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Year 5 Path > Chempath - pituitary + adrenals + lipid management > Flashcards

Chempath - pituitary + adrenals + lipid management Flashcards

1
Q

High TSH and high prolactin

A

Primary hypothyroidism

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2
Q

TRH stimulates…?

A

TSH and prolactin

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3
Q

Prolactin levels in a non-functioning pituitary adenoma?

A

Super high prolactin

normally, dopamine inhibits prolactin release. In non-functioning pituitary adenoma, dopamine release is affected

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4
Q

Sheehan’s syndrome - TSH levels?

A

normal

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5
Q

How to assess visual field in macro adenoma?

A

Humphreys 30-2 test

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6
Q

How does lactational amenorrhoea work (i.e. breastfeeding prevents pregnancy how??)

A

Prolactin –> inhibits GnRH release

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7
Q

Prolactinoma is when prolactin is…

A

> 6000

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8
Q

Pituitary microadenoma - how should you approach these patients?

A

Most of them are asymptomatic + don’t grow - removing the pit gland would require medications for life

. Scan 1 year later

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9
Q

Pituitary function testing - what 3 things do you give?

A
  1. Induce hypoglycaemia w insulin 0.15U/kg
  2. give GnRH (to see if LH/FSH is released) 100mcg
  3. give TRH (to see if TSH if released) 200mcg
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10
Q

What must be checked in a patient before testing for pituitary function?

A

No Hx of epilepsy
Normal ECG
No cardiac RFs

–> hypoglycaemia is dangerous ok1!!

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11
Q

How to prevent dangerous hypoglycaemia when testing pituitary function

A

Ensure iv access with large bore canulae (so dextrose can be given if induced hypoglycaemia is too extreme)

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12
Q

What is the first symptom of hypoglycaemia?

A

Sympathetic activation: palpitations + sweating

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13
Q

Hypoglycaemia at around 2mM - how does the patient respond?

A

AGGRESSION

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14
Q

In a patient undergoing combined pituitary function testing: if severe hypoglycemia/unconsciousness occurs, how do you rescue the patient?

A

50mL of 20% dextrose

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15
Q

what dose of insulin is given in combined pituitary function test?

A

0.15units/kg

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16
Q

what plasma level of glucose should be achieved for combined pituitary function testing

A

<2.2mM

Only at this low level of glucose will the patient elicit a stress response

17
Q

GnRH, TRH, insulin is given to ?pituitary failure patient. What is monitored once these are given? 7 things

A
  1. Glucose - to ensure hypoglycaemia isn’t too extreme
  2. GH
  3. Cortisol
  4. LH
  5. FSH
  6. TSH
  7. Prolactin
18
Q

30 mins into the combined pituitary function test, the glucose level is 4mM. what should you do?

A

give more insulin

19
Q

In a pt with prolactinoma, which treatment is urgent

A

Hydrocortisone replacement

20
Q

In a pt with prolactinoma, if LH FSH is low, what do you need to give?

A

Oestrogen replacement

21
Q

which hormone does not need to be replaced in prolactinoma?

A

Fludrocortisone

22
Q

2 tests to confirm acromegaly dx

A

OGTT

IGF1

23
Q

Treatments for acromegaly

A

Pituitary surgery = number 1!!!

2nd line = radiotherapy

Drugs: cabergoline, Ocreotide

24
Q

Ocreotide

A

GH inhibitor

25
Q

Management of addison’s disease

A

1) if severely hypotensive –> IV 0.9% saline

2) Hormone replacement - fludrocortisone and hydrocoritson

26
Q

Ddx for adrenal mass and hypertension?

give 3

A

Phaeo
Conn’s
Cushing’s

27
Q

Management of Phaeochromocytoma

A

1) IV fluids
2) urgent alpha blockade w phenoxybenzamine
3) beta blockade
4) surgical resection

28
Q

static test for suspected cushing’s

A

morning and evening cortisol

29
Q

top 3 investigations for suspected cushing’s

A

1) morning + evening cortisol
2) dexamethasone suppression test
3) pituitary MRI

30
Q

2nd line drugs for lipid lowering

A

Ezetimibe + evolocumab

31
Q

PCSK9 inhibitor - eg? how does it work?

A

Evolocumab

reduces LDLR recycling, so more LDLR is mopped up from plasma

32
Q

Ezetimibe - MOA?

A

NPC1L1 inhibitor

Prevents cholesterol absoprtion

33
Q

Empagliflozin - MOA?

A

SGLT2 inhibitor –> reduces glucose reabsorption –> glycosuria + lower plasma glucose level

34
Q

SGLT2 inhibitor - eg? how does it work?

A

Empagliflozin

- inhibits glucose reabsorption in kidney, so plasma glucose is lowered

35
Q

GLP1 agonists - give egs?

A

Seraglutide, liraglutide

36
Q

GLP1 agonists - MOA?

A

induces insulin release

37
Q

Seraglutide - MOA?

A

GLP1 agonist –> induces insulin release

38
Q

Which drug causes glycosuria in a good way?

A

Empaglifozin = SGLT2 inhibitor (inhibits renal glucose reabsorption)

Year 5 Path (63 decks)

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