endocrine disorders

Question 1

what are the 8 hormones secreted by the pituitary glands

Answer 1

ADH
oxytocin
prolactin
MSH
FSH/LH
TSH
GH
ACTH

Question 2

what might happen if ADH is effected

Answer 2

polyuria (pee more)
polydipsia (more thirsty)

Question 3

what might happen FSH/LH is effected

Answer 3

libido
irregular or absent periods

Question 4

what might happen if TSH is effected

Answer 4

fatigue
sensitive to cold

Question 5

what might happen if ACTH is affected

Answer 5

postural hypotension
nausea
lethargy

Question 6

what is the mass effect

Answer 6

effect of a growing mass that results in secondary pathological effects by pushing on or displacing surrounding tissue.

Question 7

how can you tell if theres a mass effect caused by the hypothalamus

Answer 7

as it grows, it pushes against the optic chiasm disrupting vision field
so visual field testing can be done

Question 8

what is a functional / non-functional pituitary tumour

Answer 8

functional = secretes hormones
non -functional = doesnt secrete hormones

Question 9

how are pituitary tumours classified by size

Answer 9

less then 10mm = microadenoma
more than 10mm = macroadenoma

Question 10

what do the most common functional tumours secrete

Answer 10

prolactin or growth hormone

Question 11

what is the most common route to removing a pituitary tumour

Answer 11

transsphenoidal sinus surgery
(endoscope passed through sphenoid sinus into sella turcica)

Question 12

what is craniopharyngioma

Answer 12

non-cancerous tumour arising from embryonic cells in pituitary gland

Question 13

what is pituitary apoplexy

Answer 13

haemorrhage or non-haemorrhagic infarction (ischaemic necrosis) of pituitary gland

Question 14

what is Sheehans syndrome

Answer 14

postpartum hypopituitarism (not enough pituitary hormones) caused by necrosis (death of tissue) of the pituitary gland

Question 15

what 4 things can cause pituitary apoplexy

Answer 15

radiation
traumatic brain injury
infection
autoimmunity

Question 16

what 2 things increase growth hormone release

Answer 16

slow sleep wave
hypoglycaemia (low blood glucose)

Question 17

what does GHRH and GHIH stand for

Answer 17

growth hormone releasing hormone
growth hormone inhibiting hormone

Question 18

what is acromegaly

Answer 18

excess of growth hormone leading to
- changing facial features
- increase size in tongue
- increase hand size
- impaired glucose tolerance
- arthritis and muscle pains

Question 19

what is gigantism

Answer 19

those with excess growth hormone before puberty

Question 20

what are the 2 ways of diagnosing acromegaly

Answer 20

• biochemical screening via serum IGF-1
• biochemical diagnosis via oral glucose tolerance test
  imaging MRI is indicated following biochem diagnosis

Question 21

how does biochemical diagnosing via oral glucose tolerance test prove acromegaly

Answer 21

failure to suppress IGF-1 production by administration of glucose suggests acromegaly

Question 22

what are 3 treatments used for acromegaly management

Answer 22

• transsphenoidal sinus surgery
  (if surgery fails)
• dopamine receptor agonist used for mild residual disease
• somatostatin receptor analogue used for more severe

Question 23

what is prolactinomas

Answer 23

a noncancerous tumor of the pituitary gland causing gland to secrete excess prolactin

Question 24

what are symptoms of prolactinomas in males and females

Answer 24

females:
- galactorrhea (milk making without birth)
- olihomenorrhoea ( irregular periods)
- infertility
males:
- low libido (sex drive)
- erectile dysfunction
- reduced hirsutism
- gynaecomastia

Question 25

how can you diagnose prolactinoma

Answer 25

- serum prolactin - MRI - visual field testing (maybe)

Question 26

treatment of prolactinoma?

Answer 26

- dopamine d2 agonists - transspehenoidal sinus surgery reserved fro those whose tumours dont shrink with medical therapy or cant take high dose dopamine agonist

Question 27

why is surgery not preferred for treatment of prolactinoma

Answer 27

may not be curative (difficult to remove and recurrence rate isnt insignificant)

Question 28

excess cortisol production can have many sources including pituitary gland but not limited to it

Question 29

cortisol production process

Answer 29

The hypothalamus-pituitary-adrenal axis regulates both production and secretion of cortisol. - CRH is released from the hypothalamus. - CRH stimulates the anterior pituitary to release ACTH. - ACTH acts on the adrenal cortex to release cortisol and androgens - increase in cortisol provides a negative feedback system to decrease the amount of CRH released from the hypothalamus

Question 30

excess cortisol production process

Answer 30

- ACTH secreting tumour (found in lung typically) - producing excess cortisol

Question 31

how can excess cortisol affect the body

Answer 31

causes cushing syndrome

Question 32

what is cushings syndrome

Answer 32

excess glucocorticoids Cushing syndrome — a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on the skin. - acne - weight gain etc

Question 33

what is inferior petrosal sinus sampling

Answer 33

inferior petrosal sinus drains the pituitary gland

Question 34

if the concentration of ACTH is much higher than the general circulation, it suggests theres an ACTH secreting pituitary adenoma (benign tumour)

Question 35

what is an adrenal mass

Answer 35

a benign (noncancerous) or malignant (cancerous) growth that develops on an adrenal gland

Question 36

adrenal masses are common incidental findings - roughly 3% of all routine abdominal CT scans will show adrenal incidentaloma - 10% in eldery

Question 37

what is adrenal incidentaloma

Answer 37

an adrenal tumor that is discovered on an imaging test that is being done for a problem unrelated to adrenal disease

Question 38

what is a benign lesion

Answer 38

also known as adenomas - lipid rich - dont enhance well (with contrast) - typically small

Question 39

what do you call malignant tumours of glandular tissue

Answer 39

adenocarcinoma

Question 40

what are features of malignant tumour

Answer 40

- lipid poor - enhance better (with contrast and retain it) - larger

Question 41

what is conn syndrome

Answer 41

aldosterone secreting tumour - typical in hypertension of young

Question 42

what is phaechromocytoma

Answer 42

adrenaline secreting tumour of adrenal glad - associated with hypertension, sweating, headaches