E: Hpa And Thyroid 2

Front 1

What are the 4 basic mechanisms of hyperprolactinemia?

Back 1

(1) lack of hypothalamic DA
(2) hypothalamic DA can't be delivered adequately to the ant. pituitary
(3) ant. pituitary is insensitive to hypothalamic DA
(4) lactotroph cells are being stimulated by something else (estrogen, TRH)

Front 2

What classes of drugs contain things that can cause hyperprolactinemia?

Back 2

antiHTN, GI meds, Antipsychotics, AntiD, cocaine, opiates, protease inhibitors.

Front 3

What are clinical sx of hyperprolactinemia in women? men?

Back 3

- women: 30-80% galactorrhoea, menstrual irreg, infertility
- men: <30% galactorrhoea, impotence, viz field abnormalities, HA, extraocular muscle weakness, ant. pituitary malfunction

Front 4

Sx of gonadotrophin deficiency in women? men?

Back 4

- women: amenorrhoea/oligomenorrhoea, infertility, dyspareunia, breast atrophy, loss of 2ndary sexual hair
- men: poor libido/impotence, infertile, small/soft testicles, loss of 2ndary hair.

Front 5

What is the primary tx for almost all pts with pathological hyperprolactinemia?
- current drug options for this in the US?
+ common SE?

Back 5

DA agonist therapy.
- bromocriptine, cabergoline
+ N&V, orthostatic hypotension

Front 6

Which subunit (a or b) of pituitary glycoprotein hormones is the active one?
- which do most nonfunctioning pituitary tumors secrete?

Back 6

Beta.
- alpha

Front 7

When dealing with a tumor causing mass effects on the way to panhypopituitarism, what is hte order of hormone loss?

Back 7

GH, LH, FSH, TSH, ACTH, PRL

Front 8

TSH deficiency causes what clinical sx in children? adults?

ACTH deficiency in all ages causes what?

Back 8

- growth retardation
- \energy, constipation, sensitivity to cold, dry skin, weight gain

weakness, tiredness, dizziness on standing (orthostatic hypotension), pallor, hypoglycemia

Front 9

Generally speaking, what sorts of medical problems should make us think of a pitutary tumor?

Back 9

unexplained HA, impotence, loss of pubic/axillary hair, galactorrhea, amenorrhea, infertility, anorexia/WL

Front 10

acral enlargement/coarse features, sweating, menstrual upset, HA, arthriris, carpal tunnel syndrome, diabetes, impaired libido, HTN....and many others are sx (in decreasing prevalence order) on presentation of what endocrine disorder?

Back 10

acromegaly.

Front 11

What effect does G loading have in agromegaly?

Back 11

their plasma glucose stays high on oral glucose challenge. Normally, it should drop.

Front 12

What is the surgical tx for acromegaly?

Other tx?

Back 12

transsphenoidal hypophysectomy.

Xrt, Somatostatin analogs, Dopamine Agonists, growth hormone receptor antag (directly inhib IGF-1 secretion)

Front 13

Can dopamine agonists like bromocriptine and cabergoline cause tumor shrinkage?
- what percentage of pts achieve adequate control re: IGF-1 lvls on these meds

Back 13

very little clearly documented data on this.
- 10-20%.

Front 14

What is octreotide?

Pegvisomant?
- efficacy at normalizing IGF-1 lvls?
- SE?

Back 14

somatostatin mimic, more potent than biological version.

Growth Hormone receptor antagonist.
- can be 97%+ on higher doses.
- rare LFT elevations.

Front 15

Fatigue, cold intolerance, bradycardia, constipation, dry skin, hair loss, etc. Top of the DDx?
- of these disorders, which is more severe, primary or secondary?

Back 15

hypothyroidism.
- primary

Front 16

Midline facial defects, such as cleft palate, central incisor, etc. are common in which hormone deficiency?

Back 16

GH deficiency

Front 17

Aplasia and hypoplasia of the pituitary are often due to deletions in which genes?

Howabout isolated GH deficiency?

Back 17

Prop-1 and Pit-1 (both pituitary transcription factors)

GH-N gene

Front 18

What can insulin induced hypoglycemia directly test for?

Back 18

GH secretion

Front 19

What is the metyrapone test?

Back 19

Tests the pituitary's capacity to secret ACTH by blocks 11 hydroxylation of 11- deoxycortisol, and resulting in a fall in serum cortisol and a rise in 11-deoxycortisol.

In normals the fall in cortisol results in a rise in ACTH secretion secondary to negative feedback of cortisol on ACTH (which has now been decreased b/c cortisol has dropped)