Pituitary Dz Overview Flashcards
Pituitary location, Surrounded by
Tumors can result in
Most common tumor is
Identified via
> 10 mm
<10 mm
Mass effect sx seen more often w
Sella turcica, bone
significant mass effects, such as HA, bilateral hemaniospia
Pituitary adenomas
imaging
Macroadenoma
Micro
Macro
Pituitary dz can result from
Adenoma of one cell type results in
Hyperfxn tumor can be ___ and ____ with pharm therapy
Most common hyperfxn cell ine is from ___, resulting in ____
hyperfxn cell line
excess formation of a hormone
suppressed, shrink
lactotrophs, prolactinoma
Pit Dz from generalized hypofxn due to
AP susceptible to injury bc
acute presents after
Presentation depends on
most dangerous sx occur when
ischemia or hemorrhage
more tenuous blood supply than PP
head trauma, acute blood loss, injury
amount of nonfxn pituitary
ACTH is not produce, no stress response w cortisol
Nonfxn macroadenoma can be
if large, results in
Compress surrounding gland, leading to
Goal of treatment
Usually requrie
asx, incidental finding
sx w mass effect
dec sec of pituitary hormones, compress optic chiasm (vis impairment) or generalized pressure (HA)
dec mass effect, restore hormone fxn, restore vision
surgery/radiation
Prolactinoma mc _____ tumor
made up of
Prolactins primary role in pituitary
Inappopropriate sec of prolactin in women results in
In men
hormone secreting pituitary
lactotroph cells that secrete prolactin in AP
milk prodxn after childbirth, inhibiting GnRH to dec ovulation/fertility in women
galactorrhea, amenorrhea, infertility
Low libido, galactorrhea
Dx of prolactinoma
prolactin suppresses, these should be
pregnancy can ____ prolactin, so must be
Prolactin is usually ___ by DA
Tx includes
DA agonists include
Tumors respond
serum prolactin levels
GnRH, FSH/LH, low
inc, ruled out
inhibited
DA agonists to dec prolacin release
Bromocriptine/cabergoline
well, shrink
Pituitary apoplexy caused by
usually happens bc
another mechanism
Pt presents w
Most dangerous sx
Leads to
hemorrhage or infarct of pituitary gland, leads to sudden dysfxn
macroadenoma grows/compresses blood supply- ischemia/necrosis
BV suppling tumor rupture- hemorrhage
sudden onset HA, N/V (mass effect), visual impairment, diplopia/defects
sudden onset hypopituitarism (not enough ACTH)
dec Cortisol- cant maintain stress response/blood pressure
Dx Pituitary apoplexy
Tx aimed at
May be
additional measure
imaging
relieve compression, improve sx, replace hormones for hypopituitarism
Neurosurgical emergency
replace cortisol w corticosteroids
Sheehan syndrome aka
occurs after
During pregnancy, pituitary will
after delivery w hemorrhage
typically does not result in
presents w
other hormones also
postpartum pituitary gland necrosis
intrapartum/postpartum hemorrhage
enlarge in preparation for lactotrophs to produce prolactin for breast feeding w/out inc blood supply
dec blood supply can be more significant in enlarged pituitary gland, leading to ischemia/cell death
lost pituitary fxn
failure to lactate (dec prolactin)
dec, effects produced at slower rate
Acromegaly/ Gigantism
caused by
Gigantism occurs if
Acromegaly (MC) occurs, resulting in
patients w acro have
benign pituitary adenoma, releasing excessive GH
happens before fusion of bone epiphysis, resulting in tall stature
after epiphyses fuse, bone/soft tissue enlarge
large hands/feet (inc over time), frontal bossing (inc hat size), inc space between teeth (jaw grows), macroglossia, CTS
GH other effects
excess can lead to
Testing for acromegaly
GH levels not useful bc
Tx
anti-natriuretic and gluconeogenic actions
HTN, hyperglycemia
serum IGF1 (produced by liver at steady rate)
pulsatile, varies throughout day
Surgery (if large) or octreotide (somatostatin analog) to inhibit GH release
GH deficiency
presents w
tx w
FtT, short stature, obesity, delayed puberty
synthetic GH replacement
Craniopharyngioma
tumor of brain derived from
RP forms
tumor is _____ and ___ growing, can ____
Sx include
can progress to
tx
imaging feature
remnants of Rathke pouch
adenohypophysis in wk 4 of gestation from surface ectoderm
benign, slow, invade local structures
dull HA, bitemporal hemaniopsia due to compressed optic chiasm
compress PG (hypopituitarism)
surgical resection (good prognosis)
bright structure in sella turcica indicates Ca
PP do
ADH (Vasopressin fxn)
SIADH leads to
Inadequate ADH (DI) leads to
retain H2O in kidneys
excessive retetion of water, hypoNa
excessive loss of H2O via urination- dehydration, hyperNa, impaired mental status
