Clin Med - Pituitary & Adrenal Disorders
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The releasing hormones (CRH, TRH, GnRH, PRH, and GHRH) as well as inhibiting hormones (Somatostatin for GH inhibition and Dopamine for Prolactin inhibition) are all hormones of the:

  • Posterior pituitary
  • Anterior pituitary
  • Hypothalamus (correct)
  • Thyroid

    • What hormones are released for the posterior pituitary gland?

  • ACTH (Adrenocorticotropic hormone)
  • ADH (antidiuretic hormone) and Oxytocin (correct)
  • GH (Growth hormone), LH/FSH (Luteinizing hormone / Follicle-stimulating hormone)
  • TSH (Thyroid stimulating hormone)

    • Problems at the level of the end organs such as the thyroid, adrenals, ovaries, or testes are considered:

  • secondary disease
  • primary disease (correct)
  • tertiary disease
  • fifth disease

    • A patient presents with complaints of headaches and vision loss. Upon PE you notice several cranial nerve palsies. The patient's labs show deficiencies in multiple pituitary hormones. You are suspicious for a pituitary adenomas that has lead to the impingement on the:

    <p>Pituitary, optic chiasm, cavernous sinus and CSF</p> Signup and view all the answers

    For pituitary adenomas, signs and symptoms are related to size. Microadenomas are < __cm. Most are found incidentally and asymptomatic.

    <p>1</p> Signup and view all the answers

    ~50% of all pituitary adenomas are nonfunctional, meaning non-hormone producing/secreting.

    <p>True</p> Signup and view all the answers

    What is the initial imaging study for ALL suspected adenomas?

    <p>MRI</p> Signup and view all the answers

    If you find a deficit in one pituitary hormone, check them all for good clinician skill.

    <p>True</p> Signup and view all the answers

    The treatment for a deficiency in a pituitary hormone is replacement of the necessary hormone.

    <p>True</p> Signup and view all the answers

    A male patient presents to your clinic with c/o decreased libido, depression, fatigue and headaches. On PE, you notice slight enlargement of the breast tissue. What labs might you want to order next?

    <p>Testosterone</p> Signup and view all the answers

    A prolactinoma is the most common ___________ tumor of the anterior pituitary. This is seen by markedly elevated prolactin levels.

    <p>functional</p> Signup and view all the answers

    If you are worried about a patient having a prolactinoma, what medication do you need to rule out first? This medication is know to block the D2 receptors that is dopamine sensitive.

    <p>Haloperidol</p> Signup and view all the answers

    What imaging modality would you order if you had concerns for a prolactinoma?

    <p>MRI</p> Signup and view all the answers

    When is Transsphenoidal surgery recommended for prolactinomas?

    <p>For macroprolactinomas</p> Signup and view all the answers

    A patient presents with a hunched back, enlarged hands, feet, and cranium. You suspect acromegaly. What lab finding supports this?

    <p>Increased IGF1</p> Signup and view all the answers

    Is this gigantism or acromegaly? Either way - increased growth hormone!

    <p>Stimulation of epiphyseal cartilage growth plates = Gigantism osteoblastic activity increased bone mass = Acromegaly new cartilage translates into height and length = Gigantism Enlarged bones of hands, feet, cranium, nose, supraorbital ridges, lower jawbone = Acromegaly</p> Signup and view all the answers

    What is the most common cause of growth hormone deficiency?

    <p>Pituitary tumor, or consequence of treatment of the tumor (surgery and/or radiation therapy)</p> Signup and view all the answers

    A young child with a history of early radiation therapy has been delayed in hitting their growth milestones. What could be the cause of the short-stature of this child?

    <p>GH deficiency</p> Signup and view all the answers

    Dwarfism is most commonly causes by a LACK of growth hormone.

    <p>False</p> Signup and view all the answers

    Diabetes insipidus and diabetes mellitus share common mechanisms

    <p>False</p> Signup and view all the answers

    Diabetes Insipidus - What's the problem??

    <p>There is a problem with the production of ADH = Central DI There is a problem with the kidney's response to ADH = Nephrogenic DI Deficiency of ADH = Central DI Kidney and nephron dysfunction or insensitivity = Nephrogenic DI</p> Signup and view all the answers

    Patients with Diabetes Insipidus can becomes rapidly HYPOvolemic and HYPOtensive if unable to access free water.

    <p>True</p> Signup and view all the answers

    I'm not sure, is this central or nephrogenic diabetes insipidus? I have constant excessive thirst, urination that is diluate, and I am dehydrated!

    <p>my labs are showing a LOW ADH = central my labs respond to treatment with desmopressin = central my labs have no response to desmopressin = nephrogenic my labs show HIGH ADH = nephrogenic</p> Signup and view all the answers

    Lithium toxicity can cause nephrogenic DI.

    <p>True</p> Signup and view all the answers

    What diagnostic test would you use to diagnose a patient with Central Diabetes Insipidus?

    <p>Water deprivation test</p> Signup and view all the answers

    A patient presents to the ER with seizures, headache, and BP of 180/120. You immediately notice that their urine is thick and dark. Their labs show highly concentrated urine sodium and urine osmolarity, but very diluted serum osmolarity. What is a likely cause?

    <p>Increased ADH</p> Signup and view all the answers

    I have excessive thirst.

