Pituitary Path 2

Front 1

What causes Hyperpituitarism?

Back 1

Functional anterior pituitary adenoma:
1.) Prolactinoma
2.) Growth hormone cell adenoma
3.) Corticotroph cell adenoma
4.) Null cell adenoma
5.)Thyrotroph adenoma

Front 2

What are the two type of pituitary adenoma?

Back 2

- microadenoma- less than 1 cm - functional tumor
- macroadenoma- greater than 1 cm - null cell, prolactinoma, GH adenoma

Front 3

What are microadenomas?

Back 3

Only hormonal effects:
- prolactinoma
- GH adenoma
- ACTH adenoma
- TSH adenoma

Front 4

What are macroadenomas?

Back 4

suppression of post pit.

null cell adenoma- prolactinoma, GH adenoma

Mass effect (i.e. eye problem, increase CSF)- erosion of sella:
a.) stalk effect if some tissue of anti pituitary is present
b.) hypopituitarism- if no ant pit tissue present

DI

Front 5

what is the meaning of mass effect?

Back 5

bitemporal heminopia, increase in ICP(papilledema)

Front 6

What is the meaning of stalk effect?

Back 6

all hormones low, except prolactin with intact AP

Front 7

What is the meaning of Hypopituitarism?

Back 7

all AP hormones are low (may mask stalk effects)

Front 8

What is the Most common of pituitary adenoma?

Back 8

Prolactinomas

Front 9

where do prolactinoma's arise from?

Back 9

acidophilic cells

Front 10

What does prolactinoma cause

Back 10

hyperprolactinoma

Front 11

What are prolactinoma's associated with?

Back 11

MEN 1- Wermer Syndrome

Front 12

What are the c/f of prolactinomas?

Back 12

microadenoma: hyperprolactinoma- amenorrhea, galactorhea, loss of libido, infertility

Macroadenoma: Hyperprolactinemia +mass effect+ hypopituitarism- bone fracture+ sella turcica erosion and DI

Front 13

What are lab findings of prolactinomas?

Back 13

prolactin greater than 200mg/L- secondary hypogonadism

Front 14

What is the pathophysiology of Growth hormone adenomas?

Back 14

increase in GH- increase in somatomedin C(IGF- 1)
-This causes:
lipolysis: increase risk of insulin resistance
deleterious effect on bone

Front 15

What are the two main diseases associated with Growth hormone adenomas?

Back 15

1.) Acromegaly
2.) Gigantism

Front 16

What are the clinical ft s of acromegaly?

Back 16

- excess GH AFTER closure of epiphysis
- proganthism
-Large hands and feet, internal organs
- CHF due to cardiomegaly
- increased soft tissue growth (coarse facial fts)

Front 17

What are the clinical ft.s of gigantism?

Back 17

- excess GH before closure of epiphysis
- tall with long extremities

Front 18

What is associated with Mc Cune-Albright's Syndrome?

Back 18

Gigantism

Front 19

What are the ft.s of Mc Cune -Albright's Syndrome?

Back 19

- MC in females (early breast development and secondary sexual characteristics- by age 5)
- polyostic fibrous dysplasia (abnormally soft ribs)
- cafe au lait spots
-precocious puberty

Front 20

What are the investigations you would conduct in any GH adenoma?

Back 20

-Increase in GH, increase in somatomedin, increase in insulin, increase in glucose
-abnormal OGTT( Decreased- insulin resitant)
- x ray shows increased soft tissue
- excess bone
-Secondary hypogonadism (macroadenoma= due to decreased FSH/LH= bone fracture)

Front 21

What are the ft s of a corticotroph adenoma?

Back 21

microadenoma less than 1 mm
functional tumor secretes ACTH- increase in GC= cushings disease

Front 22

What are the findings in a dexamethasone test when a pt is suffering of corticotroph adenoma?

Back 22

low dose- no change
High dose- suppresed ACTH and cortisol in serum and urine

Front 23

What is a thryotroph adenoma?

Back 23

TSH-producing secondary hyperthyroidism

Front 24

What is a Null adenoma?

Back 24

-produce only MASS effect= bitemporal hemanospia
- may produce hypopituitaris and DI
- Erosion of sella turcica

Front 25

What is the etiology of craniopharyngioma?

