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Block 2 FCM > Pituitary Disorders I > Flashcards

Pituitary Disorders I Flashcards

1
Q

Anterior Pituitary Gland 6 major hormones

A
  1. Growth Hormone (GH)
  2. Adrenocorticotropin Hormone (ACTH)
  3. Luteinizing Hormone (LH )
  4. Folllicle Stimulating Hormone ( FSH)
  5. Thyroid Stimulating Hormone (TSH)
  6. Prolactin (PRL)
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2
Q

Incidentally discovered Pituitary adenoma account for ____ of pituitary tumours

A

12 %

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3
Q

Two Key questions you have to ask if it is a Pituitary Incidentalomas

A

Is it Hormonally active ?

Is it causing a mass effect (i.e. exerting pressure on adjacent structure) ?

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4
Q

what do you do for Incidentalomas that are not hormonally active and not causing mass effect?

A

Watchful waiting (observation)

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5
Q

what hormone is produced in the neurohypophysis

A

oxytocin and vasopressin

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6
Q

what would be considered a secretory effect by macroadenoma

A

amenorrhea

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7
Q

anatomy and physiology of pituitary:

  • Pituitary is size of ___.
  • Pituitary sits in _______ in sella turcica of sphenoid bone
  • Pituitary is attached by stalk to hypothalamus called the ______.
  • Made up of 2 lobe: anterior (glans hypophysis) and posterior (neurohypophysis)- ______ lobe is bigger
A

pea
hypophyseal fossa
infundibular stalk
anterior

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8
Q

anterior pituitary secretes what hormones?

A

Luteinizing hormone, Follicle-stimulating hormone, thyrotropin, growth hormone, corticotropin, prolactin

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9
Q

posterior pituitary secretes what hormones?

A

antidiuretic hormone, oxytocin

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10
Q

in Anterior pituitary (adenohypophysis), The only inhibitory on constant basis is ____.

A

dopamine

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11
Q

if you have mass growing on pituitary gland, it can have mass effects. Once big enough it will put pressure on surrounding structures. It can go straight up and put pressure on optic chiasm, if it does this it can cause what kind of vision loss?

A

peripheral vision loss

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12
Q

Posterior lobe of pituitary will light up normally on MRI because of______.

A

vasopressin

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13
Q

If pituitary gets big enough it can push brainstem back and compress third ventricle- this could cause _______.

A

hydrocephalus

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14
Q

what is a Pituitary tumor or mass found incidentaly called?

A

Pituitary Incidentalomas

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15
Q

For pituitary incidentaloma, what is performed to evaluate unrelated disorders?

A

CT or MRI

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16
Q

clinical features of pituitary tumors

A
  1. Headaches: Stretching of Dura by tumor
  2. Hydrocephalus- HA, N and V, imbalance, cognitive and visual changes
  3. Visual field defects: Nasal retinal fibers compressed by tumour
  4. CN palsies and temporal lobe epilepsy
  5. CSF fluid rhinorrhea
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17
Q

If a pituitary tumor is < 10 mm (<1 cm) it is called ______.

A

microadenoma

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18
Q

If a pituitary tumor is > 10 mm (>1 cm) it is called ______.

A

macroadenoma

19
Q

will a Pituitary microadenoma be causing mass effect?

A

usually not, usually macroadenoma does

20
Q

pituitary hormone excess syndromes

A

o Hyperprolactinoma
o Acromegaly
o Cushing’s Syndrome
o Thyrotropin mediated hyperthyroidism

21
Q

Prolactinoma Affects _____ cells of anterior pituitary

A

Lactotroph

22
Q

There is Representative visual field loss in a patient with a pituitary macroadenoma that compresses the_____.

A

optic system

23
Q

in prolactinoma, hypothalamic regulations is by ___ and ___.

A

Prolactin-releasing factors (PRFs) and prolactin-inhibitory factors (PIFs)

24
Q

what I the is the principal PIF regulated by the hypothalamus?

A

dopamine

25
Q

what works against PIFs?

A

Prolactin releasing factors

26
Q

Example of PRFs

A

Thyrotropin-releasing hormone (TRH), Oxytocin, EST, vasoactive intestinal peptide, and peptide histidine methionine

27
Q

_____ will stimulate lactation

A

Oxytocin

28
Q

when oxytocin stimulates lactation, it will reverse effects of _____ and stimulate lactotrophs to produce prolactin

A

dopamine

29
Q

Most common secretory adenoma

A

Prolactinoma

30
Q

Overproduction of prolactin suppresses normal gonadotropin releasing hormone- this will impair release of______.

A

LH and FSH

31
Q

In men, Impaired LH and FSH release from gonadotroph cells, leading to _____.

A

hypogonadism

32
Q

Incidence of prolactinoma

A

44 out of 100,000

33
Q

60% of the males present with macroprolactinomas, while 90% of the females present with microprolactinomas, why is this?

A

because in males it is typically with hypogonadism-> which takes longer

with females it is with missed menses (amenoria) -> women are more likely to go to the doctor sooner because of missed periods and therefore catch it before it gets to be a macroprolactinoma

34
Q

Prolactinoma Prognosis

A

micro 95% do not enlarge

35
Q

is macroprolactinomas or microprolactinomas?

A

macroprolactinomas

36
Q

Prolactinoma Symptoms

in female

A

o Infertility
o Menstrual disturbances
o Oligo (scant bleeding), amenorrhea, irregular, delayed menarche
o Galactorrhea: spontaneous or expressive
o Hypoestrogenism: vaginal dryness/dyspareunia, osteoporosis/-penia

37
Q

Prolactinoma Symptoms

in male

A 
o	Hypogonadism
o	Decreased libido
o	Erectile Dysfunction 
o	Infertility 
o	Gynecomastia
o	If prepubescent: female body habitus/small testicles
38
Q

Other causes of Prolactonemia

A
  • Drugs
  • Spinal cord lesions
  • Idiopathic causes
  • Pregnancy
  • Primary hypothyroidism
  • Chronic renal failure
  • Cirrhosis
  • Adrenal insufficiency
  • Chest wall lesions
  • Breast stimulation
39
Q

in prolactinoma, why should you get hormone levels and MRI?

A

to see if there is actually any mass effect or mass

40
Q

Serum prolactin level ____ in a patient with a macroadenoma greater than 10 mm in size is diagnostic of a prolactinoma.

A

> 200 mcg/L

41
Q

Levels below 200 mcg/L and 10mm in size in microadenmoa suggests ___.

A

hyperprolactinemia secondary to hypothalamic compression

42
Q

Should you draw prolactin levels after you performed a breast exam?

A

no, It can cause prolactin levels to increase and then you will have falsely elevated amount.

43
Q

treatment goal for prolactinoma?

A

The goal is not to produce a normal prolactin level, but to control or shrink pituitary lesion size and restore normal gonadal function, and minimize breast glandular stimulation/galactorrhea

44
Q

first-line treatment for prolactinomas and hyperprolactinemia

A

Dopamine agonists

Block 2 FCM (21 decks)

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