Adrenal and Pituitary Flashcards
(140 cards)
1
Q
anterior pituitary is also called the ___
is derived from ____
A
adenohypophysis
Rathke’s pouch
2
Q
non-trophic hormones produced by anterior pituitary =
A
GH and PRL
3
Q
posterior pituitary aka ___
is an extension of ____ consisting of ___+___
A
neurohypophysis
neural tissue
modified glial cells
axonal processes
4
Q
histology of anterior pituitary = __
acidophils =+
basophils =__+__
A
islands, cords of cells ; chromophobe islands
acido = somatotrophs (GH-50%) mammotrophs (PRL 20%)
baso = corticotrophs (ACTH 20%), thyrotrophs (TSH 5%) gonadotrophs (L/FSH 5%)
5
Q
histology of posterior pituitary
A
non-myelinated axons of neurosecretory neurons
6
Q
Pituitary adenoma can be associated with __ (__ syndrome)
A
MEN1
Wermer syndrome
7
Q
3 affects of a prolactinoma
A
infertility
lack of libido
25% have amennorhoea
8
Q
large pituitary adenoma local affects may be __+__+__
A
visual field defect (bitemporal hemianopia)
P atrophy of surrounding tissue
infarction => panhypopituitarism
9
Q
ischaemic necrosis of pituitary that causes panhypopituitarism =
A
Sheehan syndrome
10
Q
granulomatous disease that can cause panhypopituitarism
A
sarcoidosis
11
Q
craniopharyngioma is derived from _____ = 1-5% of IC tumours
A
Rathke’s pouch remnants
12
Q
4 features of craniopharyngioma =
can cause ____
A
slow growing often cystic may calcify most suprasellar some are in sella => panhypopituitarism
13
Q
ages that get craniopharyngiomas
A
5-15 yos or 50-60 yos
14
Q
_+__ = symptoms of craniopharyngioma
in kids may cause ___
A
visual disturbances and headaches
growth retardation
15
Q
congenital adrenocortical hyperplasia :
pattern of inheritance =
causes _/__ of steroid enzymes => increased ___
A
auto recessive
lack/deficiency
androgens
16
Q
nodular adrenocortical hyperplasia is ACTH dep/independent?
A
ACTH independent (diffuse = ACTH driven)
17
Q
if adrenal cortex tumours in young then consider
A
Li Fraumeni Syndrome
18
Q
appearance of adrenal cortex adenomas=
A
well circumscribed encapsulated small - 2-3cm yellow/yellow-brown (lipids) small nuclei
19
Q
features of adrenal cortex carcinoma that distinguish it from adenoma
A
large (>20cm) haemorrhagic and necrotic frequent mitoses atypical mitoses lack of clear cells capsular/vascular invasion
20
Q
primary hyperaldosteronism aka
60% associate with __
A
Conn’s
diffuse/nodular bilateral hyperplasia
21
Q
Cushings that is ACTH dep = __/___
and leads to ___
A
pituitary tumour (70%) small cell lung cancer adrenal hyperplasia
22
Q
Cushings that is ACTH independent can be caused by __/___
and leads to ___
A
adrenal adenoma (10%) or carcinoma (5%) adrenal atrophy
23
Q
acute primary adrenal insufficiency caused by massive adrenal haemorrhage due to septicaemia =
A
Waterhouse Friederichsen
24
Q
causes of acute primary adrenal insufficiency =
A
rapid steroid withdrawal
stress on chronic insufficiency
massive adrenal haemorrhage - newborn, anticoagulants, DIC, septicaemia
25
3 common causes of Addisons
AI adrenalitis
infections (tb, HIV etc.)
