Term
| what happens to the endometrium in the follicular phase |
|
Definition
| functionalis (outer 2/3) proliferates |
|
|
Term
| what happens to FSH, LH in the follicular phase |
|
Definition
| FSH has a bump in the middle to help pick a dominant follicle, LH spikes at ovulation, FSH comes up a bit too |
|
|
Term
| what happens to estrogen and progesterone in the proliferative phase |
|
Definition
| progesterone is low, estrogen starts to rise a few days before ovulation |
|
|
Term
| what happens to estrogen and progesterone in the luteal phase |
|
Definition
| estrogen falls back to baseline, progesterone rises until the corpus luteum dies and then it falls (estrogen rises and falls a little with it too) |
|
|
Term
| what happens to FSH and LH in the luteal phase |
|
Definition
| after their ovulatory spikes they return to baseline |
|
|
Term
| what happens to the endometrium in the luteal phase |
|
Definition
| the functionalis (outer 1/3) proliferates until the corpus luteum dies and progesterone is lost, the rapid loss causes the spiral arteries to constrict and it falls off, the basalis layer (lower 1/3) of the endometrium remains |
|
|
Term
| what days is the follicular phase, luteal phase, ovulation |
|
Definition
| follicular 10-14, 14 ovulation, 14-28 luteal |
|
|
Term
| how can you tell when ovulation occurred based on hormones |
|
Definition
|
|
Term
| how long is a normal menstrual cycle |
|
Definition
|
|
Term
| how much menstrual bleeding is normal |
|
Definition
|
|
Term
|
Definition
|
|
Term
| % of women that consider their period excessive, % of women who have excessive periods that think its light |
|
Definition
| 33% of women think their period is heavy, 40% of women with heavy periods think their light |
|
|
Term
| % of women affected by AUB |
|
Definition
|
|
Term
|
Definition
| hCG, CBC, TSH, PRL, GC, PCOS labs |
|
|
Term
| 6 causes of AUB in order 13-18yo |
|
Definition
| anovulation, coagulopathy, pregnancy, PID, OCPs, cancer |
|
|
Term
| 7 causes of AUB in order 19-39yo |
|
Definition
| anovulation, polyps, fibroids, pregnancy, OCPs, EIN, cancer |
|
|
Term
| 5 causes of AUB in order 41yo+ |
|
Definition
| anovulation/perimenopause, atrophy, EIN, cancer, fibroid |
|
|
Term
| how much of AUB ends up being cancer |
|
Definition
|
|
Term
| % of women with liver disease that have AUB |
|
Definition
|
|
Term
| EMBx samples % of endometrium |
|
Definition
|
|
Term
| indications for screening for hemostatic disorders - 8 |
|
Definition
| HMB since menarche, PPH, post-op bleed, dental bleeding, gum bleeding, family history, brusing 1-2d/mo, epistaxis 1-2d/mo |
|
|
Term
| explain the physiology of anovulatory bleeding |
|
Definition
| no dominant follicle is chosen so no corpus luteum is made. thus no progesterone is made and there is no rapid progesterone decline either. the endometrium just keeps growing and outgrows its spiral arteries and falls off, but when it does there is no progesterone around to constrict the spiral arteries causing heavy bleeding |
|
|
Term
| treatment of non-acute AUB, what is #1 |
|
Definition
| #1 OCPs, cyclic progesterone, IUD |
|
|
Term
| treatment of chronic AUB in order from most to least effective - 6 |
|
Definition
| IUD > TXA > ethamsylate > danazol > OCPs / NSAIDS |
|
|
Term
| % TXA can reduce acute bleeding |
|
Definition
|
|
Term
| progesterone containaing treatments for acute AUB - 4 |
|
Definition
| medroxyprogesterone 20mg BID-TID, megestrol acetate 20-40mg BID, norethindrone 5mg BID, OCPs with 35mcg estrogen TID x7d monophasic |
|
|
Term
|
Definition
| decreases plasmin lysis of fibrin |
|
|
Term
| dosing of TXA for acute AUB |
|
Definition
| 1.3mg TID x5d or 10mg/kd IV q8h |
|
|
Term
|
Definition
| nausea, vomiting, dizziness, photophobia |
|
|
Term
| how is IV estrogen dosed for acute AUB |
|
Definition
| 25mg q4-6h until stops or 24h then switch to 2mg PO q6h, gradually taper to OCP and add progesterone |
|
|
Term
|
Definition
|
|
Term
| treatment options for acute AUB - 9 |
|
Definition
| progesterone, OCP, TXA, IV estrogen, UAE, tamponade, hysterectomy, ablation, D+C |
|
|
Term
| % of adolescents with PCOS |
|
Definition
|
|
Term
| percent of ER visits for HMB for adolescents that end up being PCOS |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how do androgens get increased in PCOS - 4 factors |
|
Definition
LH increases them in ovary and increases its own response to itself to make more.
