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Endocrine-Week 1/2 > Pituitary Hyperfunction > Flashcards

Pituitary Hyperfunction Flashcards

1
Q

The vast majority of Pituitary Tumors secrete what hormone(s)

A

Prolactin (50%)

Non-Secretory (40%)

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2
Q

Functions of Prolactin

A 
Milk PRODUCTION (not let-down)
Oppose action of Gonadotropins (FSH & LH) and estrogen
Inhibits GnRH release
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3
Q

How might a Prolactinoma result in low testosterone in males?

A

Prolactin opposes the action of Gonadotrophins and inhibits GnRH release

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4
Q

MOA for Hyperprolactinemia

A

Deficiency of Dopamine
Defective delivery of Dopamine
Insensitivity to Dopamine
Stimulation of Lactotroph cells (by oestrogen)

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5
Q

What are some pathologies/diseases that can cause Hyperprolactinemia

A 
Prolactinoma
Acromegaly
Pituitary stalk disease (or compression)
Renal insufficiency (dec. prolactin clearance)
Seizures
Cirrhosis
etc.
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6
Q

Medications that can cause Hyperprolactinemia

A 
Antihypertensives (Verapamil, Methydopa)
GI meds (Metoclopramide, Domperidone, H2 blockers)
Psych drugs (SSRIs, MAO inhibitors, Chlorpromazine, Atypicals)
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7
Q

Signs/Symptoms of Hyperprolactinemia

A

Female:

  • galactorrhea
  • Menstrual irregularity
  • Infertility
  • loss of pubic hair

Male:

  • galactorrhea
  • Impotence (erectile dysfunction & dec. libido)
  • Visual Field Abnormalities
  • Extraocular Muscle Weakness
  • loss of pubic hair
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8
Q

The earliest change that occurs with Hyperprolactinemia (in females) is the loss of ____ and ___ due to the inhibition of _____ release from the Hypothalamus

A

LH and FSH; GnRH

*remember that prolactin opposes the actions of gonadotrophins and inhibits GnRH

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9
Q

Treatment for Hyperprolactinemia

A

Dopamine agonist therapy (1st line)

Monitor w/o tx if asymptomatic with stable prolactin and no loss of sex hormones
*surgery and radiotherapy have limited use

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10
Q

Examples of Dopamine Agonists (for Hyperprolactinemia treatment) (2 total)

A

Bromocriptine

Cabergoline

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11
Q

Side Effects of Dopamine Agonist

A

Orthostatic Hypotension
Psychosis
Nausea & Vomiting
Sleep Disturbances

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12
Q

Acromegaly is due to _______ excess in adults

A

Growth Hormone

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13
Q

Signs of Acromegaly (GH excess)

A 
Bone growth (acral changes like shoe size, ring size, hat size)
neuromuscular
Thickening of skin (heel pad)
Hypertension
Resp. problems
Cardiomyopathy
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14
Q

IGF-I

A

insulin-like growth factor I (good for GH monitoring)

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15
Q

Diagnostic methods for Acromegaly

A
  1. Measure IGF-I (stable and unaffected by meal; more reliable than GH)
  2. Failure to suppress GH < 1 ng/mL after oral glucose administration
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16
Q

Which sign/symptom of Acromegaly (GH excess) has the most impact on mortality

A

Acromegaly + Cardiac disease (HTN, cardiomyopathy, etc.)

  • life expectancy dropped by 10 YEARS!!
17
Q

Treatments for Acromegaly

A

Medication (1st line)

  • Dopamine Agonists (direct inhibition of GH)
  • Somatostatin Analogs (direct inhibition of GH)
  • GH receptor antagonists (most potent)

Surgery
Radiotherapy

18
Q

Example of GH Receptor Antagonist

A

Pegvisomant

19
Q

The earliest presenting symptom in women with hyperprolactinemia is

A

infertility

* due to loss of mid-cycle surge of LH and FSH

20
Q

What symptoms always appears along with amenorrhea?

A

galactorrhea

21
Q

(T/F) Dopamine agonists reduce pituitary tumor size.

A

True

22
Q

_______ (organs) are stimulated by GH to synthesize _______ , which stimulate other target tissues

A
  1. bone, muscle, fat, and liver

2. IGF-1

23
Q

Pattern of GH secretion

A

pulsatile

24
Q

Examples of Somatostatin analogs (for acromegaly treatment)

A

Octreotide
Lanreotide

  • -otides
25
Q

Major pros of using D2 agonists for acromegaly tx

A

Pros:

  • GH suppression
  • Possible tumor shrinkage
  • serum IGF-1 normalizes in many patients
26
Q

Major pros and cons of using somatostatin analogs for acromegaly tx

A

Pros:

  • GH suppression
  • Possible tumor shrinkage

Cons:
- Majority of patients do not achieve IGF-1 normalization

27
Q

(GH/IGF-1) is associated with reduced morbidity (disease) and mortality (life expectancy)

A

IGF-1

28
Q

Acromegaly with un-normalized IGF-1 is associated with what morbidity conditions?

A
  1. CVD (main cause of their death)
  2. Colon cancer
  3. Thyroid cancer
  4. Diabetes Mellitus
29
Q

What is the method of choice for treating acromegaly?

A

Transsphenoidal adenomectomy

  • Medication if tumor is inoperable

Endocrine-Week 1/2 (18 decks)

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