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SM Endocrine > Cushing's, Hypopituitarism and Diabetes Insipidus > Flashcards

Cushing's, Hypopituitarism and Diabetes Insipidus Flashcards

1
Q

What happens in Cushing’s syndrome

A

Excess cortisol
Protein loss
Excess Mineralocorticoid
Excess androgen

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2
Q

Why is there an increase in blood sugars in Cushing’s syndrome

A

Carbohydrates are not being metabolised and are laid down as fat stores instead

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3
Q

where is muscle wasting likely to be seen

A

Proximally - the shoulders and limb girdles

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4
Q

What does excess androgen cause

A

Virilism
Hirsutism
Acne
Oligo/ amenorrhoea

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5
Q

What are some characteristics of Cushing’s that are not true of Obesity

A 
Thin skin 
Proximal myopathy 
Frontal balding in women 
Conjunctival oedema (chemosis)
Osteoporosis
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6
Q

Describe the appearance of a cushing’s patient’s body

A

matchstick like

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7
Q

What test do we do to test for Cushing’s syndrome

A

Giving exogenous steroid (dexamethasone) which should suppress serum cortisol

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8
Q

What are some other tests we can do to diagnose cushing’s

A

Urine free cortisol

Diurnal cortisol variation

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9
Q

What are the ectopic reasons for developing Cushing’s

A

Thymus, lung or pancreas tumours producing ACTH

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10
Q

If the pituitary was the problem for Cushing’s, what would be seen

A

ACTH of less than 300

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11
Q

If an ectopic site was the problem for Cushing’s what would be seen

A

An ACTH of more than 300

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12
Q

What would be the effect of a high dose dexamethasone suppression test if the problem was

a) pituitary
b) adrenal
c) ectopic

A

a) suppressed by 50%
b) nil
c) nil

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13
Q

What is the treatment for a pituitary causing Cushing’s

A

Hypophysectomy (removal of tumour)

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14
Q

What is the treatment for an adrenal causing Cushing’s

A

Adrenalectomy

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15
Q

What is the treatment for an ectopic cause of Cushing’s

A

Remove source or bilateral adrenalectomy

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16
Q

When would drug treatment for Cushing’s disease be appropriate

A

When surgery has failed

17
Q

What drugs can be used for Cushing’s

A

Metyrapone
Ketoconazole
Pasireotide

18
Q

What hormones does the anterior pituitary produce and what happens in pan hypopituitarism

A 
Growth hormone (growth failure)
TSH (hypothyroidism)
LH/FSH (hypogonadism)
ACTH (hypoadrenal)
Prolactin (none)
19
Q

What can occur if there is hypopiutiarism in the posterior pituitary

A

diabetes insipidus

20
Q

What are some of the causes of hypopituitarism

A 
Pituitary tumours 
secondary metastatic lesions 
local brain tumours 
granulomatous diseases 
Trauma 
Infection
21
Q

What are some signs of anterior hypopituitarism in females

A 
Menstrual irregularities 
Infertility 
Abdominal obesity 
Loss of axillary and pubic hair 
Dry skin and hair 
Hypothyroid faces
22
Q

What are some signs of anterior hypopituitarism in males

A 
Infertility, impotence 
Gynaecomastia 
Abdominal obesity 
Loss of facial hair 
loss of axillary and pubic hair 
dry skin and hair 
hypothyroid faces
23
Q

what is a sign of hypopituitarism in children

A

growth retardation

24
Q

What are the benefits of growth hormone in adults

A 
improves well being and quality of life 
decreases abdominal fat 
increases muscle mass 
improves cardiac function 
decreases cholesterol and increases LDL 
increases bone density
25
Q

How is growth hormone given

A

Daily SC injection

26
Q

How can testosterone be replaced

A

IM injection every 3-4 weeks

skin gel or prolonged IM injection every 12 weeks

27
Q

what are the main problems with tablets to replace testosterone

A

they can cause liver toxicity

28
Q

What are some of the risks of testosterone replacement

A

prostate enlargement (not cancer)
Polycythaemia
Hepatitis (oral tablets)

29
Q

What test can we do to diagnose diabetes insipidus

A

Water deprivation test

30
Q

What is the best screening test for Cushing’s syndrome

A

A 1mg overnight dexamethasone suppression test

31
Q

Can testosterone cause polycythaemia

A

Yes

SM Endocrine (27 decks)

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