18/12/18

Question 1

What is coeliac disease?

Answer 1

When the intestine becomes inflamed and it is unable to absorb nutrients.

Question 2

What are the causes of short stature?

Answer 2

G
E
S
M
M
E
S

Question 3

Describe Sheehans syndrome

Answer 3

See slides

Question 4

How do you diagnose panhypopituitarism?

Answer 4

Biochemical diagnosis
Stimulated (dynamic) pituitary function tests
Radiological diagnosis

Question 5

Define diplopia? Compression of which optic nerve will cause this?

Answer 5

Double vision
Cavernous sinus (IV,VI)

Question 6

Define ptosis? Compression of which optic nerve will cause this?

Answer 6

Dropping or falling of the upper eyelid
Cavernous sinus (III)

Question 7

How do check if growth hormone is being produced normally?

Answer 7

1) GHRH + ARGININE (IV in combination is more effective than one
2) Insulin (IV) induced hypoglcaemia
3) Glucagon (makes you vomit induces a kind of stress)
4) Exercise in children (10 mins - measure the GH concentration sequentially)

Measure the GH at specific time points (before and after)

Question 8

What are the causes of acquired panhypopituitarism?

Answer 8

Tumours
hypothalamic - craniopharyngiomas
pituitary – adenomas, metastases, cysts
Radiation
hypothalamic/pituitary damage
GH most vulnerable, TSH relatively resistant
Infection eg meningitis
Traumatic brain injury
Infiltrative disease – often involves pituitary stalk
eg neurosarcoidosis
Inflammatory (hypophysitis)
Pituitary apoplexy
haemorrhage (or less commonly infarction)
Peri-partum infarction (Sheehan’s syndrome)

Question 9

What does excess TSH cause?

Answer 9

Thyrotoxicosis

Question 10

What does excess FSH and LH cause?

Answer 10

Precious puberty in children

Question 11

What affect does high levels of prolactin have?

Answer 11

It suppresses GnRH pulsatility

Question 12

How do you treat hyperprolatinaemia?

Answer 12

First line of treatment is medical:

Cabergoline or bromocriptine - reduces prolactin secretion and tumour size.

Question 13

What are the side effects of dopamine receptor agonists?

Answer 13

Depression
Dyskinesia
Pathological gambling
Postural hypotension
Nausea and Vomiting

Question 14

What is a pathological cause of hyperprolactinaemia?

Answer 14

Prolactinoma - often a microadenoma <10mm in diameter.

Most common functioning pituitary tumour

Question 15

What grows in acromegaly?

Answer 15

periosteal bone
cartilage
fibrous tissue
connective tissue
internal organs (cardiomegaly, splenomegaly, hepatomegaly, etc.)

Question 16

What is the medical term for excess sweating?

Answer 16

Hyperhidrosis

Question 17

What are the clinical features of acromegaly?

Answer 17

excessive sweating (hyperhidrosis)
headache
enlargement of supraorbital ridges, nose, hands and feet, thickening of lips and general coarseness of features
enlarged tongue (macroglossia)
mandible grows causing protrusion of lower jaw (prognathism)
carpal tunnel syndrome (median nerve compression)
barrel chest, kyphosis

Question 18

Apart from GH what other hormone is often secreted in Acromegaly?

Answer 18

Prolactin - prolactinaemia

Question 19

How do you treat acromegaly?

Answer 19

First line treatment - transphenoidial surgery#

Medical 
Somatostatin analogues
e.g. OCTREOTIDE
Dopamine agonists (GH secreting pituitary tumours frequently express D2 receptors)
e.g. CABERGOLINE

Radiotherapy

Question 20

Give an example of a somatostatin analogue?

Answer 20

Octreotide

Question 21

Describe somatostatin analogues?

Answer 21

‘Endocrine cyanide’
Injection: sc (short acting) or monthly depot
GI side effects common eg nausea, diarrhoea, gallstones can occur
Reduces GH secretion and tumour size
Pre-treatment before surgery may make resection easier
Use post-operatively if not cured or whilst waiting for radiotherapy to take effect (slow)