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³»ºÐºñ ÃÑ·Ð ¹× Pituitary ´ëÀå°æ Á¤¸®

1. G-protein µ¹¿¬º¯À̰¡ Áõ¸íµÈ ³»ºÐºñ°è Á¾¾ç

i) pituitary somatotroph adenoma

ii) thyroid tumor: autonomously functioning thyroid adenoma, papillary carcinoma,

follicular ca

iii) adrenal cortical and ovarian tumor

2. gain of function mutation

1) Á¤ÀÇ: Ç÷Áß hormoneÀº ÃøÁ¤µÇÁö ¾ÊÀ¸³ª hormone excess manifestationÀ» º¸ÀÌ´Â °Í

2) ±âÀü: receptorȰ¼ºµµ¸¦ °è¼Ó À¯ÁöÇϰųª ¶Ç´Â ligand-binding specificity¸¦ »ó½Ç½ÃŰ´Â

º¯ÀÌ¿¡ ÀÇÇÔ.

3. hyperprolactinemia¶§ ¹«¿ù°æÀÌ »ý±â´Â ÀÌÀ¯?

PRLÀÌ hypothalamus¿¡ Á÷Á¢ ÀÛ¿ëÇÏ¿© GnRL suppression½ÃŰ¹Ç·Î

4. prolactinoma¶§ TRH stimulation testÇϸé?

º¯È­°¡ ¾ø°Å³ª Á¶±Ý¸¸ Áõ°¡ÇÑ´Ù.

cf. Á¤»ó¿¡¼­´Â 200%ÀÌ»ó Áõ°¡ÇÑ´Ù.

5. prolactinoma(microadenoma) ¼ö¼úÈÄ 24½Ã°£³»¿¡ prolactin levelÀÌ Á¤»óÈ­µÈ´Ù.

6. ras gene mutationÀº invasive prolactinoma¿Í metastatic pituitary carcinoma¿Í °ü·ÃÀÌ

ÀÖ´Ù.

7. TRH, LHRH¿Í dopamineÀÇ ¹ÝÀÀ

TRH, LHRH: Á¤»óÀο¡¼­´Â º¯È­°¡ ¾øÀ¸¸ç acromegaly¿¡¼­´Â Áõ°¡(paradoxical response

60%)

dopamine: Á¤»óÀÌ¿¡¼­´Â Áõ°¡½ÃŰ³ª acromegaly¿¡¼­´Â °¨¼Ò

(high dose dopamine agonist=bromocriptineÀ» Ä¡·á·Î »ç¿ë)

8. GH deficiency À¯¹ß°Ë»ç

insulin tolerance test, IV arginine, L-dopa, GHRH, GHRP-6

9. GH³óµµ¸¦ ¹Ý¿µÇÏ´Â ¹°Áú 2°¡Áö: IGF-1, IGFBP3

10. IGF-1ÀÇ ÃøÁ¤Àº ÃÖ±Ù 24½Ã°£µ¿¾ÈÀÇ Ã¼³» ¼ºÀåÈ£¸£¸ó ºÐºñ¸¦ ¹Ý¿µÇÑ´Ù.

11. acromegaly¿¡¼­ colonoscopyÀûÀÀÁõ

50¼¼ ÀÌ»ó, skin tag > 3°³, 10³â ÀÌ»ó º´·Â

12. GH deficiency¸¦ Áø´ÜÇϱâ À§ÇÑ ¼±º°°Ë»ç 3°¡Áö

: IGF-1, IGFBP3, clonidine stimulation test

13. acromegaly¿¡¼­ °ñ´Ù°øÁõÀÌ »ý±â´Â ±âÀü

i) hypercalciuria & negative calcium balance

ii) secondary panhypopituitarism & associated gonadal insufficiency

14. acromegalyÀÇ Ä¡·á¸ñÇ¥

i) GH & IGF-1 Á¤»óÈ­

ii) tumor size°¨¼Ò

iii) normal pituitary function À¯Áö

15. acromegaly

- GH³óµµ´Â adenomaÅ©±â¿Í ºñ·ÊÇÑ´Ù.

- ÀþÀº ȯÀÚÀϼö·Ï ´õ Å©°í aggressiveÇÏ´Ù.

- GHºÐºñ¼¼Æ÷¿¡¼­ Gs proteinÀÇ ¼Ò´ÜÀ§¿¡ µ¹¿¬º¯À̰¡ °üÂûµÈ´Ù.

16. acromegaly¿¡¼­ Ä¡·á¼º°ø ±âÁØ

GH < 2 ug/L, normal serum IGF-1

17. acromegalyÄ¡·á°¡ ¼º°øÇÏ¿´À» °æ¿ì soft tissue swellingÀº Áï½Ã È£ÀüµÇ³ª °ñ°Ý°è º¯È­´Â

È£ÀüµÇÁö ¾Ê´Â´Ù.

18. Acromegaly¼ö¼úÈÄ Àç¹ßÀ» ¿¹ÃøÇÏ´Â °¡Àå ÁÁÀº °Ë»ç¹æ¹ý: TRH stimulation test

19. somatostatin scintigraphy°¡ Áø´Ü¿¡ ÀÌ¿ëµÇ´Â ¿¹

pituitary tumor(GH secreting tumor)

pancreatic tumor(gastrinoma, insulinoma, glucagonoma)

paraganglioma, pheochromocytoma, carcinoid, lung cancer, breast cancer

20. pituitary nonfunctioning tumor·Î ÀÎÇØ ºÒÀÓ»óŰ¡ µÈ ÀþÀº ¿©¼ºÀÇ ÀÓ½ÅÀ» À§ÇØ ÃßõµÇ´Â

¾àÁ¦? hCG, hMG

21. insulin-induced hypoglycemia testÀÇ ±Ý±â 5°¡Áö

i) DM

ii) cerebrovascular disease

iii) coronary artery disease

iv) seizure Hx(+)

v) elderly

22. metyrapone: 11-deoxycortisol -> cortisolÀ» block

¡Å metyrapone test½ÃÇà½Ã cortisolÀº °¨¼Ò, 11-deoxycortisolÀº Áõ°¡

ACTH´Â Áõ°¡, 17-(OH)progesterone Áõ°¡