Back 25

- tumor derived from remnants of Rathke's pouch (child)
- suprasellar mass that causes MASS effect(hypopituitarism later)
- infiltration of posterior pituitary- DI
- Can infiltrate with somatic and sexual develpment = dwarf

Front 26

What the gross ft s of craniopharyngioma?

Back 26

solid or cystic often calcified

Front 27

What are the micro ft s of craniopharyngioma?

Back 27

dentigenous tissue or sq and columnar cells forming cystic area

Front 28

What happens in hypopituitarism?

Back 28

75% of adenohypophysis is destroyed.

Front 29

What is the etiology of hypopituitarism?

Back 29

-ischemic coagulative necrosis
1.) sheehan's syndrome- postpartum hemorrhage with hx of HOTN
2.) sickle cell anemia
3.) DIC, shock
- Nonsecretory adenomas- Null cell adenoma= compression atrophy

Front 30

What are the c/f of hypopituitarism?

Back 30

pallor: loss of MSH
Hypothyroidism: reduced TSH
Hyoadrenalism: low ACTH, Normal Na+ and K+
Amenorrhea, loss of libido, infertility: abscence of GnRH= secondary hypogonadism- osteoporosis and bone fractures

Front 31

What is the etiology of Sheehan's syndrome?

Back 31

Hx of HOTN+ pregnancy= hyperplastic pituitary- postpartum hemorrhage

Front 32

What are the effects of sheehan's syndrome?

Back 32

- Immediate: lactation abnormality due to low prolactin
- Low BMR, cold sensitivity: low TSH= secondary hypothyroidism
- Weakness, hypotension, low blood sugar: low ACTH, normal Na+ and K+

Front 33

Pt. presents with amenorrhea,myxedema, alopecia infertility, decrease in libido due to low FSH/LH and sex steroid.

Back 33

Sheehan's syndrome

Front 34

What the most imp cause of craniopharyngioma?

Back 34

Diabetes insipidus

Front 35

What is the etiology of DI?

Back 35

Neurogenic: Null cell adenoma cranopharyngioma, glioma

Front 36

What are the c/f of DI?

Back 36

polyurea and polydipsea

Front 37

What is the pathogenesis of Neurogenic DI?

Back 37

deficient production of ADH from posterior pituitary

Front 38

what are the lab findings of neurogenic DI?

Back 38

serum: hypernatremia, hyperkalemia, high osmolarity
urine- low specefic gravity and osmolarity- polyurea
greater than 50% increase in urine osmolarity following vasopressin injection

Front 39

What is the cause of Nephrogenic DI?

Back 39

unresponsive renal tubules to ADH

Front 40

What are the lab findings of Nephrogenic DI?

Back 40

- less than 10% in urine osmolarity following injection of vasopressin

Front 41

How do you differentiate btw Nephrogenic and Neurogenic DI

Back 41

give vasopressin injection:

- Neuro= greater than 50% increase in urine osmolarity
- Nephro= less than 10% increase in urine osmolality

Front 42

What happens in SIADH?

Back 42

there is an excess of ADH

Front 43

What is the etiology of SIADH?

Back 43

small cell carcinoma of lung (paraneoplastic syndrome)

Front 44

What are the lab values of SIADH?

Back 44

serum: low Na+, low osmolarity
Urine: high specefic gravity, high osmolarity

Front 45

What are the c/f of SIADH

Back 45

Oligurea (but NOT renal failure), cerebral edema

Front 46

What is another name for type 1 MEN?

Back 46

Wermer's syndrome

Front 47

What are the diseases associated with Type 1 MEN?

Back 47

Prolactinoma: mass effect and amenorrhea/ galactorrhea, bone fracture

Primary parathyroid Hyperplasia: hypercalcemia- kidney stone, acute pancreatitis

Pancreatic tumor: Gastrinoma: multiple non healing ulcers

Front 48

What are the diseases associated with MEN2 A?

Back 48

Meduallary carcinoma of they thyroid and parathyroid hyperplasia+ pheochromocytoma

Front 49

What is another name for MEN 2A?

Back 49

Sipple syndrome

Front 50

What is the genetic predisposition of MEN 2A?

Back 50

Autosomal dominent
activation of RET Protooncogene

Front 51

What is another name for MEN 2B?

Back 51

William syndrome

Front 52

What are the diseases associated with MEN 2B?

Back 52

medullary carcinoma of the thryoid and pheochromocytoma+ mucosal intestinal neuromas