Pituitary Disorders - up to Hypopituitaratism Flashcards
Management for an <1 cm incidentaloma
Prolactin level
MRI (yearly)
Management for an >1 cm incidentaloma
9: Prolactin level MRI (yearly) 24-hour urine cortisol TSH T4 LH FSH IGF Test visual fields for evidence of optic chiasm compression
Empty Sella Syndrome etiologies
associated with surgery, obesity, and radiation therapy; however, 70% are
idiopathic.
Empty Sella Syndrome management
“Check
thyroid and adrenal function.
Panhypopituitarism WEIRD name etiologies
Rathke cleft cysts, meningiomas,
craniopharyngiomas,
Panhypopituitarism Presentation
Hormone deficiency specific
can be any of them! creo
Panhypopituitarism general etiology
anything that damages
the brain, from tumor to stroke to infection to trauma, can cause panhypopituitarism.
Prolactin deficiency: cx fx
NONE in men
Women: inhibits lactation after childbirth.
LOW Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): Women
cxfx
will not be able to ovulate or menstruate normally and will become
amenorrheic.
CxFx if LOW Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): men
Men will not make testosterone or sperm.
erectile dysfunction and decreased muscle mass.
FSH
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) what happen in both sex?
Both will have
decreased libido and decreased axillary, pubic, and body hair.
Kallmann syndrome Etiology
KAL-1 mutation
Kallmann syndrome
FSH and LH?
Decreased FSH and
LH from decreased
GnRH
Kallmann syndrome cxfx
Anosmia
Renal agenesis in
50%
delayed or absent puberty.
Kallmann syndrome tx
In male individuals: testosterone
In female individuals: estrogen and progesterone
Klinefelter syndrome Etiology
47 XXY karyotype
Klinefelter syndrome
FSH and LH?
Androgen deficiency through insensitivity to FSH and LH despite
high FSH/LH levels
Klinefelter syndrome tx
Replace testosterone
Growth hormone (GH) deficiency Children cxfx
present with short stature and
dwarfism.
Growth hormone (GH) deficiency Adults
Central obesity
Increased LDL and cholesterol levels
Reduced lean muscle mass
Panhypopituitarism One important Lab
Hyponatremia is common secondary to hypothyroidism and isolated glucocorticoid underproduction.
K is normal!
Panhypopituitarism initial tests
TSH, T4, IGF, estrogen,
testosterone, LH, FSH, and prolactin.
GH deficiency Dx
best initial
stimulatory test is injecting growth hormone–releasing hormone (GHRH). The
normal response to GHRH is a rise in GH level
What confirmatory test to do after: Low thyroid-stimulating hormone (TSH) and low thyroxine levels
Decreased TSH response to thyrotropin-releasing
hormone (TRH)
What confirmatory test to do after: Decreased
adrenocorticotropic
hormone (ACTH) and
decreased cortisol level
Normal response to cosyntropin stimulation test of the adrenal.
Cortisol will rise (adrenal is normal) in recent disease, but abnormal in chronic disease
because of adrenal atrophy.
What confirmatory test to do after: Decreased LH and FSH
levels
Decreased testosterone
level
No confirmatory test
When suspecting hypopituitarism
You receive this test
GH levels low, ( and we know this finding is not helpful
since GH is pulsatile and maximum at night.)
What confirmatory test would you do next to confirm your presumption?
GH stimulation test. Results:
No response to GH releasing hormone (GHRH)
No response to arginine infusion
What confirmatory test to do after: Prolactin level low, but
not helpful
No response to TRH
when performing cosyntropin stimulation test, An elevated baseline cortisol level means that:
it excludes pituitary insufficiency.
Metyrapone test
an older and less useful test. How does it work?
Metyraprone inhibits 11-beta hydroxylase. this ↓output of the adrenal gland. this normally cause ACTH levels to ↑, as cortisol goes ↓
Insulin stimulation:
The normal effect of insulin-inducing hypoglycemia is
a rise in GH level. GH increases glucose levels because it is a stress
hormone. “Insulin-induced hypoglycemia” as a test is always the wrong
answer.
panhypopituitarism Tx
Replace deficient hormones with: Cortisone FIRST Thyroxine AFTER cort Testosterone and estrogen Recombinant human growth hormone
sheehan’s sx
also known as postpartum pituitary gland necrosis, is hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth. Causes panhypopituitarism
apoplexy
after a known or unknown pituitaty tumor, it starts to bleed, it is developed coma, nuchal rigidity, headache, visual defect. Causes panhypopituitarism
chronic hypopituitarism etiologies
autoinmune
desposition (sarcoid or amyloid)
tumor
chronic hypopituitarism cx fx
symptoms of fsh and gh insufficency
decreased libido
fatige
menstrual cycle
chronic hypopituitarism dx
insulin stimulation test. vasopresin stimulation test. MRI
high urinary Osmo and Na are important in
serum psmo and Na low
SIADH
SIADH etiologies
brain lesion lung lesion (small cell CA) tho any granuloma, any pneumonia, can do it, often a malignancy
high adhn
SIADH tx
water restriction.
Reverse underlying disease
if none works:Demeclocycline, induces Diabetes insupidus
NMT: si no te orina diles “DEMEclocycline”
kinds of diabetes insipidus and patho
Central
Nephrogenic
patho: low adh
diabetes insipidus dx
water deprivation test.
It rules out psycogenic polidypsia.
Measures de uri osmo during water depriv.
results: if just after deprivation osmo rises up:psycogenic pd. If it only goes up after ADH=diabetes insipidus central.
If even after giving ADH, osmos is same … so it is nephrogenic dbtinsp
diabetes insipidus tx
central. DDAVP, “vasopresin! intranasal
nephrogenic: gentle diuresis: hydroclorotiazide + amilioride
