- Longitudinal acceleration of linear growth secondary to insulinlike growth factor I (IGF-I) excess - Tumor mass may cause headaches, visual changes due to optic nerve compression, and hypopituitarism - Hyperprolactinemia is a common finding; it results from pituitary growth hormone (GH) excess,

Two baseline GH levels are obtained prior to ingestion of 75 or 100 g of oral glucose, and additional GH measurements are made at 30, 60, 90, and 120 minutes following the oral glucose load. A rise, or no suppression is diagnostic. Measure serum GH 1 hour after oral administration of 100 g of glucose. Clearly elevated GH levels (>10 ng/mL) after oral glucose, combined with the clinical picture, secure the diagnosis of acromegaly, while a normal GH level (< 5 ng/mL) after oral glucose essentially excludes the diagnosis. GnRH can be measured IGF-I can be measured Prolactin is often also measured since it can be co-secreted in 20% of tumors Imaging: MRI of brain CT scans of abdomen/pelvis or chest if brain is negative

#1 Trnassphenoidal Sx Radiation Octreotide - Bromocriptine - Pegvisomant (Somavert) -

recombinant Growth Hormone +/- other pituitary hormone replacement

Pituitary DO Flashcards by Shay S

HPA Axis hormones functions

respond to stress
thyroid stim, growth, reproduction

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Which pituitary gland is the producer? which is the storer?

Anterior - Producer
Posterior - Storer

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Anterior and Posterior Pituitary glands secrete which hormones?

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Growth hormone excess is referred to as _____
Growth hormone deficiency is referred to as _____

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what stim and inhibits Growth hormone secretion?

GHRH stim
Somatostatin inhibits

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High levels of growth hormone are usually caused by ____

a GH-secreting tumor

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what increases growth hormone secretion?

think big picture

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What decreases growth hormone secretion?

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Giantism vs Acromegaly
Which occurs during childhood?

Giantism = during childhood (b4 growth plates close)
Acromegaly = Adulthood

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genetic causes of Giantism

familial isolated pituitary adenoma
multiple endocrine neoplasia type 1 (MEN1)
McCune-Albright syndrome (MAS)
Carney complex with onset during
prepubescence

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Giantism SS

Longitudinal acceleration of linear growth secondary to insulinlike growth factor I (IGF-I) excess
Tumor mass may cause headaches, visual changes due to optic nerve compression, and hypopituitarism
Hyperprolactinemia is a common finding; it results from pituitary growth hormone (GH) excess,

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Acromegaly WU

Two baseline GH levels are obtained prior to ingestion of 75 or 100 g of oral glucose, and additional GH measurements are made at 30, 60, 90, and 120 minutes following the oral glucose load. A rise, or no suppression is diagnostic.
Measure serum GH 1 hour after oral administration of 100 g of glucose. Clearly elevated GH levels (>10 ng/mL) after oral glucose, combined with the clinical picture, secure the diagnosis of acromegaly, while a normal GH level (< 5 ng/mL) after oral glucose essentially excludes the diagnosis.

GnRH can be measured
IGF-I can be measured
Prolactin is often also measured since it can be co-secreted in 20% of tumors
Imaging: MRI of brain
CT scans of abdomen/pelvis or chest if brain is negative

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Acromegaly Complications

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Acromegaly Trmnt

# 1 Trnassphenoidal Sx
Radiation
Octreotide -
Bromocriptine -
Pegvisomant (Somavert) -

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MC pituitary hormone deficiency in children

Growth Hormone Deficiency

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2 main ways you get pituitary dwarfism

Isolated LOW growth hormone
Generalized - ALL pituitary hormones are LOW

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Pituitary Dwarfism WU

IGF-1 levels
XR of LT Hand to determine bone age
MRI to r/o calcifications, tumors, structural anomalies
ACTH, 8 am serum cortisol level, LH, FSH, Prolactin levels

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Dx Criteria for Pituitary Dwarfism

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Dwarfism Trmnt

recombinant Growth Hormone
+/- other pituitary hormone replacement

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Which HPA hormones should be eval for deficiencies?

