Clin Med - Pituitary & Adrenal Disorders

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:

What hormones are released for the posterior pituitary gland?

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

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:

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

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

What is the initial imaging study for ALL suspected adenomas?

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

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

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?

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

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.

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

When is Transsphenoidal surgery recommended for prolactinomas?

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

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

What is the most common cause of growth hormone deficiency?

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?

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

Diabetes insipidus and diabetes mellitus share common mechanisms

Diabetes Insipidus - What's the problem??

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

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

Lithium toxicity can cause nephrogenic DI.

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

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?

I have excessive thirst.

The adrenal glands A&P

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

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?

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?

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?

What is the initial diagnostic test for primary adrenal insufficiency?

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

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?

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

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?

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

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?

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

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

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

What is the definitive diagnostic test for Cushing's?

Is it pheochromocytoma or primary hyperaldosteronism?

What is the role of aldosterone in the body?

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

Tx of choice for Bilateral (Idiopathic) Adrenal Hyperplasia?

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?

What is the different in these tumors??

True or False: Adrenocortical Carcinomas (ACC)

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

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