Insulin increases LH response and SHBG which increases androgens.
ILGF increases LH response.
Obesity increases insulin resistance and androgens |
|
|
Term
| how do androgens cause PCOvaries |
|
Definition
| theca and stromal hyperplasia makes them large, arrest of follicle maturation makes them polycystic |
|
|
Term
| what is different for adolescents in the rhoterdam criteria |
|
Definition
|
|
Term
|
Definition
| need 2/3 - anovulation (>35d cycles) - elevated androgens (acne, hirstruism, elevated T/DHEAS) - PCOvaries (>10cc or >12 follicles on one or oboth) |
|
|
Term
|
Definition
|
|
Term
| complications of PCOS - 15 |
|
Definition
| DM 10%, glucose intolerance 35%, GDM, metabolic syndrome, NAFLD, NA steatohepatitis, OSA, EIN, endometrical CA, CVD, infertility, anxiety, depression, HTN, hirsturism |
|
|
Term
| what 2 things indicate that someone with PCOS might have very high androgens |
|
Definition
| increasesd follicles, amenorrhea (not oligomenorrhea) |
|
|
Term
| work up for PCOS - physical exam - 8 |
|
Definition
| BP, BMI, waist circumference, acne, hirsturism, balding, acanthosis, skin tags |
|
|
Term
|
Definition
| progesterone, TSH, PRL, testosterone, DHEAS, 17OHP, 2hGTT |
|
|
Term
| what is DHEAS usually in PCOS |
|
Definition
|
|
Term
| what does a testosterone >200 mean |
|
Definition
| testosterone secreting tumor |
|
|
Term
| what does a DHEAS >700 mean |
|
Definition
|
|
Term
| what is the MOST ACCURATE way to test for glucose intolerance in PCOS |
|
Definition
| hyperinsulinemic euglycemic camp - IV insulin and glucose until rate match -- less glucose means more resistance |
|
|
Term
| how much does diet and exercise improve insulin resistance in PCOS |
|
Definition
|
|
Term
| how much does metformin improve insulin resistance in PCOS |
|
Definition
|
|
Term
| 4 ways to improve insulin resistance in PCOS |
|
Definition
| diet, exercise, weight loss, metformin |
|
|
Term
| ovulation induction in PCOS medications in order of efficacy |
|
Definition
| 1- letrazone, 2- clomid, 3- gonadotropins (cause multiples too many follicles) |
|
|
Term
| best way for someone with PCOS to get pregnant |
|
Definition
| loose weight even 5% can induce ovulation |
|
|
Term
| #1 treatment for hirsturism and acne in PCOS |
|
Definition
|
|
Term
| % of hirsturism that is associated with androgen disorders |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| explain how ferryman gallaway is scored |
|
Definition
| 0 - no hair, 4 - hairy man |
|
|
Term
| list the reffyman gallaway regions - 9 |
|
Definition
| lip, chin, chest, arms, up abd, low abd, up back, low back, thighs |
|
|
Term
| explain interpretation of ferryman gallaway score |
|
Definition
| >8 hirstruism, 2+ on chin and low abd predictive or hirsturism |
|
|
Term
| what is ovarian hyperthecosis |
|
Definition
|
|
Term
| signs of virilization - 4 |
|
Definition
| deepening of voice, breast atrophy, clitoris >5mm wide >10mm long, change in habitus |
|
|
Term
| how can you make laser hair removal work better |
|
Definition
|
|
Term
| effectiveness of OCPs on hirsturism |
|
Definition
|
|
Term
| how much E2 is needed for hirstruism in OCPs |
|
Definition
|
|
Term
| why does OCPs decrease hirstuism |
|
Definition
| estrogen increases SHBG which grabs up testosterone, progresterone decreases testosterone and DHEAS |
|
|
Term
|
Definition
|
|
Term
| how can you make OCPs better at fixinig hirsturism |
|
Definition
|
|
Term
|
Definition
| GERD, nausea, fatigue, polyuria, nocturia, HA, heavy/frequent bleeding, sun burn, decreased libido, feminization of male fetus |
|
|
Term
| contraindication to spironolactone |
|
Definition
|
|
Term
|
Definition
| ornithine decarboxylase inhibitor, stops cell division in hair |
|
|
Term
|
Definition