metastases
26
chronic primary adrenal insufficiency aka
Addisons
27
signs of Addisons when >90% of adrenal glands are destroyed =
```
fatigue
anorexia
nausea and vom
wt loss
diarrhoea
pigmentation
increase K+ and decrease Na+ = hypotension
hypoglycaemia
```
28
pigmentation in Addisons is caused by
ACTH having the same precursor as MSH
29
zona glomerulosa produces __
mineralocorticoids - aldosterone
30
zona fasciculatis produces ___
glucocorticoids - cortisol
31
zona reticularis produces ___+___
glucocorticoids and sex hormones
32
adrenal medulla is innervated by ___ and chrommafin cells secrete ___
pre-synaptic sympathetic fibres
| catecholamines
33
___+___ in neuroblastoma are indicative of a poor outcome
amplification of N-myc
| expression of telomerase
34
neuroblastoma is usually diagnosed at age ___
| 40% from ___ and most of the others are found ___
18months
adrenal medulla
along sympathetic chain
35
neuroblastoma are composed of ___ cells but can show maturation and differentiation towards ___ cells
primitive
| ganglion
36
tumour of chromaffin cells in the adrenal medulla =
phaeochromocytoma
37
tumour in adrenal medulla that secretes catecholamines =
| leads to secondary =
phaeochromocytoma
| 2ndry hypertension
38
detect __+___ in urine if have a phaeo
catecholamines and metabolites
39
90% of phaeos are associated with ___ which comes on with _+_+_+_
paroxysmal hbp
| stress, palpation of tumour, exercise, posture
40
if stain phaeo with K2Cr2O7 turns ____ as the catecholamines ____
dark brown
| oxidise
41
nests of cells seen in phaeos
zellballen
42
usually phaeos metastasise to ___
skeleton
43
Phaeo is a feature of __ (sipple syndrome )
| gene mutation =
MEN 2A
| gain of function mutation in RET gene on 10q11.2
44
MEN2B mutation =
| tumours associated =
activating point mutation in catalytic zone of encoded enzyme
phaeo
MTC, neuromas/ganglioneuromas
marfanoid habitus
45
tumours ass with MEN2A
phaeo in 40%
MTC in 100%
10-20% parathyroid hyperplasia
46
hormones from hypothalamus > ___ > stimulate the ___ pituitary
portal system
| anterior
47
hyphothalamic hormones > ____ >stored in ___ pituitary
neuronal tracts
| posterior
48
in synacthen test cortisol should normally rise to ___
450-500
49
dont give a prolonged glucagon test to __/___
epileptics or CVDs
50
insulin stress test =
make bg ___ the measure __+__
normal =
<2.2mmol/l
GH and cortisol
both increase so that GH >7microg/l + cortisol >500
51
water deprivation test - if suspect __
check _+_ for 8hrs and then give ___ and check for 4hrs more
if urine:serum osmolarity >2 (even on random test ) = ___
Diabetes Insipidus
serum and urine osmolarities
desmopressin
normal
52
microadenoma = ___cm
| macroadenoma =___cm
<=1cm
| >1
53
CN at risk of compression in pituitary pathology
CN III, IV and VI
54
4 physiological causes of raised prolactin
Pregnancy
breast feeding
stress
sleep
55
5 drugs that can cause raised prolactin
```
D2 antagonist anti-emetics (domperidone +metoclopramide)
phenothiazines
TCA and SSRIs
oestrogens
cocaine
```
56
pathological causes of raised prolactin (3)
hypothyroidism (raised TSH => raised PRL)
stalk lesions
prolactinoma
57
Females with raised prolactin tend to present early/late
| with _/_/_/_
```
early
amenorrhea (most common)
infertility
menstrual irregularity
galactorrhoea
```
58
Males with raised prolactin tend to present early/late
| with _/_/_/_
```
late
impotence (decreased testosterone)
visual field abnormality
headache
anterior pituitary malfunction
```
59
investigations for suspected raised prolactin
PRL concn
MRI (prolactinoma, stalk lesion, optic chiasm)
visual fields
pituitary FTs
60
Rx for raised prolactin
| effect on tumour size
dopamine agonists - usually cabergoline (bromocriptine / quinogolide)
tumour shrinks
61
route that cabergoline is given and how frequently
PO
| twice a week
62
headache in acromegaly is caused by ___
hyperdynamic blood flow
63
signs and symptoms of acromegaly
```
thickened soft tissues
spade hands
macrognathia
hbp
HF
headache
sleep apnoea
DM
colonic polyps and cancer
visual disturbances
```
64
