex?

A

ACTH

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10
Q

What hormones

stimulates the thyroid to produce T3/T4 → stimulates metabolism of many tissues in the body?

A

TSH

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11
Q

What hormone triggers ovulation and development of corpus luteum in females?

A

LH

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12
Q

What hormone stimulates Leydig cell production of testosterone in men?

A

LH

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13
Q

What hormone stimulates growth of ovarian follicles?

A

FSH

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14
Q

What hormone stimulates formation of secondary spermatocytes?

A

FSH

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15
Q

What hormone Stimulates growth, cell reproduction, and cell regeneration?

A

GH

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16
Q

What hormone stimulates milk production?

A

Prolactin

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17
Q

What hormone works with LH and testosterone to increase reproductive function

A

Prolactin

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18
Q

What part of the pituitary only secretes hormones synthesized in the hypothalamus?

A

Posterior pituitary

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19
Q

What are the 2 hormones of the posterior pituitary?

A
  1. ADH

2. Oxytocin

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20
Q

What hormone is released in response to hypertonicity and causes the kidneys to reabsorb solute- free water producing concentrated urine and reduced urine volume?

A

ADH

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21
Q

What hormone increases uterine contractions?

A

Oxytocin

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22
Q

What hormone is released via positive feedback loop?

A

Oxytocin

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23
Q

What hormone promotes stretching of cervix and uterus during labor and stimulates milk release?

A

Oxytocin

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24
Q

What part of the pituitary synthesizes and secretes MSH?

A

Intermediate pituitary

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25
Q

What is the most common place to develop brain masses?

A

Sellar turcica

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26
Q

Visual impairment and diplopia, +/- HA are sx of what?

A

Sellar mass

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27
Q

What is the most common type of visual impairments associated with a sellar mass due to midline compression/lesion of the optic chiasm?

A

bitemporal hemianopsia

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28
Q

What is the most common type of benign sellar tumors?

A

Pituitary adenoma

Other: craniopharyngioma, meningioma, cysts

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29
Q

What is the most common pituitary adenoma?

A

Prolactinoma (60%)

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30
Q

How are pituitary adenomas generally classifed?

A

Size and cell of origin from anterior pituitary

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31
Q

Is a microadenoma bigger or smaller than 1 cm?

A

Smaller (< 1 cm)

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32
Q

Is a macroademona bigger or smaller than 1 cm?

A

Bigger (> 1 cm)

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33
Q

Are the following benign or malignant causes of sellar masses?

  1. primary-germ cells tumor
  2. chordoma
  3. lymphoma
  4. metastatic breast or lung cancer
A

Malignant

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34
Q

When and why would you check the following once a sellar mass has been identified?

  1. Serum prolactin
  2. serum IGF-1
  3. 24-hour urine cortisol, 4. T3/T4/TSH
A

You would check the following if the mass is symptomatic or causing hormonal abnormalities to determine a treatment plan

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35
Q

30 y/o F presents with amenorrhea, galactorrhea, and concerns of infertility. What disease are you concerned about?

A

Prolactinoma ( serum prolactin is > 30 ng/mL)

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36
Q

60 y/o F presents with headache and impaired vision. On exam her serum prolactin in > 20 ng/mL. What disease are you concerned about?

A

Prolactinoma

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37
Q

35 y/o M presents with decreased libido, gynecomastia and concerns of impotence/infertility. What disease are you concerned about?

A

Prolactinoma (serum prolactin > 20 ng/mL)

38
Q

Penothiazine, halperidol, benzodiazepines can all cause hyper secretion of what hormone?

A

Hyperprolactinemia

39
Q

What 2 meds do you used to treat prolactinoma?

A
  1. Cabergoline (prolactin antagonist)

2. Bromocriptine

40
Q

What is the standard of care for treating prolactinoma?

A

Transphenoidal resection

41
Q

What is recommended to do prior to a tansphenoidal resection to make the treatment more effective?

A

Radiotherapy to shrink the size of the tumor

42
Q

Acromegaly is a result of an excess of what hormone?

A

GH

43
Q

Acromegaly is most commonly caused by what?

A

Benign pituitary macroadenoma

44
Q

Serum levels of what hormone are an important marker for excess GH?

A

IGF-1 (released from the liver)

45
Q

On exam of 40 y/o M pt you find enlargement of hands, feet, and jaw. What disease are you concerned about?

A

Acromegaly.

Also will have enlargement of internal organs, specifically the heart

46
Q

Pts w/ acromegaly are at an increased risk of developing what 3 diseases?

A

DM, HTN, CAD

47
Q

When evaluating a pt w/ suspected acromegaly, what lab do you check first?

A

Serum IGF-1 (if low, no GH excess)

48
Q

If serum IGF-1 is normal/elevated in pt w/ suspected acromegaly. What test should you order 2nd to help make a dx?

A

2 hr OGTT

49
Q

What test is gold standard for dx of acromegaly?

A

2 hr OGTT

50
Q

If 2 hr OGTT is preformed on pt w/ suspected acromegaly, what are the expected results?

A

Failure of GH to decrease (definitive dx)

51
Q

Is a random serum GH an accurate test for diagnosing acromegaly?

A

No. Levels fluctuate

52
Q

What imaging will show a prolactinoma?

A

MRI

53
Q

What imaging would you order in pt w/ acromegaly to ID a pituitary tumor?

A

MRI

54
Q

What is the medication tx for acromegaly?

A

Somatostatin analogs (octreotide, lanreotide) → inhibitory and may decrease tumor size

55
Q

What is surgical tx for a pituitary tumor?

