Pituitary Dysfunction

Question 1

Hyper TSH

Answer 1

TH resistance
Tumor (thyrotropinoma) - goiter, wt loss, heat intolerance.
Elevated T4 & non-supressed TSH

Question 2

Hypo TSH

Answer 2

Hypothyroidism
Central TSH Deficiency - disease or drug induced
Low T4, normal TSH

Question 3

Hyper PRL

Answer 3

amenorrhea, decrease in libido, inhibition of GnRH
pregnancy, suckling, sleep
Prolactinoma

Question 4

HypoPRL

Answer 4

Rare, Failed lactation in females, nothing in men

Question 5

HyperGonadotropin

Answer 5

Hypertrophic hypogonadism

Adenoma - silent w/mass effect HA, nerve palsies, vision loss

Question 6

Hypogonadotropin

Answer 6

Hypogonadotropic hypogonadism
Females - amenorrhea, Breast atrophy
Male - erectile dysfxn, infertility
Both - down libido, hot flashes
Low FSH/LH

Question 7

Hypercortisol

Answer 7

ACTH-dependent - adenoma, Cushing’s

ACTH-independent - adrenal adenoma, adrenal carcinoma

Question 8

Hypocortisol

Answer 8

Primary AI - high ACTH - darker skin
2nd - most from glucocorticoid
fatigue, anorexia, nausea, weight loss, hyponatremia and hypoglycemia, orthostatic
dizziness, altered mentation, scant axillary/pubic hair

Question 9

HyperGH

Answer 9

before puberty=Gigantism

o Excess after puberty= Acromegaly

Question 10

HypoGH

Answer 10

Laron’s dwarfism (nl GH but bad receptors)

 African pygmies (nl GH but abnl IGF)

Question 11

SIADH

Answer 11

inappropriate ADH release

inappropriately concentrated urine in setting of hypo-osmolality (100 osm)

Question 12

DI

Answer 12

low ADH or ADH insensitivity
hypotonic polyuria (voluminous (>40 ml/kg/d)

Question 13

Nephrogenic DI

Answer 13

won’t respond to dDAVP

Congenital (XR), Drugs (demeclocycline, lithium, amphotericin B), HypoK, hyperCa, Sarcoid, sickle cell

Question 14

Neurogenic DI

Answer 14

will respond to dDAVP

Pituitary tumor, congenital, diz, trauma

Question 15

Cushing’s

Answer 15

Female, Middle-aged
Plethoric/moon facies
Wide (>1 cm), violaceous striae 
Proximal Muscle Weakness
Early/Atypical  Osteoporosis
Obesity, Menstrual Irregularities, Hirsutism
High ACTH, microadeomas

Question 16

Central Adrenal Insufficiency

Answer 16

Suppression of the HPA axis
Fatigue
Anorexia, nausea/vomiting and weight loss
Generalized malaise/aches
Scant Axillary/Pubic hair (DHEA-S dependent in females)
Hyponatremia and Hypoglycemia

Question 17

Apoplexy

Answer 17

headache, vision changes, ophthalmoplegia and altered mental status sudden infarction pituitary gland
Treatment: Surgery, steroids

Question 18

Post Op/Trauma DI

Answer 18

1 - DI-polyuric down AVP release
2 - SIADH from degenerating neurons/excessive AVP release
3 - Permanent DI after depleted ADH

Question 19

Non-secreting tumors

Answer 19

Gonadotroph - presents w/mass effects, make FSH/LH

80% are macroadenomas - resolved w/surgery

Question 20

ACTH tumors

Answer 20

Majority microadenomas
Cushing’s
Basophilic tumor - inferior petrosal sampling

Question 21

GH tumors

Answer 21

80% Macroadenomas
If not 100% resected, can have some hyperGHstill have symptoms and affects lifespan
o Goal is to get