Clinical Chemistry Cases - Pituitary

Question 1

Pituitary Failure Causes Hypotension

T TRUE
F FALSE

Answer 1

False

Adrenals will still make aldosterone even in pituitary failure

Question 2

What is Sheehans?

Answer 2

Pituitary gland enlarges during pregnancy and is just barely perfused by capilliaries

If a rupture happens e.g. Placental abruption (Detaches from wall) and mother bleeds.

If stabilised, mother will survive but pituitary is now infarcted as it was critically ischaemic during the bleed

Question 3

What will the mother report after Sheehans?

Answer 3

Can’t breastfeed - Prolactinaemia

No periods - No FSH/LH

Tiredness - No TSH

BP normal - Aldosterone still produced by adrenals

Question 4

Two symptoms of pituitary failure due to macroadenoma

Answer 4

Galactorrhoea

Amenorrhoea

Question 5

What complication should you look for if patient has:

Galactorrhoea
Amenorrhoea

Answer 5

Bitemporal Hemianopia

Question 6

How to test for bitemporal Hemianopia

Answer 6

Visual Fields testing of each eye individually

Question 7

A CT scan of her pituitary shows a large (2cm) macroadenoma.

Her prolactin level comes back at 30,000 (normal <600). She has not had sexual intercourse.

Diagnosis?
A) Cushing’s disease
B) Acromegaly
C) Prolactinoma
D) Non-functioning pituitary adenoma
E) Conn’s syndrome

Answer 7

C) Prolactinoma

If prolactin over 6000, always prolactinoma

Question 8

What investigation for prolactinoma?

Answer 8

1) Serum Prolactin
2) MRI
3) Pituitary function test

Question 9

What needs to be given for Combined Pituitary Function Test

What 2 things would be contraindications

Answer 9

TSH + GnRH + Insulin

Cardiac issues and Epilepsy

Question 10

How low must glucose drop for CPFT?

Answer 10

< 2.2

Question 11

A patient has pan hypopituitarism in CPFT with prolactin of 30000

Most likely diagnosis?

Answer 11

Prolactinaemia

Question 12

Which one is urgent in panhypopituitarism

A) Fludrocortisone replacement
B) Hydrocortisone replacement
C) Thyroxine replacement
D) Oestrogen replacement
E) GH replacement

Answer 12

B) Hydrocortisone replacement

Question 13

Prolactinoma Patient

Hydrocortisone replacement
Thyroxine replacement
Oestrogen replacement
GH replacement

NAME ONE OTHER DRUG THAT SHE NEEDS:

Answer 13

Cabergoline

Question 14

27 year old woman with large pituitary adenoma and bitemporal hemianopia

CPFT shows panhypopituitarism and prolactin of 2700

Diagnosis?

Answer 14

Nonfunctioning pituitary adenoma

Question 15

27 year old woman with large pituitary adenoma and bitemporal hemianopia

CPFT shows panhypopituitarism and prolactin of 2700

Which one is not needed?

A) Fludrocortisone replacement
B) Hydrocortisone replacement
C) Thyroxine replacement
D) Oestrogen replacement
E) GH replacement

Answer 15

A) Fludrocortisone replacement

Question 16

27 year old woman with large pituitary adenoma and bitemporal hemianopia

CPFT shows panhypopituitarism and prolactin of 2700

Hydrocortisone replacement
Thyroxine replacement
Oestrogen replacement
GH replacement

What other drug is needed?

A) Carbimazole
B) Dexamethasone
C) Cabergoline
D) Octreotide
E) Nothing

Answer 16

E) Nothing

Carbimazole for hyperthyroid

Dexamethasone only for big brain tumours

Cabergoline possibly, but won’t do much

Octreotide for Acromegaly

Question 17

28 year old woman, large pituitary adenoma, bitemporal hemianopia

CPFT - GH massively raised, prolactin 2800

Likely diagnosis?

Answer 17

Acromegaly

Question 18

Acromegaly

Dynamic test to confirm:

A) Low dose dexamethasone suppression test
B) High dose dexamethasone suppression test
C) Synacthen test
D) Glucose tolerance test
E) TRH stimulation test

Answer 18

D) Glucose tolerance test and measure GH and failure to suppress is acromegaly

Question 19

Name another test (Not GTT) you could do to confirm acromegaly

Answer 19

Serum IGF 1

Question 20

Best treatment for Acromegaly along with replacement?

A) Pituitary surgery
B) Pituitary radiotherapy
C) Cabergoline
D) Octreotide
E) All of the above.

Answer 20

E) All of the Above

Order of preference of treatment is A to D. Octreotide is super expensive and must be given for life