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medicine > Pituitary Disorders - Cryar > Flashcards

Pituitary Disorders - Cryar Flashcards

1
Q

What are the main pituitary disorders

A 
Hypopituitarism
Hyperprolactinemia
Acromegaly
Cushings disease
Diabetes insipid us
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2
Q

What is hypopituitarism?

A

Diminished or absent secretion of anterior pituitary hormones

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3
Q

What are two ways you can have hypopituitarism?

A

Primary disorder of anterior pituitary cells

Reduced stimulation by the hypothalamus

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4
Q

What is pan hypopituitarism?

A

Generalized loss of anterior pituitary hormones

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5
Q

What are the causes of hypopituitarism?

A 
neoplasms
infections or granulomas
vascular
infiltrative
physical injury
releasing hormone deficiencies
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6
Q

Clinical features of panhypopituitarism

A 
weakness, malaise, nausea, vomiting
amenorrhea, breast atrophy
testicular atrophy
absence of axillary and pubic hair
waxy skin, fine periorbital wrinkling
hypothermia
hypotension, hypoglycemia
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7
Q

What features are not usually present in panhypopituitarism?

A

hyperpigmentation

aldosterone is less frequently involved

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8
Q

What causes the weakness, malaise, nausea and vomitting of panhypo pit?

A

adrenal insufficiency - lack of ACTH secretion from the ant pit

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9
Q

What is often the key diagnostic sign of panhypo pit?

A

absence of axillary and pubic hair

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10
Q

What causes the hypothermia of panhyp pit?

A

lack of thyroid hormones from the ant pit

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11
Q

What causes the hypotension and hypoglycemia of panhypo pit?

A

lack of glucocorticoids

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12
Q

What do the clinical features of Panhypo pit depend on?

A

the specific deficiencies
age
sex

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13
Q

How does age affect the clinical features of panhypo pit?

A

short stature and delayed puberty in children

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14
Q

How does sex affect the clinical features of panhypo pit?

A

impotence in men

ammenorrhea in women

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15
Q

What is pituitary apoplexy?

A

rapid hemorrhage into the pituitary gland

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16
Q

What is pituitary apoplexy characterized by?

A

sudden onset of excruciating headache
diplopia
hypopituitarism

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17
Q

What is the etiology of diplopia in apoplexy?

A

pressure on the oculomotor nerves

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18
Q

Hypopituitarism

A

sella has no way to expand

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19
Q

What is pituitary apoplexy often mistaken for?

A

stroke

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20
Q

What is the most important endocrine consideration for treatment with apoplexy?

A

Treatment of cortisol deficiency

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21
Q

How is pituitary apoplexy treated?

A

surgery for ocular consequences
treat cortisol def.
spontaneous improvement of both ocular and hormonal deficiencies can occur with time so milder cases can be watched and supported

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22
Q

What is Sheehan’s syndrome?

A

infarction after postpartum hemorrhage

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23
Q

How does severe sheehan’s syndrome present?

A

lethargy, anorexia, weight loss, failure to lactate

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24
Q

How does a mild case of Sheehan’s present?

A

failure to lactate and failure to resume menses

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25
Q

What eventually happens to the pituitary in Sheehan’s syndrome?

A

eventual development of small pituitary in a normal sized sella

26
Q

What is Sheehan’s sometimes mistaken for?

A

empty sella syndrome

27
Q

If Sheehan’s is suspected, what most be promptly assessed and treated?

A

adrenal insufficiency - the remaining deficiencies can be evaluated 4-6 weeks later

28
Q

What deficiency from Sheehan’s is there no treatment for?

A

prolactin deficiency - which prevents lactation

29
Q

What do you find on diagnosis of panhypo pit?

A

low levels of target organ hormones without a compensatory increase in pituitary hormones

30
Q

What levels do you want to avoid measuring as the only screening for a possible hormone deficiency? and why?

A

anterior pituitary hormones - bc the levels may be low, normal or high - the key is how they are relative to end organ hormone levels

31
Q

How do you treat panhypo pit?

A

the same way you would treat primary deficiencies

32
Q

What do you need to be cautious of when treating hypothyroidism?

