Cushings Hypopituitarism + Diabetes Inspidus

Question 1

What happens with Cushings syndrome?

Answer 1

Excess cortisol
Protein loss
Altered carbohydrate/lipid metabolism
Altered psyeche, psychosis and depression
Excess mineralocorticoid
Excess Androgen

Question 2

What are differences between obesity and Cushings?

Answer 2

Thin skin
Proximal myopathy
Frontal balding in women
Conunctival oedema (chemosis)
Osteoperosis

Question 3

What are tests for Cushing’s?

Answer 3

Screening - overnight 1mg dexamethasone suppression test
Urine free cortisol (24hr collection
Diurnal cortisol variation (midnight/8am)

Question 4

What is a definitive test for Cushing’s?

Answer 4

Low dose DST, 2 day 2mg/day dexamethasone suppression test.

Question 5

What are treatments for Pituitary problems?

Answer 5

Hypophysectomy

External radiotherapy if recurs

Question 6

What is the treatment for adrenal problems?

Answer 6

Adrenalectomy

Question 7

What are treatments for Ectopic problems?

Answer 7

Remove source

Bilateral adrenalectomy

Question 8

What are possible drugs used in Cushing’s?

Answer 8

Metyrapone (if other treatments fail)
Ketaconazole (hepatotoxic)
Pasireeotide - new somatic analogue + receptor 2 and 5 blocked

Question 9

What is Pan Hypopituitarism?

Answer 9

Anterior  - Growth hormone failure
TSH hypothyroidism
Lh/FSH hypogonadism
ACTH hypoadrenal
Prolactin none known
Posterior: - deiabetss insipidus

Question 10

What are symptoms and signs of hypopituitarism?

Answer 10

Menstrual irregularities
Infertility/impotence
Gynaecomastia 
Obesity
Loss of facial, auxillary and pubic hair
Dry skin and hair
Hypothyroid faces
Growth retardation

Question 11

What is a recommended dose of thyroxine for hypopituitarism?

Answer 11

100-15-mcg/day

Question 12

What is the recommended dose of hydrocortisone for hypopituitarism?

Answer 12

10-25mg/day (am/pm)

Question 13

What other drugs are recommended for hypopituitarism replacement therapy?

Answer 13

ADH - desmospray (nasal) or tablets
GH - nightly sc
Sex steroids - HRT, Oest/prog pill for female, testosterone for males

Question 14

In adults, what benefits do growth hormones have?

Answer 14

Decreased abdo fat
Increase muscle mass, strength, exercise capacity and stamina
Improves cardiac function
Decreases cholesterol and increases LDL
Increases bone density
Given daily via injection sc

Question 15

How is testosterone delivered?

Answer 15

IM injection every 3-4 weeks
Skin gel (testogel, tostram)
Prolonged IM injection, 10-14 weeks (nebido)
Oral tablets = restandol

Question 16

What are risks of testosterone?

Answer 16

Prostate enlargement, does not cause prostate cancer but may make it grow
Polycythaemia
Hepatitis

Question 17

What are causes of diabetes inspidus?

Answer 17

Familial - DIDMOAD
Acquired - Idipathic 50%, trauma surgery, skull fracture
Rare - traums, sarcoid, irradiation, meningitis

Question 18

What would the dose of desmospray be?

Answer 18

nasally, 10-60 mcg/day

Question 19

What would the dose of Desmopressin oral tablets be?

Answer 19

100-1000 mcg per day

Question 20

What would the dose of desmopressin sublingual tablets be?

Answer 20

60-360 mcg per day

Question 21

What would the dose of desmopressin injection be?

Answer 21

1-2mcg IM per day