| HAIR COMES BACK WHEN YOU STOP, acne, folliculitis, stinging, rash, pruritic, allergy |
|
|
Term
|
Definition
| ferminization of male fetus |
|
|
Term
| least effective hirstruism treatment |
|
Definition
|
|
Term
|
Definition
|
|
Term
| slowest hirsturism treatment |
|
Definition
|
|
Term
|
Definition
| dry skin/sclap/hair, GREEN PEE AND LFTs = FETAL hepatoTOXICITY |
|
|
Term
| options for hirsturism treatment - 6 |
|
Definition
| mechanical, OCPs, spironolactone, eflornithine, finasteride, flutamide |
|
|
Term
| what is idiopathic virilization of pregnancy |
|
Definition
| pregnancy causes increased androstendione, testosterone and DHEAS. the placenta makes SHBG and aromatase which balances this. an imbalance causes maternal virilization |
|
|
Term
| cause of placental aromatase deficiency |
|
Definition
| AR mutation in CYP19 in fetus causes aromatase deficiency. elevated maternal androstendione is never converted to estrone |
|
|
Term
| 2 complications placental aromatase deficiency |
|
Definition
| maternial virilization, female fetus with ambiguious genitalia |
|
|
Term
| ovarian leutoma appearance - 5 |
|
Definition
| bilateral, solid, multinodular, yellow (cholesterol), 6-10cm |
|
|
Term
| risks for ovarian leutoma - 3 |
|
Definition
|
|
Term
| complications ovarian leutoma - 3 |
|
Definition
| maternal virilization, female fetus with ambiguious genitalia 65%, torsion |
|
|
Term
| % of ovarian leutoma that are bilateral |
|
Definition
|
|
Term
| 2 conditions of pregnancy causing maternal virilization that also cause female fetus with ambiguious genitalia, and the MOA of each |
|
Definition
placental aromatase deficiency - baby has no aromatase to stop maternal androstenedione
ovarian leutoma - even though baby has aromatase there is so much androgen, overload |
|
|
Term
| what is hyperreactor luteinalis |
|
Definition
| elevated hCG causes multiple theca lutein cysts |
|
|
Term
| risks for hyperreactor luteinalis - 3 |
|
Definition
| multiples, mole, choriocarcinoma |
|
|
Term
| hyperreactor luteinalis appearance and why |
|
Definition
| spoke wheel ovary - compression of stroma with many simple vs hemorrhagic cysts |
|
|
Term
| hyperreactor luteinalis when does it happen |
|
Definition
|
|
Term
| hyperreactor luteinalis signs - 6 |
|
Definition
| maternal virilization 30%, OHSS like (ascites, pleural effusions), torsion, rupture, bleeding |
|
|
Term
| hyperreactor luteinalis management |
|
Definition
|
|
Term
| PCOS symptoms prognosis in pregnancy |
|
Definition
|
|
Term
| #1 androgen secreting tumor pre menopause |
|
Definition
|
|
Term
| #1 androgen secreting tumor post menopause |
|
Definition
|
|
Term
| what type of tumor is a leutinizing thecoma |
|
Definition
| benign sex cord stromal tumor |
|
|
Term
| complication leutizing thecoma |
|
Definition
|
|
Term
| androgen secreting tumors - 8 |
|
Definition
| Sertoli Leydig, hilus cell, leutinized thecomoa, cystadenoma/carcinoma, granulosa-theca cel, brenner, kerunkenburg, adrenal adenocarcinoma, ovarian leutioma (pregnancy), hyperreacto leutinalis (pregnancy) |
|
|
Term
| androgen INCREASING tumors (not directly secreting) |
|
Definition
| ACTH secreting pituitary adenoma |
|
|
Term
| 2 androgen secreting tumors/ovarian conditions in pregnancy |
|
Definition
| ovarian leutiomoa, hyperreacto leutinalis |
|
|
Term
| signs of androgencreting tumor - 3 |
|
Definition
| rapid virilization, new PCOS in 40s, virilizing <15yo |
|
|
Term
| labs for androgen secreting tumor - 4 |
|
Definition
| testosterone >200, DHEAS 500-700, normal ACTH and cortisol |
|
|
Term
| labs for adrenal adenoma - 4 |
|
Definition
| testosterone <200, DHEAS >700, ACTH low, cortisol high |
|
|
Term
| conditions associated with adrenal adenoma - 3 |
|
Definition
