pituitary neoplasia

Question 1

PITUITARY ADENOMAS: Indications for Interventive Therapy (4)

Answer 1

1. hypopituitarism
2. mass effects
3. hypersecretion
4. pituitary apoplexy

Question 2

NONFUNCTIONING PITUITARY ADENOMA Presentation (4)

Answer 2

1. headache
2. visual field abn
3. cranial nerve abn.
4. hypopituitarism

Question 3

NONFUNCTIONING PITUITARY ADENOMA Treatment

Answer 3

surgery is the primary method and with some radiotherapy and pharmacotherapy

Question 4

HYPERPROLACTINEMIA IN WOMEN most common presentation

Answer 4

amenorrhea and galactorrhea

Question 5

HYPERPROLACTINEMIA IN MEN most common presentation however In contrast to women, most men present with _______________, often with headache and visual symptoms in addition to hypogonadism.

Answer 5

loss of libido/ hypogonadism

often present with macroadenomas

Question 6

Don’t just put patient on pharmacologic therapy without exploring cause.

Answer 6

yep

Question 7

prolactinomas express dopamine D2 receptors

Answer 7

yep

Question 8

CABERGOLINE

Answer 8

treatment of prolactinomas by binding to D2 receptor

Question 9

X-LAG seen in pediatric population with gigantism in children due to duplication of __________________________ expressed on X chromosome. Some adults also found with mutation of GPR101.

Answer 9

G-protein-coupled receptor

Alpha-subunit of the stimulatory G protein (GNAS gene or gsp oncogene) (low GTPase activity) conferring constitutive activation of cyclic AMP

Question 10

acreomegaly what have increased?

Answer 10

both elevated GH and IGF-1

Question 11

dopamine agonist in acromegaly

Answer 11

some effect with IGF-1 normalized (not tumor shrinkage)but it is limited by side effects

Question 12

release of ACTH from the pituitary

Answer 12

cushing sydnrome

Question 13

treatment of cushing’s disease

Answer 13

1. transsphenoid microsurgery- very good for microadenomas
2. radiation therapy
3. bilateral adrenalectomy

Question 14

_____________ usually distinguishes tumor from cyst.

Answer 14

Architectural complexity

Question 15

___________ are non-secretory, often suprasellar and consist of architecturally complex arrangements of squamous, cuboidal, and columnar cells and keratinous debris.

Answer 15

Craniopharyngiomas

Question 16

Pituitary adenomas arise in the _____________(or rarely in pharyngeal pituitary remnant), are homogeneous and usually grow in diffuse sheets

Answer 16

adenohypophysis

Question 17

Treatment of _____________ may include surgery, radiation and medications to inhibit cortisol synthesis (ketoconazole), ACTH secretion (somatostatin analogues) or block the glucocorticoid receptor (mifepristone)

Answer 17

Cushing’s disease

Question 18

If one has a clinical suspicion for Cushing’s syndrome based on history and physical, initial testing may include a 1 mg ____________ suppression test, 24 hour urinary cortisol or nighttime salivary cortisol. If initial testing suggests Cushing’s, an _______ should be done

Answer 18

dexamethasone suppression test

If initial testing suggests Cushing’s, an ACTH level should be done

Question 19

Cushing’s syndrome can be subtle in most cases but can lead to significant morbidity due to the chronic effects of cortisol excess on the body.

Answer 19

yep

Question 20

Acromegaly is uncommon but can cause an increase in mortality. __________ level may be diagnostic if elevated for age and gender. A __________ test to assess for GH suppression is often done for confirmation. Treatments include surgery, radiation, somatostatin a

Answer 20

IGF-1 level may be diagnostic if elevated for age and gender.

A glucose tolerance test to assess for GH suppression is often done for confirmation.

Question 21

_____________ are the most common secretory adenomas and are usually treated medically with dopamine agonists (primarily cabergoline).

Answer 21

Prolactinomas

Question 22

The vast majority of pituitary neoplasms are _______________ . About one third of pituitary __________ are clinically silent. Treatment may not be needed unless the ________ is causing a clinical syndrome or is causing local symptoms such as compression of the optic chiasm or cavernous sinus invasion with cranial nerve deficits.

Answer 22

benign adenomas

Question 23

In addition to pituitary tumors, ______________ may be related to pregnancy, several medications especially those which block dopamine, primary hypothyroidism, liver disease, kidney disease and other situations.

Answer 23

hyperprolactinemia