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Endocrine 6 Pit d/o

Pituitary disorders

QuestionAnswer
A pt has exophthalmos, pretibial myxedema, and a decreased TSH. What is the dx? Graves
What are the most worrisome SE of the ADHD drug atomoxetine? Increased suicidal ideation. Liver injury.
What important SE are common to many of the atypical antipsychotics? Weight gain. Type 2 DM.
What are the sx of hyperprolactinemia in a premenopausal female? Hypogonadism: infertility, oligo/amenorrhea; rarely galactorrhea
What are the sx of hyperprolactinemia in a postmenopausal female? None since already hypogonadal; rarely galactorrhea
What are the sx of hyperprolactinemia in a male? Hypogonadism: low libido, impotence, infertility (low spermy ct), gynecomastia, rarely galactorrhea
First line tx for prolactinoma? Dopa agonist like cabergoline; also bromocriptine or pergolide
If DA agonists (e.g., cabergoline) are ineffective against a prolactinoma, what is the next line of tx? Surgery (try 2 different dopa agonists first). Radiation therapy may be necessary after surgery if tumor was large.
How is a prolactinoma treated in a woman desiring pregnancy? Transphenoidal surgery.
Name 3 tests used to diagnose acromegaly. Serum IGF-1, oral glucose suppression test, pituitary MRI (look for mass or empty sella)
Tx for acromegaly? Transphenoidal resection or external beam radiation. If surgery doesn't work, use octreotide or lanreotide.
If octreotide or lanreotide (SST analogues) don't work, what should be used to treat acromegaly? cabergoline (bromocriptine is not very effective)
What is the MC presentation of hyperprolactinemia? Hypogonadism (amenorrhea, low libido)
What drugs are known for causing elevated prolactin levels? Phenothiazines (anti-nausea agents), risperidone, haloperidol, methyldopa, verapamil
What is the next step in managment of a pt with hyperprolactinemai not due to an obvious drug cause? MRI brain/pituitary, TSH
What is the next step in the management of a pt found to have an absent pituitary on MRI (empty sella)? Nothing. Reassure if pt is asymptomatic.
What is a lactotroph adenoma? Prolactin secreting adenoma
What is a somatotroph adenoma? GH-secreting adenoma
What is the visual field deficit classically associated with prolactinoma? Bitemporal hemianopia
What complications can result from acromegaly? Cardiac failure, DM, spinal cord compression, optic n compression
What is Sheehan's syndrome? Postpartum necrosis of the pituitary gland
Created by: sarah3148
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