Tidbits 2

Question 1

If someone has acromegaly they almost certainly have____.

Answer 1

A pituitary macroadenoma.

Question 2

Pituitary stalk disruption would likely cause hyper or hypoprolactinemia?

Answer 2

Hyperprolactinemia, due to loss of tonic inhibition by dopamine

Question 3

What is the most common functional pituitary adenoma?

Answer 3

Prolactinoma. 10:1 F:M. Tends to be a microadenoma in a woman of reproductive age (mean 34)

Men get macroadenomas and rarely lactate. More often mass effect symptoms.

Question 4

Cortisol excess is caused by ACTH dependent and independent mechanisms. Name several of each

Answer 4

ACTH dependent (75%)
Corticotroph Adenoma (Cushing’s Disease)
Ectopic Cushing’s (ACTH/CRH tumors)

ACTH independent (25%)
Adrenal Adenomas
Adrenal Carcinoma
Nodular Hyperplasia (micro or macro)

Question 5

Cortisol levels fluctuate. When are they low and high?

Answer 5

Low - midnight

Highest - am

Question 6

Fatigue/weakness
Anorexia, nausea/vomiting and weight loss 
Generalized malaise/aches
Scant Axillary/Pubic hair 
Hyponatremia and Hypoglycemia

What is likely the cause?

Answer 6

Central adrenal insufficiency.

Question 7

Primary adrenal insufficiency most common cause?

CRF, ACTH, Cortisol, Aldosterone, androgen levels?

Answer 7

Addison. (Also TB, HIV, fungi, etc)

CRF, ACTH are up.
Cortisol, aldosterone, androgens are down.

Question 8

What is meant by “Autoimmune Polyglandular Syndromes”?

Answer 8

If a person has one autoimmune disorder, they are likely to have another in the same category. Two syndromes exist, APS-1, and APS-2

Question 9

What diseases are associated with APS-1? What gene is implicated?

Answer 9

Adrenal Insufficiency (Addison’s Disease)
Hypoparathyroidism
Type 1 Diabetes Mellitus
Mucocutaneous Candidiasis

Autoimmune Regulator Gene is implicated

Question 10

What diseases are associated with APS-2? What gene is implicated?

Answer 10

Adrenal Insufficiency (Addison’s Disease)
Hypothyroidism (Hashimoto’s Thyroiditis)
Type 1 Diabetes Mellitus

HLA Associated

Question 11

Two main causes of primary aldosteronism?

Answer 11

Aldosterone producing adenoma (unilateral)
Idiopathic hyperaldosteronism (66%) - bilateral adrenal hyperplasia

Question 12

What familial syndromes are associated with pheochromocytoma (the 10%)?

Answer 12

Multiple Endocrine Neoplasia Type 2A/2B
Von Hippel Lindau Syndrome
Neurofibromatosis Type 1
Familial Paragangliomas (SDH Mutations)

Question 13

What is the rule of 10 regarding pheochromocytoma?

Answer 13

10% bilateral
10% familial
10% benign
10% ectopic (outside adrenal gland)

**Triad of HTN plus sweating, headaches, palpitations raises suspicion for pheochromocytoma

Question 14

Hyperpigmentation =

Answer 14

Addisons = Adrenal insufficiency