24. Pituitary and Adrenal disease

Question 1

How can pituitary function be assessed?

Answer 1

Insulin tolerance test
Short synacthen test
Thyroid axis
Gonadal axis

Question 2

What does the insulin tolerance test test?

Answer 2

Hypoglycaemia triggers ACTH and GH release

Tests whether the response is within a normal range or increased

Question 3

What are the contraindications for an insulin tolerance test?

Answer 3

Seizures

Ischaemic heart disease

Question 4

What does the short synacthen test test for?

Answer 4

Adrenal insufficiency

Baseline cortisol checked and then again 30 mins after giving ACTH

Question 5

How is a GH excess confirmed?

Answer 5

Serum IGF-1 level

Oral glucose tolerance test

Question 6

How does the oral glucose tolerance test show GH excess?

Answer 6

Normally GH is suppressed by a glucose load, in excess GH it may rise or stay the same

Question 7

What screening should be done in a patient with confirmed GH excess?

Answer 7

ECHO: may seen LV hypertrophy and mitral regurg
Colonoscopy: increased risk of polyps
Visual fields

Question 8

When should ACTH and cortisol be measured?

Answer 8

In the morning; highest due to diurnal rhythm

Question 9

What are the treatment options for GH excess?

Answer 9

Surgery and radiotherapy for tumour
Somatostatin analogues or GH receptor blocker
Replace other pituitary hormones if low
Treat co-morbidities

Question 10

What is the management of adrenal insufficiency?

Answer 10

Replace cortisol and aldosterone

Double the dose when unwell

Question 11

What are the causes of ‘pseudocushing’s’?

Answer 11

Alcohol

Depression

Question 12

What criteria must be positive to diagnose Cushing’s disease?

Answer 12

2 of:
24 hour urine cortisol
overnight dexamethosone depression test (normal=reduced)
Late night salivary cortisol

Question 13

What tests can be done to establish the aetiology of Cushing’s disease?

Answer 13

Measure ACTH
CT of adrenals
MRI of pituitary