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Endocrinology > Pituitary tumors > Flashcards

Pituitary tumors Flashcards

1
Q

what visual pattern do you see with pituitary tumors

A

bitemporal hemianopsia

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2
Q

clinical presentation of acromegaly

A

changes in appearance, sizes for gloves, hats, rings, shoes

see carpal tunnel syndrome, hypertension, impaired glucose tolerance and OSA and increased risk for colon cancer

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3
Q

initial screening exam for acromegaly?

A

IGF-1 and if elevated next step is to do a glucose tolerance test and measure Growth hormone levels

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4
Q

diagnosis of acromegaly

A

positive IGF-1

then a impaired glucose tolerance test and high Growth hormone levels

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5
Q

treatment of acromegaly

A

surgical

if pt has prolactinoma then try medical management.

But if any loss of vision need surgery.

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6
Q

normal physiological causes of hyperprolactinemia

A

pregnancy, breast feeding and stress

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7
Q

pathological causes hyperprolactinemia

A

pituitary adenomas (prolactinomas)
hypothalamic dx with decreased dopamine (malignancy, sarcoidosis)
drugs (antipsychotics, metoclopramide)
hypothyroidism
chest wall injury (burns and herpes zoster)
chronic kidney disease
following a generalized tonic clonic seizure or focal seizure

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8
Q

what kind of seizures can cause an acute rise in prolactin?

A

generalized tonic clonic or focal seizure

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9
Q

pt has elevated prolactin and herpes zoster

A

chest wall injury can increase prolactin levels

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10
Q

what other endocrine disorder can be associated with high prolactin level?

A

hypothyroidism

due to stimulatory effect of TRH on prolactin as it’s trying to stimulate pituitary to release TSH.

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11
Q

what medications can cause an elevated prolactin level?

A

antipsychotics, metoclopramide

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12
Q

how does CKD cause elevated prolactin level?

A

it is not cleared as well and drop in 30% clearance. See a 3 fold increase in prolactin release (as a result of altered inhibitory effect of dopamine

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13
Q

mens symptoms of high prolactin

A

ED, decreased libido, infertility, gynecomastia, and rarely galactorrhea

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14
Q

pre menopausal women with high prolactin have these symptoms

A

galactorrhea and menstrual irregularities

can have amenorrhea

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15
Q

post menopausal women with elevated prolactin levels

A

asymptomatic.

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16
Q

what is screening test for acromegaly (first test)

A

IGF-1 level.

If elevated need to follow with a oral glucose suppression test.

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17
Q

if considering acromegaly and first IGF-1 was elevated, what test do you order to confirm this?

A

oral glucose suppression test.

If adequate GH suppression then not acromegaly

If inadequate GH suppression then you need to order a MRI of pituitary to look for a mass.

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18
Q

what does oral glucose suppression test look at?

test is (75 g oral glucose load) then measure GH hormone within 2 hrs

A

confirmatory testing for acromegaly since there was an elevated IGF-1 level.

A normal (non acromegaly pt) will have adequate GH suppression. GH decreases to <1 ng/ml

Someone with acromegaly will have inadequate GH suppression. GH levels <2 ng/ml

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19
Q

management of acromegaly with a pituitary mass

A

needs surgical management

could consider medical management

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20
Q

If pt has suspected acromegaly with (elevated IGF-1 and inadequate GH suppression) but MRI brain DOES NOT have a pituitary mass what to check next?

A

need to evaluate for extra pituitary cause of acromegaly (ectopic GH or GHRH secreting tumor)

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21
Q

presentation of acromegaly

A

new bilateral carpel tunnel syndrome
new skin tags, oily skin, excessive malodorous sweat and enlarging hands
OSA

22
Q

how many people with acromegaly also have carpel tunnel syndrome?

A

about 20% incidence and likely from edema in the median nerve.

23
Q

how to treat carpel tunnel induced acromegaly?

A

treat acromegaly and symptoms of CTS resolve.

24
Q

Why do we check IGF-1 levels when concerned for acromegaly

A

because IGF-1 levels are consistently high in pts with acromegaly.

Don’t measure growth hormone levels because this can fluctuate in diurnal pattern and cannot be used to make diagnosis.

