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¤»óȵȴÙ.
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°¡