E2: Pituitary Tumors, Johnston

Front 1

3 ways in which a patient with a pituitary tumor will present

Back 1

symptoms of hormone hypersecretion
hypopituitarism due to compression
neurologic symptoms related to mass effect

Front 2

% of tumors that are "hormonally" silent, or non-functioning

Back 2

30-40%

Front 3

most common hormonally active pituitary tumors (2)

Back 3

prolactinomas (#1) and growh hormon secreting tumors

Front 4

size that differentiates between microadenomas and macroadenomas

Back 4

1 cm

Front 5

other potential causes of hyperprolactinemia (a lot)

Back 5

pregnancy/surgery/seizure
primary hypothyroidism
kidney/liver failure
medications (phenothiazines, TCAs, methyldopa, verapamil, cimetidine)
chest wall or spinal cord lesions
herpes
breast stimulation
cysts/infiltrative lesions

Front 6

after obtaining elevated prolactin levels, lab workup for suspected prolactinoma

what is the imaging modality of choice when needed?

Back 6

TSH, HCG (in amenorrheic women), careful history

MRI

Front 7

treatment of choice for prolactinomas

Back 7

medication: Bromocriptine or Cabergoline (dopamine agonists that normalize prolactin)

good, effective treatment

Front 8

important complications of acromegaly

Back 8

CV (htn, hypertrophy, ischemic heart disease)

diabetes mellitus (decreased insulin sensitivity)

Front 9

acromegaly prompts increased risk of what malignancy?

Back 9

colon cancer

Front 10

what is the definitive test for acromegaly?

Back 10

growth hormone level fails to suppress below 2ng/ml 60 minutes following oral glucose load

Front 11

initial blood test to run if suspected acromegaly

Back 11

IGf-1 (twice)

Front 12

treatment of choice for a pituitary tumor that produces growth hormone

Back 12

transsphenoidal surgery

Front 13

ACTH tumors cause ___

what test to diagnose?

Back 13

Cushing's disease

24 hour urine free cortisol

Front 14

hemorrhage or infarct of the pituitary gland

Back 14

pituitary apoplexy