Im Endo Pituitary Usmle 2

Front 1

Where is the anterior pituitary derived from?

Back 1

Rathke's pouch

Front 2

Where is the posterior pituitary derived from?

Back 2

Hypothalamic neuronal axon terminals of the brain

Front 3

what multiendocrine problem includes pituitary tumors?

Back 3

MEN-1
(pituitary, pancreas, parathyroid)

Front 4

where is the site of the primary tumors of the pituitary?

Back 4

Anterior pituitary only
(none in posterior)

Front 5

MC pituitary tumor, it presents w/ glactorrhea and amenorrhea

Tx?

Back 5

Prolactinoma

Tx: Bromocriptine (DA agonist)

Front 6

Dx:
pituitary tumor that presents w/ visual changes or slightly high prolactin levels

Tx?

Back 6

Nonfunctioning Tumor

Tx: surgery

Front 7

Definition:
MC tumor of the suprasellar region in children that arises from the remnants of Rathke's pouch and is solid or cystic; usually calcified

Back 7

Craniopharyngioma

Front 8

Dx:
HA, compression of optic chiasm "tunnel vision", signs of increased intracranial pressure

Back 8

Craniopharyngioma

Front 9

Dx Test for Craniopharayngioma
(3)

Back 9

X-ray - shows enlarged sella

CT / MRI

Hormone studies: excess deficiencies

Front 10

Tx for craniopharyngioma
(3 together)

Back 10

1. Surgery

2. Hormone replacement

3. Dopamine agonist if prolactin-related Sx are noticed

Front 11

specific Etiology of Acromegaly

Back 11

pituitary Somatotrophic Adenoma secreting GH

Front 12

Dx:
progressive enlargement of the peripheral body parts, particularly head, hands, and feet; decreased glucose tolerance; hyperphosphatemia

Back 12

Acromegaly

Front 13

Acromegaly in children

Back 13

Gigantism

Front 14

What hormone in excess is related to acromegaly?

Back 14

GH

Front 15

Dx tests that confirm Acromegaly
(3)

Back 15

1. Serum GH levels - measured in bed in am

2. Lack of GH suppression by glucose

3. Elevated serum IGF-I levels

Front 16

Aside from surgery and radiation, what is the medicine used to Tx Acromegaly?

Back 16

GH receptor blocker:

Pegvisomant
(Somavert)

Front 17

Dx:
29-yo woman w/ inability to lactate after childbirth. Delivery was complicated by blood loss and hypotension

Back 17

Sheehan's syndrome

Front 18

Etiology of Hypopituitraism
(3)

Back 18

Tumors;

Medical/surgical destruction;

Sheehan's syndrome

Front 19

Dx:
36-yo woman complains of amenorrhea for 1 year, increasingly bad HA, clumsiness and sporadic nipple discharge; beta-hCG levels are normal

Back 19

Prolactinoma

Front 20

Drugs that inhibit DA and as a result, cause hyperprolactinemia
(6)*

Back 20

The Prolactin Has Magnified My C-cups:
TCAs;
Prochlorperazine;
Haloperidol;
Methyldopa;
Metoclopramide:
Cimetidine

Hint 20

The Prolactin Has Magnified My C-cups

Front 21

Difference b/t Central DI and Nephrogenic DI w/ respect to ADH

Back 21

Central DI:
inadequate pituitary secretion of ADH

Nephrogenic DI:
lack of renal response to ADH

Front 22

Etiology of Central DI
(4, 3 are systemic)

Back 22

PENS:

1. Posterior pituitary damage
(tumor, trauma, etc)

2. Encephalitis;

3. Neurosyphillis;

4. Sarcoidosis

Hint 22

PENS

Front 23

Dx:
Psychiatric disorder of compulsive water drinking common in young to middle aged women; polyuria and dilute urine.

How is it distinguished from DI?

Back 23

Psychogenic Polydipsia

difference w/ DI:
PP has a low plasma osmolality

Front 24

Etiology of Nephrogenic DI aside from Drugs, renal Dz and electrolyte disorders

Back 24

Sickle cell

Front 25

(3) Drugs that can cause nephrogenic DI

Back 25

"Liquid DM":

Lithium;

Demeclocycline;

Methoxyflurane

Hint 25

Liquid DM

Front 26

Dx:
polyuria (3-15 L/day); thirst; dilute urine (sp gravity < 1.005)

Back 26

DI

Front 27

Dx test for DI
(3)

Back 27

1. plasma Osmolality: High

2. Exogenous ADH: leads to Water deprivation

3. Infusion of hypertonic saline: no response

Front 28

Compare the urine osmolality before and after the infusion of exogenous ADH in:

1. Normal patient

2. Central DI patient

3. Nephrogenic DI patient

Back 28

Normal:
High urine Osm -> high urine Osm

Central DI:
Low urine Osm -> high urine Osm

Nephrogenic DI:
Low urine Osm -> low urine Osm

Front 29

Tx for Central DI

Back 29

Desmopressin (DDAVP)

Front 30

Tx for Nephrogenic DI

Back 30

Thiazide Diuretics

Front 31

Definition:
Excess production of ADH

Back 31

SIADH

Front 32

basic Etiology of SIADH
(3)

Back 32

PIE:

Pharmacologic stimulation of hypo-pit axis;

Idiopathic overproduction of axis;

Ectopic production from tumors

Front 33

what (2) tumors cause SIADH?

Back 33

Small cell lung CA

Pancreatic CA

Front 34

what are the Idiopathic causes of the overproduction of ADH in SIADH?
(5 in 2 categories)

Back 34

CNS:
encephalitis, trauma, stroke

Pulmonary Dz:
TB, pneumonia

*any problem to Lungs or Brain (+ Pancreatic CA) can cause SIADH!

Front 35

(4) Pharmacologic causes of SIADH

Back 35

Carbamazepine;

Chlorpropamide;

Clofibrate;

Vincristine

Front 36

(4)* other causes, aside from small cell and pancreatic cell cancer, of ADH secretion

Back 36

Adrenal failure;

Renal failure;

Edema;

Fluid loss

Hint 36

A REF

Front 37

Dx:
hyponatremia; low serum osmolality; high urinary sodium; urine osmolality > serum

Back 37

SIADH

Front 38

Tx for SIADH
(2 w/ fluids, 1 drug)

Back 38

Fluid restriction;

Hypertonic saline in severe HypoN;

Demeclocycline
(lowers CD response to ADH)