Chem Path: Pituitary

Question 1

What are the 6 hormones made by the anterior pituitary?

Answer 1

ACTH, TSH, LH, FSH, prolactin, GH

Question 2

How do you do pituitary fx test?

Answer 2

Triple test aka CPFT:

Insulin to see if ACTH and GH rise
TRH
LHRH

Question 3

What happens to your brain when you are severely hypoglycaemic

Answer 3

Neuroglycopaenia

Question 4

What do you give

Answer 4

20% dextrose 50ml

Question 5

How is the CPFt done

Answer 5

0.15U/kg insulin
200mg TRH
100mg LHRH
All IV

Question 6

Which is the most important hormone replacement in pituitary failure?

Answer 6

Hydrocortisone

Question 7

In what order do you replace the hormones?

Answer 7

Hydrocortisone
Thyroxine
Oestrogen
GH

Question 8

What would you give a patient with prolactinoma?

Answer 8

Dopamine agonist - bromocriptine and cabergoline

Question 9

What is non-functioning adenoma

Answer 9

Disconnection hyperprolactinaemia. The adenoma presses on the stalk, therefore causing a drop in all hormones produced. This means that prolactin will increase due to nothing inhibiting it.

Question 10

Which hormone does not need replacement in this case?

Answer 10

Fludrocortisone as it is not a pituitary hormone. It is to replace aldosterone, which is not affected in this case.

Question 11

What else would you give this patient?

Answer 11

Cabergoline - dopamine agonist and will normalise the prolactin, allowing for fertility

Question 12

What is acromegaly?

Answer 12

Excess GH

Question 13

How is it diagnosed?

Answer 13

Glucose tolerance test

Question 14

What is another test to confirm it?

Answer 14

IGF - 1 levels

Question 15

What’s the best treatment?

Answer 15

Surgery, radiotherpay, cabergoline, octeotride