Endo II - Hypothalamus & Pituitary Disorders

Question 1

what mass lesions can cause hypopituitarism

Answer 1

craniopharyngioma
Rathke’s pouch cyst
meningioma
non-functional pituitary macroadenoma
metastasis from lung
intrasella ICA aneurysm

Question 2

what drug causes lymphocytic hypophysitis

Answer 2

ipilimumab

Question 3

what hormone deficiency does haemochromatosis cause in pituitary

Answer 3

deficiency in gonadotropin

Question 4

list infiltrative lesions affecting pituitary

Answer 4

lymphocytic & granulomatous hypopthysitis
haemochromatosis
infection
systemic corticosteroids
genetic

Question 5

ischaemia causing necrosis & haemorrhage
sudden onset
headache
visual disturbances
vomiting
occular paresis CNIII, disruption to IV and VI

Answer 5

pituitary apoplexy

Question 6

blood loss during childbirth
postpartum pituitary necrosis / haemorrhage
severe lethargy
norexia, weight loss
failure post partum lactation
amenorrhoea weeks/months post delivery
GH, PRL, GnT deficiency

Answer 6

Sheehan syndrome

Question 7

obese
female
HTN
defect in diaphragm of sella
excess CSF –> herniate SA space into sella

Answer 7

primary - empty sella syndrome

(2’ regression size pituitary)
(3’ transcription factor abnormality - pituitary differentiation)

Question 8

mutation KAL1 and FGFR1
failure of migration of neurons
testicular hypotrophy
pubic hair present
hypo/anosmia

Answer 8

Kallman Syndrome (genetic)

Anosmia because migratory neurons arise in olfactory epithelium

Question 9

posterior pituitary hypofunctino is associated with

Answer 9

arginine vasopressin (ADH) deficiency
central diabetes insipidus

Question 10

sequence for testing pituitary hormones

Answer 10

test in pairs i.e. cortisol & ACTH
timing
deprivation test i.e. psychogenic DI
stimulatory test - if no increase, there is deficiency
MRI
biopsy

Question 11

short, obese stature
AR
resistance to GH
abnormalities in GHr
high serum GH
low IGF-1

Answer 11

Laron Syndrome

Question 12

polydipsia
polyuria
hypernatraemia
dilute urine
confusion

Answer 12

diabetes insipidus
(ADH absense/loss)

Question 13

name the type of diabetes insipidus:
1) problem with no ADH
2) problem with kidney
3) no problem with function

Answer 13

1) central DI
2) nephrogenic DI
3) psychogenic polydipsia

Question 14

normal ADH
hypernatraemia
high plasma osmol
low urine osmol

Answer 14

nephrogenic DI

Question 15

decreased ADH
hypernatraemia
high plasma osmol
low urine osmol

Answer 15

central DI

Question 16

N/increased ADH
hyponatraemia
low plasma osmol
low urine osmol

Answer 16

primary polydipisa (psychogenic)

Question 17

water deprivatino test:
- plasma osmol increases
- urine osmol low
desmopressin admin (DDAVP):
- plasma osmol decreases

Answer 17

central DI

Question 18

water deprivatino test:
- plasma osmol increases
- urine osmol low
desmopressin admin (DDAVP):
- plasma osmol remains high

Answer 18

nephrogenic DI

Question 19

water deprivatino test:
- plasma osmol increases
- urine osmol increases
desmopressin admin (DDAVP):
- not required

Answer 19

psychogenic polydipsia

Question 20

hypoosmolality
euvolemic hyponatremia
concentrated urine
high urinary Na+
nausea, muscle cramps

Answer 20

SIADH

Question 21

causes of SIADH

Answer 21

antidepressant agents - SSRIs
SCLC - paraneoplastic
CNS infection, trauma

Question 22

drug cause of nephrogenic DI

Answer 22

Lithium

Question 23

goitre - iron collar
stony hard fibrosis
tan-grey woody thyroid
fibrosclerotic changes
pathcy lymphocytic & eosinophilic infiltration

Answer 23

Riedel syndrome