|
|
Term
| signs of adrenal adenoma - 7 |
|
Definition
| hyperandrogenism, anxiety, HTN, DM, hypokalemia, palpitations, sweating |
|
|
Term
| causes of cushing syndrome - ACTH dependent - 2 |
|
Definition
| pituitary adenoma, bronchial (or other random cancer with neuroendocrine components) |
|
|
Term
| causes of cushing syndrome - ACTH independent - 2 |
|
Definition
| adrenal adenoma cortisol secreting, exogenous steroids |
|
|
Term
| how do you diagnose if someone has cushing syndrome (not what has caused it) |
|
Definition
| 24h urine cortisol or low dose dexamethasone suppression test (1mg dex at 11pm and check cortisol at 8am), if AM cortisol <5 or urine <100 then normal, if AM cortisol >5 or urine >100 likely cushing syndrome |
|
|
Term
| after you diagnose cushing syndrome what is the next test you get |
|
Definition
|
|
Term
| how do you diagnose what the cause of cushing syndrome is |
|
Definition
| ACTH <5 adrenal tumor, ACTH >5 need high dose dexamethasone test, if after the test the cortisol is high its ectopic ACTH if it is low its a pituitary adenoma |
|
|
Term
| dosing high dose dexamethasone test |
|
Definition
|
|
Term
| signs of cushing syndrome - 11 |
|
Definition
| hirsturism, central obesity, fatigue, proximal muscle weakness, skin atrophy, hyperpigmentation, easy bruising, moon facies, buffalo hump, striae, HTN |
|
|
Term
| % of reproductive age women with endometriosis |
|
Definition
|
|
Term
| % of infertile women with endometriosis |
|
Definition
|
|
Term
| % of chronic pelvic pain patients with endometriosis |
|
Definition
|
|
Term
| average age of endometriosis diagnosis |
|
Definition
|
|
Term
| if you have a 1st degree relative with endometriosis what is the chance you have it |
|
Definition
|
|
Term
| 4 physiologic mechanisms found to suggest there is a genetic component |
|
Definition
| abnormal cell adhesion molecules that improve cell transport, abnormal MMP that improve peritoneal sticking, abnormal aromatase production increasing ectopic estrogen, increased cell resistance to apoptosis |
|
|
Term
| 4 theories of endometriosis |
|
Definition
| Sampson, lymphovascular, coelomic metaplasia, immunologic |
|
|
Term
| evidence for Sampson theory - 2 |
|
Definition
| dependent portions of pelvis with more endometriosis, increase endometriosis in patients with outflow obstruction |
|
|
Term
| evidence for lymphovascular theory |
|
Definition
| endometriosis in CNS and lungs |
|
|
Term
| evidence for coelomic metaplasia theory |
|
Definition
| male and pre-pubescent endometriosis |
|
|
Term
| evidence for immunologic theory - 4 |
|
Definition
| increased macrophages, cytokines, GF, NK activity |
|
|
Term
| how does endometriosis respond differently to estrogen and progesterone |
|
Definition
| it has increased aromatase which makes more estrogen and is more sensitive to estrogen causing it to make more estrogen, it is resistant to progesterone which allows more estrogen to be made |
|
|
Term
| pathology findings of endometriosis - 3 |
|
Definition
| endometrial glands and stroma, hemosiderin laiden macrophages |
|
|
Term
| how is endometriosis staged |
|
Definition
| we don't care, because it has no correlation with fertility ratees or pain |
|
|
Term
| physical exam findings of endometriosis - 2 |
|
Definition
| uterosacral nodularities, ovarian mass endometrioma |
|
|
Term
| TVUS findings of endometriosis - 1 |
|
Definition
| endometrioma (ground glass) |
|
|
Term
| LSC findings of endometriosis - 3 |
|
Definition
| powder burn lesions, vesicular lesions (brown, red, white), allen masters windows |
|
|
Term
| symptoms of endometriosis - 5 |
|
Definition
| dysmenorrhea, dysparunea, dysuria, infertility, back pain |
|
|
Term
| first line for pain in endometriosis - 2 |