    <p>high urinary output, I am losing too much fluid = Diabetic Insipidus low urinary output, I am retaining too much fluid = SIADH Hypernatremia and dehydrated = Diabetic Insipidus Hyponatremia and over-hydrated = SIADH</p> Signup and view all the answers

    The adrenal glands A&P

    <p>Stores lipids = adrenal cortex controlled by sympathetic division of ANS and changes persist of several minutes = adrenal medulla produces epinephrine (adrenaline) and norepinephrine = adrenal medulla produces steroid hormones (corticosteroids) that persist of several days or weeks = adrenal cortex</p> Signup and view all the answers

    What are the most common drug causes of primary adrenal insufficiency?

    <p>Ketoconazole</p> Signup and view all the answers

    A mother has just given birth to her child, but begins to rapidly deteriorate due to excessive blood loss from childbirth. She passes away from an acute infarct from secondary adrenal insufficiency. What is this condition called?

    <p>Sheehan’s syndrome</p> Signup and view all the answers

    A patient presents with fatigue, weight loss, anorexia, and hyperpigmentation of their skin. The nurse lets you know that they have low blood pressure and positive orthostatics. After running some labs, you find hyponatremia and hyperkalemia. What is a likely cause?

    <p>Adrenal Insufficiency</p> Signup and view all the answers

    57-year-old woman presented with symptoms of diffuse skin hyperpigmentation developed during last year, including increased pigmentation of palmar creases and wrists compared to a normal female. What is a likely cause?

    <p>Addison's Disease</p> Signup and view all the answers

    What is the initial diagnostic test for primary adrenal insufficiency?

    <p>Morning cortisol</p> Signup and view all the answers

    What is the definitive test for primary adrenal insufficiency (Addison's)?

    <p>Cosyntropin (Cortrosyn) Stimulation Test</p> Signup and view all the answers

    Primary adrenal insufficiency can present as an acute, medical emergency due to surgery, acute illness, infection, stress, or abrupt removal from steroids. Patients often present with s/s of shock, hypotension and dehydation. What is this life-threatening medical emergency called?

    <p>Adrenal Crisis</p> Signup and view all the answers

    What is NOT a potential cause of the high levels of cortisol seen in Cushing's syndrome and disease?

    <p>High BMI due to diet and lack of exercise leading to increased cortisol</p> Signup and view all the answers

    A female patient presents with thin extremities in comparison to the higher distribution of abdominal and facial fat. You notice enlargement of the fatty area of her lower neck and upper-back. The patient has HTN and dark facial hair. You notice abdominal striae and poor wound healing. What might you be suspicious of?

    <p>Cushing's</p> Signup and view all the answers

    What is the preferred initial diagnostic test for Cushing's that can show elevated levels of cortisol?

    <p>Late night salivary cortisol</p> Signup and view all the answers

    A patient presents with palpitations, headaches, and diaphoresis to their PCP. The PCP has recently been trying to control their HTN, but it has been resistent to therapy thus far. What condition are you concerned of?

    <p>Pheochromocytoma</p> Signup and view all the answers

    What is the diagnostic initial testing to confirm the presence of increased catecholamines in a patient with possible pheochromocytoma?

    <p>24-hr Fractionated metanephrines &amp; catecholamines</p> Signup and view all the answers

    What imaging modality is used to confirm the presence of a tumor in Pheochromocytoma?

    <p>MRI/CT</p> Signup and view all the answers

    The treatment for Pheochromocytoma is surgical resection. What medication MUST be given before this can take place?

    <p>Alpha-blockers</p> Signup and view all the answers

    What is the definitive diagnostic test for Cushing's?

    <p>Dexamethasone suppression test</p> Signup and view all the answers

    Is it pheochromocytoma or primary hyperaldosteronism?

    <p>About 40% of cases due to a genetic condition like MEN = pheochromocytoma Mostly due to a hormone secreting tumor or idiopathic = primary hyperaldosteronism Triad of symptomatic attacks like palpations, headache and sweating. All with tx resistant HTN = pheochromocytoma Symptoms include metabolic alkalosis in the setting of hypokalemia, headache, muscle weakness and tx resistant HTN = primary hyperaldosteronism</p> Signup and view all the answers

    What is the role of aldosterone in the body?

    <p>Help increase BP/volume by reabsorbing water and salt in the distal nephron</p> Signup and view all the answers

    What syndrome causes a increase in aldosterone due to the presence of a hormone secreting tumor?

    <p>Conn</p> Signup and view all the answers

    Tx of choice for Bilateral (Idiopathic) Adrenal Hyperplasia?

    <p>Spironolactone</p> Signup and view all the answers

    A female patient presents with increased hair growth in male patterned areas. She has a known history of PCOS and is T2DM with insulin resistance. What hormone-secreting tumor should you look for using labs and imaging in this patient?

    <p>Androgen</p> Signup and view all the answers

    What is the different in these tumors??

    <p>benign, non-cancerous, tumor that started in the epithelium = adenoma malignant, cancerous, tumor that starts in the skin or tissue that lines organs = carcinoma malignant, cancerous, tumor that starts in the glandular cells = adenocarcinoma a = aa</p> Signup and view all the answers

    True or False: Adrenocortical Carcinomas (ACC)

    <p>This is a rare for of malignant cancer that starts in the glandular tissue and targets the outer layer of the adrenal gland = True This mainly targets children in Brazil = False Most are FUNCTIONING masses and secrete cortisol which leads to Cushing's = True This is more common in women than men = True</p> Signup and view all the answers

    Adrenal Incidentaloma are benign masses that are becoming more commonly identified due to widespread use of high-resolution imaging .

    <p>True</p> Signup and view all the answers

    Acute adrenal insufficiency is characterized by which of the following laboratory abnormalities?

    <p>hyponatremia and hyperkalemia</p> Signup and view all the answers

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