Pituitary Gland Disorders Flashcards
1
Q
Hypopituitaryism- Eti
A
- Due to hypothalamic or pituitary dysfunction
- Single to multiple hormone deficiencies
- Due masse, lesions, hemorrhages & infarction, trauma, infections
2
Q
Hypopituitaryism- Sx
A
- Symptoms are based deficiency in hormones effected
- Confusing clinical presentation
- Adrenal insufficiency is life threatening
3
Q
Anterior Pituitary Hormones
A
- Growth hormone
- Prolactin
- Adrenocorticotropic hormone
- Thyroid stimulating hormone
- Lutenizing & Follicle Stimulating hormone
4
Q
Growth Hormone deficiency
A
- Mild to moderate central obesity
- Decreased energy, concentration, depression
- Reduced been mass, increase LDL
- Decreased CO
5
Q
Gonadotropin deficiency
A
- Decrease LH & FSH
- Loss of facial, axillary, pubic & body hair
- Men: libido, ED, infertility
- ## Women: Amenorrhea, infertility, osteoporosis, muscle atrophy
6
Q
TSH deficiency
A
Hypothyroidism- fatigue, weakness, weight gain, hyerplipidemia
7
Q
ACTH deficiency
A
Weakness, fatigue, wt loss, hypotension
-
8
Q
Hypopituitaryism- Dx
A
- Lab studies based on suspected deficiency:
- TSH + Free T4
- LH, FSH, Estrogen, testosterone & prolactin
- Cortisol & ACTH response
- Serum IGF-I
- MRI of hypothalamus & pituitary
9
Q
Hypopituitaryism- Tx
A
- Replacement of missing hormones
- Surgical debulking if indicated
- Hydrocortisone, levothyroxine, rhGH
10
Q
Diabetes Insipidus- Eti
A
- Deficiency or resistance of ADH/ vasopressin
- Primary due to autoimmune reaction, genetics
- Secondary due to hypothalamic or stalk damage
11
Q
Diabetes Indipidus- Sx
A
- Intense thirst
- Polyuria- 2-20 L daily
- Hypernatremia & dehydration
12
Q
Diabetes Indipidus- Dx
A
- No single diagnostic test
- 24hr urine creatinine & volume >2L
- Serum gluvose, urea, calcium, potasssium, sodium & uric acid
- Vasopressin challenge test with desmopressin
13
Q
Diabetes Indipidus- Tx
A
- Desmopressin acetate
14
Q
Acromegaly & gigantism- Eti
A
- Acromegaly = pituitary adenoma, macro, non-malignant
- GH stimulates release of IGF-I from liver & other tissue
- McCune-Albright and Carney complex
15
Q
Acromegaly & gigantism- Sx
A
- Youth: tall stature & gigantism
- Dough, moist, enlarged hands
- Coarse facial features & voice
- Cardiomegaly & HTN
- Arthralgia, spinal stenosis
- Skin tags, acne, acanthosis nigricans
16
Q
Acromegaly & gigantism- Dx
A
- Serum IGF-I- screening
- Fasting IGF-I, PRL, glucose and CMP to determine increased levels
- MRI indicating pituitary tumor (90% pts have)
17
Q
Acromegaly & gigantism- Tx
A
- Pituitary transsphenoidal microsurgery- Remission in 70% patients
- Cabergoline- dopamine agonist, tumor reduction
18
Q
Acromegaly & gigantism- Prog
A
- M & M from cardiovascular disorders
19
Q
Hyperprolactinemia- Eti
A
- Microadenomas
- Medications (opioids, antipsych, estrogen, SSRI, tricyclics)
20
Q
Hyperprolactinemia- Sx
A
- Reduced fertility
- Women: amenorrhea, galactorrhea, oligomenorrhea
- Men: Hypogonadism, decreased libido, ED, infertility
21
Q
Hyperprolactinemia- Dx
A
- Eval for pregnancy, hypothyroid, kidney & liver disease, & hyperparathyroid to RO other causes
- MRI
22
Q
Hyperprolactinemia- Tx
A
- Stop offending meds
- Dopamine agonists!- 90% effective (cabergoline, bromocriptine)
- No surgery
23
Q
SIADH- Eti
A
- Excess of ADH leads to retention of water, hyponatremia
- Carcinomas, osmostat disorders
- Hypotonic, euvolemic hyponatremia
24
Q
SIADH- Sx
A
- CNS symptoms- lethargy, weakness, confusion, delerium, seizures
25
SIADH- Dx
- Serum Na+ concentration <135
| - Decreased serum osmolality with increased urine osmolality
26
SIADH- Tx
- Furosemide
| - Restrict water intake