|
Definition
|
|
Term
| options for pain in endometriosis - 7 |
|
Definition
| NSAIDS, OCPs, IUD, letrazole, progesterone, danazol, lupron |
|
|
Term
| second line for pain endometriosis |
|
Definition
|
|
Term
|
Definition
|
|
Term
| contraindications orlissa - 6 |
|
Definition
| pregnancy, <18yo, osteoporosis, liver disease, on gemfibrazil or cyclophosphamide |
|
|
Term
|
Definition
| hot flashes, night sweats, spotting, HA, nausea, SI |
|
|
Term
| 3 progesterone's used for pain in endometriosis |
|
Definition
| depo, medroxy 10-30mg/d, IUD |
|
|
Term
|
Definition
| steroid with androgen effects |
|
|
Term
|
Definition
| hair growth, deepening of voice, breast atrophy, mood swings, increased LFTs |
|
|
Term
| contraindications of danazol |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 3.17mg IM monthly or 11.25mg q3mo |
|
|
Term
| how can you decrease the rate of bone loss in lupron |
|
Definition
|
|
Term
| recommended add back therapy for lupron |
|
Definition
| norethindrone 5mg, provera 2.5mg + E2 patch 25mcg |
|
|
Term
| how beneficial is one or two or more surgeries for endometriosis fulguration for pain |
|
Definition
| 1st surgery is most beneficial, improvement at 6mo after 1st surgery is 83% and second 53% |
|
|
Term
| how long does pain relief from LSC fulguration for endometriosis last, how can you improve this |
|
Definition
| 65% at 6mo, 55% at 1y say they had improvement, prolong with hormonal management |
|
|
Term
| should you cut out or burn endometriosis lesions |
|
Definition
|
|
Term
| surgical methods for endometriosis pain treatment - 5 |
|
Definition
| LSC ablation, uterosacral nerve ablation (maybe helps, eh), pre-sacral neurectomy, hysterectomy alone, hysterectomy with BSO |
|
|
Term
| complications of pre-sacral neurectomy - 2 |
|
Definition
| high rates of bleeding and GI issues |
|
|
Term
| how much does hysterectomy alone improve endometriosis pain |
|
Definition
| 31% need another surgery within 5y, 61% recurrence |
|
|
Term
| after a hysterectomy BSO why do some patients with endometriosis still have pain - 2 |
|
Definition
| exogenous estrogen production via aromatase in endometriosis implants, add back therapy |
|
|
Term
| how can you reduce the potential for add back therapy to cause some reactivation of endometriosis pain |
|
Definition
|
|
Term
| not utilizing add back therapy after HS/BSO for endometriosis not only increases PMP issues but what else |
|
Definition
| potential for estrogen sensitive cancers because of aromatization of estrogen in endometrial implants |
|
|
Term
| does surgical exicision of endometriosis help with fertility |
|
Definition
| BLUF - helps but magnitude is uncertain, Stage 1-2 likely small benefit, Stage 3-4 maybe some more benefit because restoring anatomy, repeat operations not beneficial |
|
|
Term
| indications for removal of endometrioma in an infertility patient - 3 |
|
Definition
| its causing them pain and they want it out, it is in the way of your egg retrevial, it is >3-4cm (consider how much tissue will be left, if its causing them pain and its eating the whole ovary just take it out, if it isn't causing them pain and there is some viable ovary there just leave it alone) |
|
|
Term
| if you are going to take out an endometroma, what is the best way to do it for infertility patient |
|
Definition
| if it is >4cm studies show that cystectomy is better for fertility than drainage/ablation, if it is <4cm there is no recommendation/evidence |
|
|
Term
|
Definition
| painful regular periods, heavy bleeding, usually shows up 10y post endometriosis diagnosis |
|
|
Term
| average age of endometriosis |
|
Definition
| almost never <20yo, usually >30yo |
|
|
Term
| elevated prolactin accounts for % of amenorrhea |
