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Pathoma – Endocrine (USMLE Step 1): Q’s And A’s
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Pathoma – Endocrine (USMLE Step 1): Q’s And A’sName: A benign tumor of anterior pituitary cells that does NOT produce
hormones? Right Ans - Nonfunctional pituitary adenoma
Name: A benign tumor of anterior pituitary cells that DOES produce hormones
Right Ans - Functional pituitary adenoma
What are the signs/sx of a nonfunctional pituitary adenoma? Right Ans -
Mass effect (bitemporal hemianopsia, hypopituitarism, H/A)
What are possible sequelae of mass effect d/t nonfunctional pituitary
adenoma? Right Ans - Bitemporal hemianopsia, hypopituitarism, H/A
Which is the most common functional pituitary adenoma? Right Ans -
Prolactinoma
What are the signs/sx of a prolactinoma? (M vs F) Right Ans - Males:
Decreased libido and h/a; Females: Galactorrhea and amenorrhea; decreased
GnRH
How do you treat a prolactinoma? Right Ans - DA agonists; surgery
NOTES: What is the mechanism of amenorrhea in a PRL-oma? Right Ans -
PRL inhib GnRH synthesis, won't get FSH and LH, so won't get menstruation
NOTES: MOA of decreased libido in male? Right Ans - PRL inhib GnRH
synthesis, won't get FSH and LH, so won't get libido
Rx for Prolactinoma? Right Ans - Bromocriptine or Cabergoline - DA
agonist (DA from hypothalamus inhibits PRL secretion)
Which neoplasm causes gigantism in children and acromegaly in adults?
Right Ans - GH adenoma
Dx: Enlargement of hands, feet, and jaw of an adult with persistent h/a
Right Ans - Acromegaly d/t GH adenoma of anterior pituitary
,What is the most common cause of death in pts with GH adenomas? Right
Ans - Cardiomegaly (heart failure)
What is the HY association with GH adenomas? Right Ans - Secondary
diabetes (GH inhibits Glucose uptake at cells)
How do you diagnose suspected GH adenoma (2 ways)? Right Ans - 1.
Elevated GH and Elevated IGF-1 (GH stimulates liver to secrete IGF-1, which
causes cell growth peripherally); 2. Failure of GH suppression with glucose
administration
What is the treatment for GH adenoma? Right Ans - 1. Octreotide
(somatostatin analog that blocks ant pit response to GHRH), 2. GH receptor
antagonists, 3. Surgery
What is the result of an ACTH cell adenoma (of the anterior pituitary)? ***
Right Ans - Cushing's DISEASE!
Which hormones are produced by the anterior pituitary? Right Ans - GH,
PRL, ACTH, TSH, LH, FSH
Which are the 4 main causes of hypopituitarism? Right Ans - 1. Pituitary
adenoma (adults) - compression OR apoplexy (bleeding into space); 2.
Craniopharyngioma (arises ~sella) (children); 3. Sheehan syndrome
(pregnancy high demand of hormone, pit doubles in size, but blood supply
doesn't increase, so pit is susceptible to infarction, present with poor lactation
and LOSS OF PUBIC HAIR - dep on androgens (from LH)); 4. Empty sella
syndrome (via trauma to pituitary OR primary d/t congenital defect of sella
where you get herniation of arachnoid/CSF into sella - compresses normal pit
and destroys it)
BUZZ: post partum female loses her pubic hair Right Ans - Sheehan
syndrome - pituitary infarct d/t blood loss and hypertrophied pituitary
Which hormones are made in the posterior pituitary? Right Ans - ADH,
Oxytocin - trick question - made in hypothalamus
What's the role of ADH Right Ans - Regulates free water at distal collecting
ducts
, Diagnose: An ADH deficiency with polyuria and polydipsia Right Ans -
Central diabetes insipidus
What causes central diabetes insipidus? Right Ans - Tumor, trauma,
infection, inflammation of anterior OR of posterior pituitary
What serum values might you expect with central diabetes insipidus? Right
Ans - HypERnatremia (concentrate salt b/c losing free water) and High serum
osmolality (concentrated)
What urine values would you expect with central diabetes insipidus? Right
Ans - Low osmolality and low specific gravity
How do you dx central diabetes insipidus Right Ans - Water deprivation
fails to increase urine osmolality
How do you treat central diabetes insipidus? Right Ans - ADH analog
(desmopressin)
What is nephrogenic diabetes insipidus? Right Ans - Lack of renal response
to ADH (d/t hereditary cause or secondary to hypercalcemia, lithium,
demeclocycline (ADH antagonist))
lithium, amethocycline cause... Right Ans - Nephrogenic diabetes insipidus
What causes nephrogenic diabetes insipidus? Right Ans - Inherited
mutations or drugs (lithium or amethocycline)
How do you differentiate central vs. nephrogenic diabetes insipidus? Right
Ans - Nephrogenic has no response to desmopressin (ADH analog)
What is SIADH? Right Ans - Too much ADH secretion
Which serum changes would one expect in SIADH? Right Ans -
HypOnatremia and LOW serum osmolality (hold on to too much H2O)
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