Endocrine - Pituitary Disease

Question 1

features of a prolactinoma?

Answer 1

amenorrhoea
infertility
galactorrhoea
decreased libido
osteoporosis
bitemporal hemianopia

Question 2

Ix for a prolactinoma?

Answer 2

PRL (raised)

MRI

Question 3

Tx for prolactinoma?

Answer 3

observe if asymptomatic
dopamine agonist (e.g cabergoline, bromocriptine)
surgery

Question 4

what can cause hypopituiatrism?

Answer 4

problem with
hypothalamus
pit stalk
pituitary

Question 5

what causes acromegaly?

Answer 5

increase in growth hormone secretion due to a pituitary adenoma

Question 6

features of acromegaly?

Answer 6

headache
fatigue
spade hands
big tongue
DM
HT
visual field defects
coarse facial features

Question 7

Ix for acromegaly?

Answer 7

GTT (GH production not switched off)
pituitary MRI
Pituitary hormone profile

Question 8

what is involved in a pituitary hormone profile?

Answer 8

TSH
GH
PRL
oestradiol/testosterone
cortisol

Question 9

Tx for acromegaly?

Answer 9

somatostatin analogues (e.g ocretide)
dopamine agonist (e.g cabergoline)
shrink tumour pre surgery

Question 10

what risk factors need to be monitored in acromegaly?

Answer 10

colon cancer (scope)
CVS risks
sleep apnoea
DM

Question 11

features of cushing’s?

Answer 11

frontal balding 
proximal myopathy
HT
DM
osteoporosis
immunosuppresion
facial plethora
striae
acne
psychosis
wt gain (central obesity)
buffalo hump
hirsutism

Question 12

what cancers can produce ectopic ACTH?

Answer 12

renal cell carcinoma

small cell lung cancer

Question 13

what does a craniopharyngioma cause?

Answer 13

inferior visual field loss
growth failure (panhypopit)

Question 14

what happens in pituitary apoplexy?

Answer 14

increase in size due to a bleed

Question 15

features of pituitary apoplexy?

Answer 15

decreased GCS
meningism (neck stiffness, headache, photophobia)
ophthlamoplegia

Question 16

Tx for pituitary apoplexy?

Answer 16

IV hydrocortisone

Question 17

what drugs can cause increased PRL?

Answer 17

MDMA
methyldopa
antipsychotics
metaclopramide
oestrogens

Question 18

what is ACTH dependent cushing’s?

Answer 18

cushing’s disease

Question 19

what is cushing’s disease?

Answer 19

pituitary adenoma secreting ACTH

causes bilateral adrenal hyperplasia

Question 20

what are the two causes of ACTH dependent cushing’s?

Answer 20

cushing's disease
ectopic production (tumour)

Question 21

causes of ACTH indepedent cushing’s?

Answer 21

cushing’s syndrome

e.g iatrogenic
adrenal adenoma
adrenal nodular hyperplasia

Question 22

what is the overnight dex suppression test? results?

Answer 22

low dose cortisol given

if suppresses = cushing’s syndrome

Question 23

what do plasma ACTH results tell you about the cushing’s cause?

Answer 23

if detectable = ACTH dependent

undetectable = cushing’s syndrome

Question 24

what results would lead you to do a CT/MRI in cushing’s?

Answer 24

low dose dex = no suppression

undetectable ACTH in plasma

(adrenal hyperplasia/adenoma suspected)

Question 25

what do results of the high dose dexamethasone suppression test tell you?

Answer 25

suppression = cushing's disease
none = ectopic

Question 26

what other blood tests and results should be done in cushing’s?

Answer 26

high Na
low K
high BM
high lipids
metabolic acidosis

Question 27

what does cortisol do?

Answer 27

increases BP
increases BM
delays digestion
delays ovulation
hypothyroid

Question 28

Tx for cushing’s disease?

Answer 28

transphenoidal removal of tumour