|
Definition
|
|
Term
| elevated prolactin accounts for % of AUB |
|
Definition
|
|
Term
| elevated prolactin accounts for % of PCOS |
|
Definition
|
|
Term
| elevated prolactin accounts for % of infertility |
|
Definition
|
|
Term
| when do you get a prolactin lab |
|
Definition
| follicular phase, first thing in the AM, no sex |
|
|
Term
|
Definition
| sometimes really high PRL can interact with the test and show very low, fix by diluting 1:1000 |
|
|
Term
| how is prolactin stimulated in the pituitary, what does dopamine have to do with it |
|
Definition
| TRH from the hypothalamus stimulates PRL, dopamine stops this |
|
|
Term
| at what PRL level will there be a short luteal phase |
|
Definition
|
|
Term
| at what PRL level will there be oligomenorrhea |
|
Definition
|
|
Term
| at what PRL level will there be amenorrhea and PMP symptoms |
|
Definition
|
|
Term
| at what PRL level will there be infertility |
|
Definition
|
|
Term
| how is galactorrhea associated with PRL level |
|
Definition
| only 50% will have elevated |
|
|
Term
| if someone has a PRL secreting adenoma what additional symptoms other than PRL symptoms might they have - 5 |
|
Definition
| BT heminopsia, nausea, vomiting, seizure, PRL >200 |
|
|
Term
| how is estrogen and PRL related |
|
Definition
| more PRL means less estrogen |
|
|
Term
| indications to test PRL - 3 |
|
Definition
| galactorrhea, AUB, infertility |
|
|
Term
|
Definition
| hCG, check medications, CMP, TSH, ILGF, MRI of pituitary if PRL elevated |
|
|
Term
| if you find something on an MRI of the pituitary what additional labs do you need to get - 4 |
|
Definition
| 24h cortisol, ILGF, FSH/LH, thyrotropin |
|
|
Term
| causes of PRL that happen every day - 7 |
|
Definition
| pregnancy, nipple stimulation, stress, sex, food, exercise, menses |
|
|
Term
| causes of PRL that are associated with inhibition of dopamine - 7 |
|
Definition
| antipsychotics - Haldol, risperidone, TACs, SSRIs, chlorpromazine, buspar, alprazolam, |
|
|
Term
| medications that can cause elevated PRL (not the BH ones) - 6 |
|
Definition
| metoclopramide, a-methyldopa, verapamil, morphine, H2 agonists, estrogen |
|
|
Term
| other than every day changes, dopamine meds, and medications what non-iratogenic causes of increased PRL are there - 7 |
|
Definition
| hypothyroidism, tumor causing increased production, interruption of the HPA causing increased production, neurogenic stimulation, decreased PRL elimination, endocrine disease SE, SE from another type of adenoma |
|
|
Term
| why does hypothyroid cause elevated PRL |
|
Definition
| low T4 causes increased TRH which along with TSH, stimulates PRL release |
|
|
Term
| what are 3 pituitary conditions that can cause direct increased production of PRL |
|
Definition
| pituitary adenoma, hypothalamic stalk interruption, empty sella syndrome |
|
|
Term
| 2 conditions that cause decreased elimination of PRL |
|
Definition
|
|
Term
| what neuroendocrine stimulation can cause increased PRL production |
|
Definition
|
|
Term
| what endocrine conditions have a side effect of PRL production - 2 |
|
Definition
|
|
Term
| what are 4 adenomas that done make PRL, but have SE of PRL production and the lab to test for each |
|
Definition
| somatotrophic (GHRH) ILGF, gonadotrophic (GNRH) FSH/LH, corticotrophic (CRH) 24h cortison or ACTH, thyrotrophic (TRH) thyrotropin |
|
|
Term
|
Definition
|
|
Term
| #1 pituitary macroadenoma |
|
Definition
|
|
Term
| #1 pituitary macroadenoma |
|
Definition
| gonadotrophic - GH releasing tumor |
|
|
Term
| signs of microprolactinoma |
|
Definition
| usually asymptomatic, PRL is usually inactive and has low elevations |
|
|
Term
| define micro and macroprolactinoma |
|
Definition
|
|
Term
| PRL level micro vs macroprolactinoma |