25
Q

indications for treatment for prolactinoma female

A

females: classic symptoms of amenorrhea, galactorrhea,
infertility
acne and hirsutism

26
Q

indications for treatment for prolactinoma male

A

hypogonadism, erectile dysfunction

gynecomastia

27
Q

indications for treatment for prolactinoma for both sexes

A

enlargement of adenoma, mass effect symptoms

osteoporosis or increased risk for bone loss

28
Q

Treatment of lactotroph pituitary adenomas or prolactinoma is dependent on

A

tumor size and metabolic complications

> 10 mm is a macroprolactinoma and needs tx

<10mm is a microprolactinoma and doesn’t need tx.

29
Q

long term effects of not treating a microprolactinoma

A

Hyperprolactinoma causes gonadotropin secretion suppression and can cause low estrogen leading to infertility, amenorrhea, oligomenorrhea, vaginal dryness with dyspareunia and hot flashes. can also cause osteoporosis.

30
Q

treatment of microprolactinoma

A

treat with cabergoline which can lower prolactin production and stop hypoestrogenic complications

31
Q

untreated acromegaly clinical features of local tumor effect

A

pituitary enlargement visual field defects, headache, cranial nerve defects

32
Q

untreated acromegaly clinical features of MSK/skin

A

gigantism, maloccluded jaw, arthralgias, arthritis, proximal myopathy
hyperhidrosis
skin tags
carpel tunnel syndrome

33
Q

untreated acromegaly clinical features of: cardiovascular

A

cardiomyopathy, HTN, heart failure, valvular disease (mitral and aortic regurgitation)

34
Q

untreated acromegaly clinical features of pulmonary and GI

A

OSA, narcolepsy, colon polyps and cancer and diverticulosis

35
Q

untreated acromegaly clinical features of enlarged organs?

A

tongue, thyroid, salivary glands, liver, spleen, kidney and prostate

36
Q

endocrine effects of untreated acromgely are:

A

galactorrhea, decreased libido, DM2, hyperparathyroidism and hypertriglycercidemia

37
Q

acromegaly is at increased risk for:

A

colon, esophageal, gastric and melanoma

due to IGF1 stimulating the mucosal cell proliferation.

38
Q

who has higher risk for developing cancer with acromegaly?

A

family history of colon cancer, age >50
male sex
longer duration of acromegaly
>3 skin tags

39
Q

screening colon colonoscopy should be at

A

time of diagnosis and every 3-4 years after the age of 50 yrs

40
Q

untreated acromegaly also has a higher risk for

A

mortality for cardiovascular dx and cancer

41
Q

hyperphosphatemia is seen in

A

acromegaly pts too due to IGF1 stimulation of renal tubular phosphate reabsorption

42
Q

what is lymphocytic hypophysitis?

A

rare disease that is caused by inflammatory infiltration of the pituitary gland and marked by inflitration of the lymphocytes

seen in women and mostly those after pregnancy or post partum period

will have hypopituitarism and so needs testing.

43
Q

Diagnosis of lymphocytic hypophysitis

A

MRI will show diffuse homogenous sellar mass with both an enlarged pituitary gland and largement of the pituitary stalk which looks “pear shaped”

44
Q

lymphocytic hypophysitis presentation

A

mimic a pituitary adenoma and so see headache which can be severe, intractable and generalized or focal retroorbital or bitemporal.

see fatigue, lethargy and loss of libido, amenorrhea, dizziness, nausea and vomiting and DI

45
Q

pituitary hypofunction from tumors in sella result from

A

compression of normal pituitary stalk

seen with craniopharyngiomas, Rathke cleft cysts, arachnoid cysts

46
Q

hypophysitis is

A

diffuse enlargement of the pituitary gland

seen in infiltrative disorders like sarcoidosis, TB, lympohma and normal pregnancy.

47
Q

for macroadenomas visual field testing should happen every

A

6-12 months.

48
Q

prolactinoma present and pt is pregnant. what is preferred treatment

A

bromocriptin over cabergoline due to shoert acting

49
Q

side effects of dopamine agonists (bromocriptine and cabergoline)

A

insomnia, constipation and nasal stuffiness and dry mouth

50
Q

when do we transphenoidal surgical resection of prolactinoma?

A

if prolactinoma doesn’t respond to maximal drug therapy after several months of treatment

also can be done in women who want fertility and have masses >3 cm

51
Q

what is macroprolactinemia?

A

benign condition that has NOTHING TO DO WITH A PROLACTINOMA

caused by preciptitation of IgG bound to prolactin.

Endocrinology (26 decks)

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