Term
| Name five different mechanisms of acquired hypopituitarism. |
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Definition
Anticoagulation or bleeding disorders
Patients on heart-lung bypass
Diabetes mellitus
Pituitary irradiation
Sheehan's Syndrome
Large pituitary tumors
Prior pituitary surgery
Prior pituitary irradiation
Infiltrative diseases
Empty sella – fluid pushes it
Hypothalamic disease |
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Term
| Clinical diagnosis: panhypopitutarism |
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Definition
Inability to breast feed
Fatigue
Loss of body hair
Amenorrhea
Cold intolerance, slowed mentation
Minimal orthostatic BP changes |
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Term
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Definition
“Due to hemorrhage and shock”
during delivery |
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Term
| On MRI you see the Pit stalk coming down, deviated….all surrounded with fluid pushing the sella down. What is this? |
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Definition
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Term
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Definition
TSH - Treat with levothyroxine – it’s not normal for her…needs this! You’re instead going to follow her T3/4, not TSH.
ACTH - Treat with hydrocortisone – would have inc mineralo and glucocort…but this isn’t part of the physiologic control mech of aldost
LH & FSH
Estrogen (or testosterone in men)
If fertility is desired, treat with LH and FSH
ADH - ddAVP (synthetic ADH)
Usually given as nasal spray or pill |
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Term
| T/F: GH and prolactin replacements are viable parts of sheehan's tx |
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Definition
F
GH
Adults - Minimal indications for replacement, but available at $10,000 a year
Children - Need to be replaced through puberty
Prolactin - No replacement available |
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Term
When you shake hands with a patient, you are struck by the fleshy feeling of his palm. You also notice his large jaw, protruding forehead, and widely spaced teeth. You can't feel his calcaneus...
What optic findings do you expect? |
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Definition
| Eyes: Loss of peripheral vision (bitemporal hemianopsia) |
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Term
| What labs do you expect (Glucose/GH/Somatomedin C/MRI |
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Definition
all elevated
Pituitary MRI: Large pituitary tumor, extending above the sella and pressing on the optic chiasm |
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Term
| T/F: acromegaly can be due to both GH and GHRH producing tumors that have been around for even 9 years |
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Definition
T: but GHRH tumors are RARE
Some cases are due to Gas mutations that constituitively activate adenylate cyclase |
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Term
| T/F: Unlike Somatomedin C, GH is the more reliable measure of GH secretion after diagnosis with an MRI |
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Definition
F:IGF-I (Somatomedin C)
Most reliable
Reflects overall GH secretion over time
GH
Unreliable by itself
Usefulness increases in setting of a GTT
MRI - inappropriate
You do NOT make endocrine diagnoses with imaging procedures. |
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Term
| T/F: An acromegaly px can be diagnosed by the abnormal pulsations in GH levels over 24 hrs. |
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Definition
| T: they never go down to ZERO especially in the AM or with a glucose tolerance test |
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Term
| Disorders associated with acromegaly |
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Definition
Cardiovascular disease
Respiratory complications
Glucose intolerance or diabetes
Hypertension
Colonic malignancies
Neuromuscular |
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Term
Post surgery the patient's GH levels decreased but IGF-1 levels were high and he was HTNsive and Diabetic...
What was his chance of recurrence?
What's the next course of treatment? |
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Definition
Surgical resection
Cure rates (for small tumors) about 50-60%
Recurrence is about 10%
External beam radiation
For recurrent disease
Takes years for full effect
Associated with loss of other pituitary function |
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Term
The patient refuses to get radiation therapy and wants to get medical therapy that he read about that would either
a) inhibit GH secretion or
b) antagonize the GH receptors
Given his diabetes which therapy is better and what are the names? |
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Definition
Pegvisomant
Somatostatin analogues: octreotide or lanreotide
Somatostatin normally inhibits GH secretion
Octreotide reduces GH levels and tumor size
Complications: hyperglycemia and gallstones. SRIF => decreases insulin => diabetes...
Short and long acting forms available
Pegvisomant
GH receptor antagonist
Works as well as octreotide |
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Term
QUIZ: A 26 year old woman presents with a chief complaint of amenorrhea for about one year. She has been having frequent headaches and nausea lately, which is unusual for her. She has never been pregnant, and is taking no medications.
Physical exam: Normal except for milky discharge expressed from each breast.
What test to order? |
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Definition
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Term
What levels are indicative of prolactinomas?
T/F: prolactinomas are bigger in women than men |
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Definition
>200 prolactin level
<100 are rarely prolactinomas
False. |
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Term
| In a prolactinoma patient it's common to get galactorrhea. What other condition do you get this in? |
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Definition
TRH stimulates galactorrhea so in hyperthyroidism u get it
most prolactinoma px get galactorrhea and oligoamenorrhea |
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Term
| List the Causes of hyperprolactinemia |
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Definition
Pituitary disease
Prolactinoma
Acromegaly
Neurogenic
Breast stimulation
Chest wall lesions
Hypothalamic disease (including stalk) |
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Term
| T/F: a macroadenoma can secrete prolactin and increase levels |
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Definition
| F: it blocks dopamine transport inhibiting prolactin |
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Term
| QUIZ: medications that cause hyperprolactinemia |
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Definition
Medications
Neuroleptics (antidopaminergic)
Triccyclic antidepressants
Estrogens (including oral contraceptives)
Cocaine
Narcotics
Reglan
Verapamil
Aldomet |
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Term
| Other physiologic Causes of hyperprolactinemia |
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Definition
Pregnancy
Hypothyroidism
Chronic renal failure
Cirrhosis
Adrenal insufficiency
Idiopathic |
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Term
| Treatment issues - Is hyperprolactinemia bad for you? |
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Definition
Yes
If the tumor is big
If menses are not normal
If fertility is an issue
If galactorrhea is concerning to the patient |
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Term
| When is surgery indicated for prolactinomas? radiation? |
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Definition
Surgical
Best for big, bulky tumors with extension
External beam radiation
Rarely indicated |
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Term
| Male presentation of prolactinoma |
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Definition
Impotence
Panhypopituitarism
Local compression
Symptoms go unnoticed while tumor grows
Loss of interest in TV remote control |
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