2 best Investigations for suspected acromegaly
IGF-1 blood test (increased)
| OGTT - and check GH response normal = <0.4microg/l
65
first line treatment for acromegaly
transspenoidal Sx
66
drug treatment for acromegaly if tumour is unresectable
somatostatin analogues - octreotide / lanreotide
D2 agonists - cabergoline
GH receptor antagonists - pegvisomant (last line)
67
D2 agonists are better for the treatment of acromegaly if there is also ___
co-secretion of PRL
68
can use SSAs pre op for acromegaly because it __/___
relieves headache in 1hr
| gives a better outcome
69
side effects of SSAs used for Rx of acromegaly
flatulence, diarrhoea (long term)
| gallstones (decreased GB contractions)
70
___ = drug that can reduce the size of acromegalic pituitary tumour
SSAs - octreotide
| re-expands 6wks after stop the drug
71
cancer surveillance for acromegalic patients = __+__
colon and tubulo-villous adenoma - every 3 yrs
72
excess cortisol in Cushings causes __ loss, altered __+__ metabolism, __ and central ___
protein loss
lipid and carb
DM
obesity
73
proximal myopathy, thin skin, frontal balding (F), chemosis and osteoporosis are characteristics of __
Cushing's
74
chemosis =
conjunctival oedema
75
best screening test for Cushing's =
| normal and abnormal limits =
overnight 1mg dexamethasone suppression test
normal = <50nmol/l
abnormal =>100
76
2 screening test for Cushing's =
overnight 1mg dexamethasone suppression test
| urine free cortisol (24hr urine collection)
77
definitive diagnostic test for Cushing's =
| normal =
low dose dexamethasone suppression test
2mg/day for 2 days
normal = <50nmol/l 6 hrs after last dose
78
Cushing's disease is due to a __
pituitary cause
79
ACTH test results for pituitary, adrenal and ectopic causes of Cushing's
```
pit = <300
adrenal = <1
ectopic = >300
```
80
high dose DST result in pituitary, adrenal and ectopic causes of Cushing's
pit = suppress by 50%
| adrenal and ectopic = nil
81
treatment for pituitary cushings
hypophysectomy (maybe + external radio.)
| OR bilateral adrenalectomy
82
treatment for adrenal causes of Cushings
adrenalectomy
83
drug treatment for Cushings if Sx fails
metyrapone, ketoconazole, pasireotide (SSA)
84
if get normal pituitary hormone levels with low peripheral hormones= _____ = __
inappropriately normal
| hypopituitarism
85
treatment of hypopituitarism =
replacement hormones - give hydrocortisone and then thyroxine then the others
86
testosterone replacements IM = ___, PO = ___
```
IM = nebido every 10-14wks
PO = restandol (if very mild hypo-testosterone)
```
87
DIDMOAD aka __
stands for ___
pattern of inheritance =
Wolfram Syndrome
Diabetes insipidus, Diabetes mellitus, opti atrophy, deaf
auto recessive
88
test to diagnose DI
water deprivation test
89
treatments for DI =
desmospray (nasal)
| desmopressin PO/IM
90
if a Glucocorticoid receptor dimer is allowed to bind to GRE then steroid causes ___
activation of the gene
91
if nGRE only allows a GR monomer to bind then steroid causes ___
gene repression
92
steroid effect depends on __ not on __
gene sequence
| not on the steroid used/the type of receptor
93
steroids also activate the ___ which leads to the adverse effects __+__
mineralocorticoid receptor
| thin skin and poor wound healing
94
if co-administer a ___ with steroids then can inhibit __+__ as it saturates the __
mineralocorticoid
inhibit skin atrophy and increase wound healing
Mineralocorticoid receptor
95
GR activation in the __ of the brain can lead to ___
amygdala
| alcohol craving
96
Is licensed for acute Cushing' crisis as it binds to GR and blocks =
mifepristone (morning after pill)
97
sign of high androgen levels in CAH for F and M
```
F = ambiguous genitalia
M = precocious puberty
```
98
adrenal cortex layers outer to inner =
GFR
glomerulosa
fasciculata
reticularis
99
zona glomerulosa is regulated by
ATII and extracellular K+
100
zona fasciculata is regulated by
ACTH
101
zona reticulatis is regulated by
ACTH and others
102
RAS is activated by ___ and it causes __+___
```
decreased bp
vasoconstriction (ATII)
salt retention (aldosterone)