A

Transsphenoidal microsurgery

56
Q

When will Transsphenoidal microsurgery be most successful for pt w/ acromegaly? (2)

A
  1. GH levels are low

2. Small tumor

57
Q

What long term follow up is needed in pts with acromegaly?

A

Measure IGF-1 every 3-6 mos

58
Q

What is the #1 cause of adult onset GH deficiency?

A

Pituitary ademona

59
Q

Sheehan syndrome is a rare disease that will cause what hormonal deficiency?

A

GH deiciency

60
Q

Hx of GH deficiency in childhood is a RF for what disease?

A

Adult onset GH deficiency

61
Q

A 30 y/o M pt presents with:
↓ Lead body mass & ↑ fat mass
↓ bone mineral density
↓ QoL.

What disease are you concerned for?

A

Adult onset GH deficiency

62
Q

What is the tx for GH deficiency if onset in childhood?

A

GHRT - daily subQ injections

63
Q

What are the possible SEs of GH therapy? (4)

A
  1. peripheral edema
  2. arthralgia
  3. paresthesia
  4. worsening of glucose tolerance (DM risk)
64
Q

Low T and high FSH/LH levels are diagnostic for primary or secondary hypogonadism?

A

Primary (hypergonadotropic hypogonadism)

65
Q

What is the cause in secondary hypogonadism?

A

Defects in the HPT axis levels

66
Q

30 y/o M presents w/ hot flashes, ED and decreased libido, muscle mass and body hair. What disease should you be concerned about?

A

Secondary hypogonadism (hypogonadotropic hypogonadism)

67
Q

Low T and normal to low FSH/LH levels are diagnostic for primary or secondary hypogonadism?

A

Secondary

LH/FSH levels are low b/c no feedback loop due to ↓ ant. pituitary

68
Q

Hx of prostate cancer is a contraindication for what HRT?

A

Testosterone

69
Q

What two tests do you need to conduct before starting hypogonadic male on T therapy?

A
  1. DRE

2. PSA

70
Q

What is the initial T regimen for male w/ hypogonadism?

A

IM injections Q 2 wks

Other: Transdermal patch/cream/gel applied daily

71
Q

Once T levels are back w/in normal range, how does the tx regimen change for T replacement therapy in male w/ hypogonadism?

A

Pellets placed subQ Q 3 months

72
Q

How does testosterone therapy place you at an increased coagulation risk?

A

T increases RBC production (erythrocytosis)

73
Q

In addition to lifelong monitoring of free and total T and free estradiol in a M w/ hypogonadism, what tests do you need to preform annually? (2)

A

DRE

PSA

74
Q

Global anterior pituitary dysfunction that leads to decreased ant. pituitary hormones is what disease?

A

Pan-hypopituitarism

75
Q

What are the two most common causes of pan-hypopituitarism?

A
  1. radiation therapy

2. sheehan syndrome

76
Q

What disease is caused by postpartum pituitary gland necrosis due to blood loss and hypovolemic shock during/ after childbirth?

A

Sheehan syndrome

77
Q

What is the most common initial sx of Sheehan syndrome?

A

Agalactorrhea/difficulties with lactation

78
Q

Decreased serum levels of ACTH, TSH, LH, FSH, GH, and prolactin are concerning for what disease?

A

Pan-hypopituitarism

79
Q

Extensive hormone replacement therapy & Ca + Vit. D supplementation is the tx for what ant. pituitary disease?

A

Pan-hypopituitarism

80
Q

What is the most common cause of central diabetes insipidus?

A

idiopathic

81
Q

Will ADH levels be high or low w/ CDI?

A

low

82
Q

Pt presents to you with polyuria, polydipsia, nocturia/ enuresis. Do you expect them to have concentrated or dilute urine?

A

Dilute (central diabetes insipidus)

83
Q

Labs for a pt show:

Hypernatremia (Na > 135)
Serum osmolality = N/↑
Urine osmolality = ↓ (< 250 mOSM/kg)
24 hr urine collection (polyuria > 3L/day)

What disease are you concerned about?

A

central diabetes insipidus

84
Q

What is the drug therapy for central diabetes insipidus?

A

Desmopressin (DDAVP) intranasal

85
Q

Nephrogenic DI is due a lack of production of ADH or a defect in the kidney’s sensitivity to ADH?

A

kidney defect (insensitive to ADH)

86
Q

What is the tx for nephrogenic DI?

A
  • Diuretics (ADH antagonist)

- Low salt/ low protein diet (correct hyponatremia)

87
Q

An ↑ in release of ADH due to CNS disorders, ectopic ADH by malignancies, drugs, surgery/stress, pain is concerning for what disease?

A

SIADH

88
Q

PT presents with N/V and lethargy. Their labs show:

24 hr urine collection = ↓
Serum Na = ↓
Serum osmolality = ↓
Urine osmolality = ↑

What disease are you concerned about?

A

SIADH

89
Q

A pt presents w/ hyponatremia, concentrated urine and decreased urine volume. Do you expect their urine osmolality to be increased or decreased?

A

Increased (SIADH)

90
Q

What is the TX for SIADH?

A

fluid restriction (< 800 mL/day)

91
Q

What physiologic conditions can cause an increase in prolactin? (4)

A
  1. Pregnancy
  2. Breast feeding
  3. Exercise
  4. Stress
92
Q

Will ADH levels be high, low, or normal w/ nephrogenic DI?

A

Normal

Clin Med II (12 decks)

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