ALL
Cortisol
Thyroid
ADH
Sex hormone around time of puberty

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Why do new moms need to try breastfeeding ASAP

Stim Prolactin -> breastfeeding

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What stim prolactin secretion

sleep
stress
pregnancy
chest wall stimulation or trauma
TRH, dopamine receptor antagonists, primary hypothyroidism
prolactinomas (tumor)

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Approximately 75% of patients presenting with galactorrhea and amenorrhea have _____.

hyperprolactinemia

Drugs that can cause Hyperprolactinemia

Dopamine-receptor antagonists (phenothiazines, butyrophenones, thioxanthenes, metoclopramide, sulpiride, pimozide)
Conventional and atypical antipsychotics (Haloperidol, risperidone{70-100%}, olanzapine, quetiapine, amisulpride)
Dopamine-depleting agents (methyldopa, reserpine)
Others (isoniazid, danazol, tricyclic antidepressants, monoamine antihypertensives, verapamil, estrogens, antiandrogens, cyproheptadine, opiates, H2-blockers [cimetidine], cocaine)

Prolactin levels >_______ req brain imaging

100-250ng/mL ## Footnote Med induced will be high but under 100 usually

why may you need a DEXA scan if you have Hyperprolactinemia?

persistent low estrogen/testosterone can lead to osteoporosis

Initial drug of choice if hyperprolactinemia ET is pituitary in orgin

**Bromocriptine** (Dopamone AGONIST)

Prolactin Deficiency is MC assosiated with post-partum _____ Syndrome

Sheehan ## Footnote postpartum pituitary necrosis necrosis of cells of the anterior pituitary gland following significant post-partum bleeding, hypovolemia, and shock.

Mom lost a lot of blood during birth and is having trouble starting breastfeeding. Concern for?

Sheehan syndrome (postpartum pituitary necrosis) Prolactin deficiency ## Footnote Lose blood flow to anterior pituitary -> ischemia

WU for prolactin deficiency

Prolactin Deficiency trmnt

**Lifelong replacement of pituitary hormones:** Hypothyroidism can be treated with levothyroxine Cortisol deficiency can be treated with prednisone or hydrocortisone. Gonadotropin deficiency should be treated with estrogen if the uterus has been removed with a combination of estrogen and progesterone if a uterus is present. The growth hormone is probably the most common hormone that needs replacing, and the dosage must be individualized to the patient's need. For patients who develop diabetes insipidus, desmopressin (DDAVP)

Excess ADH is ____

SIADH

ADH deficiency is ____

Diabetes insipidus

what does ADH do?

dont pee save water at collecting duct Vasoconstricts at high levels

What incr and decr ADH secretion?

Central Diabetes Insipidus (ADH Deficiency)

Primary vs Secondary Central Diabetes Inspidus

Non-central Diabetes Insipidus

* Nephrogenic Diabetes Insipidus - tubule receptors dont respond correctly to ADH * Psychogenic Polydipsia - drinking too much water -> kidney becomes insensitive to ADH (>6L)

Water Deprivation Test

Pt does water deprivation test. No urine concentration increase is seen. What may this be?

Diabetes insipidus

Are those with psychogenic polydipsia able to concentrate their urine during water deprivation test?

YEs

Tx for water deprivation test?

restrict fluid intake to ≤ 2 L/day Norm concentrating ability will return within several weeks

Central Diabetes Insipidus (ADH Deficiency) Trmnt

Desmopressin (DDA VP) ## Footnote mimics endogenous vasopressin

3 non-hormonal drugs that reduce polyuria?

1. Diuretics, primarily thiazides 2. Vasopressin-releasing drugs (eg, chlorpropamide, carbamazepine, clofibrate) 3. Prostaglandin inhibitors(NSAIDs)

Chlorpropamide, carbamazepine, and clofibrate stimulates increased renal tubular water reabsorption (pee less). This is effective on which type(s) of diabetes Insipidus?

ONLY central diabetes insipidus. May even eliminate need for vasopressin! ## Footnote WONT work for nephrogenic diabetes insipidus bc their receptors are shot

Nephrogenic Diabetes Insipidus Trmnt

Indomethacin (NSAIDs make you pee less) Na+ intake restriction Thiazide Diuretic

ADH excess is referred to as ____

SIADH Syndrome of Innapropriate AntiDiuretic Hormone Secretion

SIADH definition

Dilute serum (hyposmolarity) concentrated urine ## Footnote NO other physiological cause of vasopressin secretion Normally, low plasma osmolality inhibits vasopressin secretion, allowing the kidneys to produce dilute urine.

Euvolemic vs Hypervolemic vs Hypovolemic Hyponatremia

* Euvolemic - norm water gain and loss (equalized free water) * Hypervolemic - water retention is greater (CHF, Cirrhosis) * Hypovolemic - Na+ loss is greater (MCC by renal diuretic like thiazide or extra renal causes)

Which type of hyponatremia is SIADH?

Euvolemic Hyponatremia

SIADH etiology

SIADH WU

SIADH Trmnt

Treatment of cause Fluid restriction Sometimes a vasopressin receptor antagonist Sometimes NS

# SIADH Fluid Restriction only drink ____ L a day

250-500L ## Footnote Also give loop diuretic combo with IV 0.9% saline to slowly correct severe Na+ deficits without inducing vol overload

If pt with SIADH cannot tolerate water restriction, giving ____ will unconcentrate the urine. However, it can cause acute kidney injury (AKI)

Demeclocycline