```
103
excess cortisol causes osteoporosis because
increases osteoclastic activity
| decreases serum Ca2+
104
cortisol ___ lipolysis and cause fat to be deposited __
increases
| centrally
105
effect of cortisol on proteolysis
increases it
106
cortisol ___ capillary dilatation and permeability
decreases
107
cortisol ___ CO, bp, renal blood flow and GFR
increases
108
Ix for diagnosis of Addisons (5)
```
biochem (Na + bg low, K+ high)
short synACTHen
raised ACTH in blood
raised renin and low aldosterone levels
adrenal autoIgs
```
109
Rx for addison crisis
DON'T delay treatment
hydrocortisone IV immediately
later = fludrocortisone
110
Rx that replaces aldosterone
fludrocortisone
111
sick day rules for Rx of Addisons
x2 dose if sick
if vomit - retake
if cant keep anything down = IM and go to hospital within 6-8hrs
112
2ndry adrenal insufficiency has same features as primary but __+___
no pigmentation (ACTH low) and aldosterone production is intact
113
Rx in secondary adrenal insufficiency
just hydrocortisone
| no need for fludrocortisone
114
results of long ACTH test in 2ndry adrenal insufficiency -
long gradual rise = due to adrenal atrophy
115
purple striae =
Cushings
116
gradual withdrawal of steroid therapy is over ___
4-6wks
117
Conns (primary hyperaldosteronism) features =__+__
increases number and activity of _____
can lead to __+__
hbp and hypokalaemia
Na+ reabsorption channels
LV hypertrophy and atheroma
118
commonest cause of primary hyperaldosteronism (usually older patients) =
bilateral adrenal hyperplasia
119
cause of primary hyperaldosteronism (usually in young patients)
Conn's - adrenal adenoma
120
genetic mutations in ___ can cause primary hyperaldosteronism
K+ channels
121
to confirm hyperaldosteronism Ix = __
| if it is increased then test to confirm primary hyperaldosteronism =
plasma aldosterone:renin, plasma K+
| saline suppression test (fail to suppress by >50% with 2L = PA)
122
3 Ix to confirm the subtype of primary hyperaldosteronism
adrenal CT
adrenal vein sampling (confirms adenoma)
11C metomidate PET-CT
123
if adrenal adenoma is cause of primary hyperaldosteronism Rx =
unilateral laparoscopic adrenalectomy
124
if bilateral adrenal hyperplasia is cause of primary hyperaldosteronism Rx =
MR antagonists (spironolactone)
125
classical CAH = __+__
| non-classical = __
salt wasting + virilising
| hyperandrogenaemia
126
diagnosis of CAH is dependent on __+__ (Ix)
basal/stimulated 17-OH progesterone concn (increased)
| gene analysis
127
____ is the stage before 21alpha hydroxylase - a precursor for __>testosterone
17-OH progesterone
| androstenedione
128
Rx for CAH in paeds =
gluco (+maybe mineralo) corticoid replacement
| Sx
129
Rx for CAH in adults -
control androgen excess
restore fertility
avoid overreplacing steroids
130
__>L-DOPA>___>NA>___
tyrosine
dopamine
adrenaline
131
biochemistry of phaeo =
```
hyperglycaemic
maybe decreased K+
increased Hb
mild hyperCa2+
lactic acidosis
```
132
Ix to confirm catecholamine excess in phaeo/paragangliomas
2x24hr urine fo catecholamines/metanephrins
| plasma levels of catecholamines
133
3 diagnostic Ix for phaeo/paraganglioma=
MRI
MIBG (meta-iodidbenzylguanidine)
PET (-ve in slow growing/benign)
134
drugs for phaeo/paraganglioma
```
alpha blocker (phenoxybenzamine 1st line - others = prazosin/doxazosin)
followed by beta blocker (propanolol/metoprolol)
```
135
malignant phaeos and extraadrenal paragangliomas are less efficient at catecholamine synth and so instead ___ increase
precursor levels eg. dopamine
136
ectopic causes of cushings commonly originate in _+_+_
thymus
lungs
pancreas
137
if low dose dex suppression test confirm Cushings then next Ix= ___ to determine if pituitary, adrenal or ectopic
high dose dexamethasone suppression test (2mg/6hrs for 2 days)
138
adrenaline acts on ___ receptors in the heart
___ in the vessels
__ in muscles
__ in islet beta cells
beta1 heart
alpha 1 vessels
beta2
beta2
139
paragangliomas commonly occur here
aortic bifurcation
140
pigmentation in addisons is especially noticable in __+__
buccal mucosa
| palmar creases