A

Be sure to recognize and treat any underlying adrenal insufficiencies first

33
Q

How do pituitary neoplasms often present?

A

headache and visual disturbances (especially if non secretory)
excessive secretion or deficiency of ant pit hormones may be present

34
Q

How is prolactin unique among the anterior pituitary hormones?

A

it is under tonic suppression

this means lesions in the hypothalamus or affecting the pituitary stalk cause increased prolactin secretion

35
Q

What are some causes of hyperprolactinemia?

A

prolactin secreting pituitary adenoma
loss of dopaminergic suppression from the hypothalamus
nipple stimulation or chest wall injury
estrogen - increase is proportional to levels of estrogen
hypothyroidism
chronic renal failure
multiple drugs

36
Q

What are one of the main classes of drugs causing hyperprolactenemia?

A

antipsychotics

37
Q

How does hyperprolactermia present in women?

A

as a microadenoma
amenorrhea
galactorrhea

38
Q

How does hyperprolacternemia present in men?

A

macroadenoma
impotence
visual disturbances

39
Q

Differential of prolactin levels?

A

normal < 20
intermediate 21 - 150
tumor > 150

40
Q

What is the treatment for hyperprolactinemia?

A

Dopamine Agonists

- bromocriptine
- cabergoline
41
Q

What is the major risk of treatment of hyperprolactinemia with cabergoline?

A

valvular heart disease seen in patients treated for parkinsons disease

42
Q

What is MAINLY seen with acromegaly?

A

acral enlargement

soft tissue overgrowth

43
Q

What are some other things seen with acromegaly?

A 
headache
vision loss
hypopituitarism
cardivascular disease
visceral enlargement
sleep apnea
increased risk for malignancies (colon)
44
Q

How do you clinically diagnos acromegaly?

A

fully developed syndrome is unmistakable

more commonly found in earlier, less pathognomonic stages

45
Q

How do you diagnosis acromegaly with laboratory confirmation?

A

somatomedin-C (IGF-I) is the best screening test (GH levels are variable)

46
Q

How do you treat acromegaly?

A

primary treatment is surgical - but it is often not curable

secondary therapy is - radiation of the sella or somatostatin analogues

47
Q

What is cushings syndrome?

A

clinical manifestations of glucocorticoid excess (from any source)

48
Q

What is cushings disease?

A

glucocorticoid excess specifically due to ACTH secretion from a pituitary adenoma

49
Q

How do you determine the etiology of Cushing’s syndrome?

A

exogenous steroids or adrenal tumor = low ACTH
Cushing’s Disease = normal to high ACTH
ectopic ACTH = very high ACTH

50
Q

How do you diagnos Cushing’s Disease?

A

Relies on the ability to suppress ACTH

dexamethasone - demonstrate suppressibility of endogenous cortisol production

51
Q

What would a dexamethosone suppression test show on a patient with Cushing’s Disease?

A

No cortisol production suppression

52
Q

Why is imagine problematic in cushing’s disease?

A

50% of patients have a “normal” pituitary on CT or MRI

53
Q

How can you localize the source of ACTH to the pituitary when no adenoma is imaged?

A

Inferior petrosal sinus testing for ACTH

54
Q

How is ADH secretion regulated?

A

very tightly regulated by osmolality

osmotic regulation is overridden by volume status

55
Q

What is diabetes insipidus?

A

failure to appropriately concentrate the urine

56
Q

What is central vs. nephrogenic DI?

A

central - inadequate ADH

nephrogenic - failure of kidney to respond to ADH

57
Q

What is the etiology of central DI?

A

trauma, surgery, infiltrative or idiopathic

58
Q

How do you diagnos DI?

A

polyuria and polydipsia
urine volumes > 3L per day
dilute urine with a serum osmolality > 295 (although some patients can compensate)

59
Q

What is the water deprivation testing for DI?

A

water is withheld until urine osmolality stable
primary polydipsia - urine osmolality > serum
DI - urine osmolality remains low while serum osmolality increases

60
Q

How do you tell the difference bw central or nephrogenic DI?

A 
Administer DDAVP (AHD analogue)
central DI - urine osmolality increase by 50%
nephrogenic DI - no change

medicine (15 decks)

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