ENDOCRINOLOGY - PITUITARY DISORDERS

Question 1

For acromegaly , what is the screening test you will order after the physical examination?

What do you expect from the screening ?

Answer 1

Early GH , IGF-1
-elevated for acromegaly

Question 2

What is the confirmation test after elevated early GH and IGF-1 ?

What do you expect ?

Answer 2

OGTT-GH suppression .
-GH non suppressed
-confirm acromegaly

Question 3

Now after you confirm that is acromegaly , what do you do for localization ?

Answer 3

MRI pituitary
APH profile

Question 4

To look for complication of acromegaly , what screening you order ?

Answer 4

A1C
BP
Colonoscopy
DXA scan
Echocardiogram

Question 5

What is the complications of acromegaly ?

Answer 5

Secondary DM
Hypertension
Colonic polyps / carcinoma
Osteoporosis
Cardiomyopathy

Question 6

What is the treatment for acromegaly ?

Answer 6

Transsphenoidal surgery
Radiotherapy
Somatostatin analogues
Dopamine agonists

Question 7

When you meet a Cushing syndrome patient , what do want to do first ?

Answer 7

To rule out exogenous Cushing , I will order for 8am serum cortisol .

-If it is low , I will suspect Exogenous Cushings
-If it is normal or high , I will start suspecting endogenous cushings and do screening for endogenous causes

Question 8

To screen for endogenous cushing , what will you do ?

What result did you expect ?

Answer 8

Overnight Dexamethasone Suppression test

24h urinary free cortisol

Midnight serum cortisol

Non suppressed / elevated
2/3 positive - Cushing’s syndrome

Question 9

So what test did you use to confirm that it is a Cushing’s syndrome ?

What if positive indicate what , negative indicate what ?

Answer 9

Low Dose Dexamethasone Suppression Test

-Non suppressed
-if suppressed , it indicate pseudocushing’s

Question 9

For MNSC , why it is measured at night ?

Answer 9

because :
-the cortisol level normally at its lowest during night time and and its highest in the morning as it follow a circadian rhythm
-so when midnight serum cortisol level is higher than normal it can indicate Cushing ‘s syndrome

Question 10

For localization in Cushing Syndrome , what test did you order ?

What if elevated ? what if low ?

Answer 10

Serum ACTH .
elevated :
-proceed with MRI pituitary , Bilateral Inferior Posterior Sinus Signs , Anterior Pituitary Hormone

low :
-proceed with CT adrenal

Question 11

What is the complications of Cushing syndrome ?
SIHONA

Answer 11

Secondary DM
Infection
Hypertension
Osteoporosis
Neurocognitive
Atherosclerosis

Question 12

What is the differential diagnoses of hyperprolactinoma ?

Answer 12

Physiological : pregnancy , breastfeeding
Drugs : anti-emetic , anti psychotics
Primary hypothyroidism

Question 13

What is the clinical features of prolactinoma ?

Answer 13

Female : amenorrhea , infertility

Male : pattern hair loss , reduced libido , galactorrhea

Osteoporotic fractures