2 Endocrine - Pituitary diseases

Question 1

Deficiencies in vasopressin (Anitdiuretic hormone) cause…

Answer 1

diabetes insipidus - ADH normally allows you to concentrate your urine

Question 2

Treatment for non-functioning pituitary tumors?

Answer 2

Surgery-

the aims are to protect eyesight (as the optic nerve is close) and restore pituitary function

Question 3

Tumors in the …… producing………… can cause cushings

Answer 3

Pituitary

ACTH

Question 4

How can we used DA receptor agonist to treat proclactinomas (tumor secreting prolactin)?

Answer 4

Prolactin is inhibited by the release of DA from the hypothalamus. Enhance DA causes fall in prolactin.

Question 5

How to get pregnant with a prolactonoma?

Answer 5

Need to restore menstral cycle before you can get pregnant as you won’t ovulate otherwise - use cabergoline (a DA receptor agonist)

Question 6

Agromedly is caused by….?

Treatment is…

Answer 6

Excess growth hormone (in childhood this causes gigantism)

Surgery

Question 7

Cushings symptoms: (8)

Answer 7

Bruising
Central obesity & peripheral wasting and myopathy
Moon face/buffalo hump

Hypertension
Diabetes
Low K
Gastric ulcers

Psychological illnesss

Question 8

Treatments of Cushings surgically is achieved how:

Answer 8

Remove tumor - Metyrapone in preparation for surgery

Question 9

Why use Metyrapone in preparation for surgery to resolve cushings?

Answer 9

Blocks hydrocortisone synthesis - the goal is to achieve normal cortisol before surgery to aid healing/reduce chance of infection (your immune system is suppressed)

Question 10

Pituitary failure: hormones you must mimic…

Answer 10

Growth hormone
Oestrogen/testosterone (LH and FSH)
Thyoxine (TSH)
Cortisone (ACTH)
Desmopressin (to prevent diabetes insupidus)

Question 11

What is the difference between primary and secondary hypothyroidism?

Answer 11

Primary: underactive thyroid
Secondary: pituitary isn’t stimulating your thyroid enough to produce hormones
Tertiary: hypothalamus isn’t stimulating your pituitary enough

Question 12

What to monitor in secondary hypothyroidism?

Answer 12

TSH is no useful. You need to monitor free T4 only.

Question 13

Why use hydrocortisone instead of prednisolone?

Answer 13

hydro is shorter acting - mimics natural rhythm.

pred is longer - use for asthma

Question 14

Cortisol is a GC or MC?

Answer 14

GC

Question 15

Fucntion of MCs?

Answer 15

maintain your BP

Question 16

What is used to substiture deficint MC?

Answer 16

fludrocortisone

Question 17

is fludrocortisone needed in pituitary failure?

Answer 17

no - only needed when your adrenals don’t work too

Question 18

Equivalent dose

20mg hydrocortisone = ……….mg predinisolone = ……..mg dexamethasone

Answer 18

20mg hydro = 5-7.5mg pred = 0.75mg dexameth

Question 19

Hydrocortisone sick day rules -

Answer 19

• double dose with fever/broken limb/surgery/shock/long haul flight
• double dose with gastroeneteritis + IM
• 20mg for dental exraction

Question 20

Function of desmopressin

Answer 20

acts on kidney collecting ducts to allow water reabsorbtion - aim is to control polyuria. Check sodium levels.