|
Definition
|
|
Term
| PRL level in macroprolactinoma is associated with - 2 |
|
Definition
| increasesd PRL means increased size and invasion |
|
|
Term
| complication of macroprolactinoma and rate |
|
Definition
|
|
Term
| signs of pituitary apoplexy - 6 |
|
Definition
| headache, nausea, vomiting, change in vision, lethargy, panHypoPituitarism leading to loss of adrenal function and death |
|
|
Term
| risk factors for pituitary apoplexy - 6 |
|
Definition
| sudden change in BP, prior RT, starting dopamine agonist, anticoagulation, head injury, dynamic functional pituitary testing |
|
|
Term
| management (RX, follow up) of hyper PRL - asymptomatic, no macroadenoma - 3 |
|
Definition
| OCPs for bone loss, MRI and PRL q1y (can do MRI q2y if stable) |
|
|
Term
| management (RX, follow up) of hyper PRL - symptomatic, or macroadenoma |
|
Definition
| bromocriptine or cabergoline, MRI in 3-6mo if macroadenoma, PRL 2 wk after med start |
|
|
Term
| effectiveness of medical management for symptomatic hyper PRL or macroadenoma |
|
Definition
| 3/4 have normal PRL in 3mo, most have decreased size |
|
|
Term
| bromocriptine side effects - 5 |
|
Definition
| nausea, vovmiting, orthostatic hypotension, depression, congestion |
|
|
Term
| cabergoline side effects - 4 |
|
Definition
| nausea, vomiting, orthostatic hypotension, heart valve changes leading to insufficiency |
|
|
Term
| which dopamine agonist is beter and why |
|
Definition
| cabergoline, better tolerated, increased potency, increased tumor shrinking |
|
|
Term
| management of hyper PRL if resistant to meds, cannot tolerate meds, or visual chagnes |
|
Definition
|
|
Term
| complications of transsphenoidal surgery - 8 |
|
Definition
| pituitary insufficiency 20%, DI 18%, SCF leak 3%, meningitis 1%, blindness 1%, death 1%, CVA 0.5%, ocular motor palsy 0.5% |
|
|
Term
| success rates transsphenoidal surgery for micro and macropituitary adenoma |
|
Definition
| micro 90%, macro <50%, less is cavernous sinus involvement |
|
|
Term
| what CN are in the cavernous sinus |
|
Definition
|
|
Term
| recurrence rates transphenoidal surgery for macro and micropituitary adenoma |
|
Definition
|
|
Term
| what do you do if a pituitary adenoma occurs after transsphenoidal surgery |
|
Definition
|
|
Term
| when can you consider disconitinuing hyper PRL meds |
|
Definition
| 2y asymptomatic with normal PRL and MRI |
|
|
Term
| complication of discontinuing hyper PRL meds |
|
Definition
| rapid growth of tumor if not really gone |
|
|
Term
| prognosis microadenoma pregnancy |
|
Definition
|
|
Term
| prognosis macroadenoma pregnancy |
|
Definition
| 35% progress, risk is associated with pre-pregnancy size |
|
|
Term
| are dopamine agonists ok in pregnancy |
|
Definition
| stop taking with +hCG no increase in SAB/malformations in early pregnancy, but no testing in 2-3T. if has symptoms can use |
|
|
Term
| what do you do if a pregnant lady has symptomatic hyper PRL or macroadenoma that is growing causing symptoms |
|
Definition
| bromocriptine 1st line, cabergoline 2nd line, transphenoidal surgery if refractory |
|
|
Term
| in someone with hyper PRL when do you recheck their PRL after pregnancy |
|
Definition
| 2mo or when done breastfeeding |
|
|
Term
| is breastfeeding ok if hyper PRL |
|
Definition
| contraindicated if had neuro symptoms in pregnancy or if on dopamine agonists |
|
|
Term
| cause of empty sella syndrome |
|
Definition
| subarachnoid herniates into pituitary fossa smooshing the pituitary |
|
|
Term
| symptoms of empty sella syndrome - 8 |
|
Definition
| obesity 75% (associated not caused by), HTN, HA, fatigue, decreased libido, infertility, AUB, 1/3 asymptomatic |
|
|
Term
| usual age empty sella syndrome |
|
Definition
|
|
