Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 > Non-Functioning Tumours and Pituitary hormone testing > Flashcards

Non-Functioning Tumours and Pituitary hormone testing Flashcards

1
Q

Name two structures in the parasellar area of the pituitary gland

A
  1. Optic chiasm

2. Hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the development of the pituitary gland (embryology)

A
  1. infundibulum becomes hypothalamus and infundibulum
  2. Rathe’s pouch stalk degenerates and the body of the pouch becomes the intermediate and anterior lobe of the pituitary glands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where do craniopharyngiomas arise from

A
  1. Squamous epithelial remnants of Rathe’s such
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name the two types of craniopharyngiomas

A
  1. Adamantinous: cyst formation and calcification
  2. Squamous papillary: well circumscribed

These extend into suprasellar region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Age prevalence of craniopharyngiomas

A
  1. 5 to 14

2. 50 to 74

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical presentation of crnaiopharyngiomas

A
  1. Headaches (obstructive hydrocephalus)
  2. Polydipsia
  3. Polyuria
  4. Bitemporal hemianopia (presses against optic chiasm)
  5. Vomiting
  6. Raised ICP
  7. Weight increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would be seen in a CT for crnaiopharyngiomas

A

CYSTIC MASS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnosis of craniopharyngiomas

A
  1. MRI

2. CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Rathke’s cysts

A
  1. Single layer of epithelial cells with mucoid and cellular components in cyst fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Difference between Rathke’s cyst and craniopharyngiomas

A
  1. Intrasellar component (don’t usually extend to parasellar)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical presentation of Rathke cyst

A

ASYMPTOMATIC:

  1. Headache
  2. Ammorheoa
  3. Hypopituitarism
  4. Hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When are meningiomas common

A

After radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical presentation of meningioma

A
  1. Visual acuity loss and visual field defects
  2. Endocrine dysfunction
  3. Focal seizures
  4. ICP raised
  5. Diplopia if third and 6th cranial palsy occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is meningioma diagnosed

A

MRI with contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is an MRI done with contrast for meningioma

A

Because meningiomas can hypo intense to pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is lymphocytic hypophysitis

A
  1. Inflammation of pituitary gland due to an autoimmune reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name three types of lymphocytic hypophysitis

A
  1. Lymphocytic adenohypophysitis
  2. Lymphocytic infindibuloneurohypophysitis
  3. Lymphocytic panhypophysitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In what gender is LAH common in

A

Women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Age of presentation of LAH

A
  1. 35 - women
  2. 45 - men

Usually occurs postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is seen in a CT for LAH

A
  1. Stalk enlargement

2. Pituitary enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is non-functioning pituitary adenoma

A
  1. A type of intracranial tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Peak incidence for NFPA

A

20 and 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clinical presentation of non-functioning pituitary adenoma

A
  1. Large cerebral size
  2. Cavernous sinus invasion
  3. Lobulated suprasellar margins
  4. Visual disturbances
  5. Headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How are pituitary adenomas classified

A
  1. Microadenomas without sella expansion
  2. Macroadenomas which extend above sella
  3. Macroadenomas with enlargement and invasion of floor or suprasellar extension
  4. Destruction of the sella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diagnostics of non-functioning pituitary adenomas

A
  1. Test for absence of hormone secretion

2. Test normal pituitary function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What surgical procedure is done to remove NFPA

A
  1. Trans-sphenoidal surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do we test for pituitary function

A
  1. If peripheral target organ is working normally then that hormone is being secreted fine

A LOT OF HORMONES ARE SECRETED BY THE PITUITARY GLAND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do test the pituitary-thyroid axis for Primary hypothyroidism

A

Raised TSH low T4 (WE LOOK AT Ft4 in pituitary diseases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Result of axis test in hypopituitary

A

Low T4 normal or low TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Test for Grave disease via axis

A

Suppressed TSH

High T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Test for TSHoma via axis

A

High TF

High TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Test for hormone reisstance via the axis

A

High T4

High TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Gonadal axis for men in primary hypogonadism

A
  1. Low Testosterone, raised LH/FSH
34
Q

Gonaldal axis for men with hypopituitary

A

Low Testosterone

Low LH and FSH

35
Q

Testing the gonadal axis for men who have used anabolic

A

Low Testosterone and Low LH

36
Q

When do we measure the gonadal axis

A

0900h fasted T and LH/FSH

37
Q

Gonadal axis for females before puberty

A

Estradiol low

LH and FSH is low (FSH slightly greater)

38
Q

Role of estradiol

A

Responsible for secondary sexual characteristics such as breast, widening of the hips

39
Q

Gonadal axis for females during puberty

A

Pulsatile LH increase

Oestradiol increase

40
Q

Gonadal axis for females post menarche

A

Mid-cycle surge in LH and FSH

Levels of estradiol increases through cycle

41
Q

Gonadal axis for females with primary ovarian failure

A
  1. High LH and FSH
  2. Low estradiol
  3. FSH > LH
42
Q

Gonadal axis for females with hypopituitary

A
  1. Ammenorrheoa
  2. Low estradiol
  3. Low FH and FSH
43
Q

How do we test the HPA axis

A
  1. Measure cortisol and syncathen test at 0900h
44
Q

How do we diagnose hypopituitarism

A

Poor response to synacthen

Low cortisol
Low ACTH

45
Q

How do we diagnose Primary Adrenal Insufficiency

A

Low cortisol
High ACTH
Poor response to synacthen

46
Q

When is pulsatory GH secretion greatest

A

Night

47
Q

What happens to GH levels with age

A

Decreases

48
Q

What the reactor causes decrease in GH

A

Obesity

49
Q

What two ways can we test the GH/IGF1 axis

A
  1. Insulin stress test (GOLD STANDARD for assessing HPA axis)
  2. Glucagon test
50
Q

What is the insulin stress test

A
  1. Insulin is injected into a patient’s vein after which glucose levels are measured at regular interval
51
Q

What response would we see in a norma functioning HPA axis for the insulin stress test

A

Gh réponse exceeds 20mU/L

52
Q

What inhibits the action of prolactin

A

Dopamine

53
Q

How do we monitor if prolactin is being produced properly by the pituitary

A
  1. Measure prolactin or cannulated prolactin (3 samples over an hour to exclude stress of venipuncture)
54
Q

What may raise prolactin levels

A
  1. Stress
  2. Antipsychotics
  3. Stalk pressure
  4. Prolactinoma
55
Q

What is suppression testing

A

Where one substance is measured before and after the administration of a drug to determine is levels are stimulated or suppressed by the pituitary axis

56
Q

How is Cushing’s syndrome diagnosed

A

DEXAMETHASONE suppression testing

57
Q

What is the dexamethasone suppression test

A
  1. 1-2 mg dexamethasone is given which should suppress cortisol production in individuals who have a normal HPA axis
  2. 8mg Dexamethasone is given which exerts a negative feedback mechanism
58
Q

What is a positive dexamethasone suppression test for Cushing’s syndrome

A
  1. If cortisol level is not suppressed by low doses and ACTH is low then hypercortisolism is not being driven by ACTH - cushion’s syndrome
59
Q

What is a positive dexamethasone suppression test for cushion’s disease

A
  1. Cortisol is suppressed in high doses but not in low doses
  2. ACTH is elevated

Cushing’s disease because pituitary has some feedback control

60
Q

What suppression test is done for acromegaly

A

Oral glucose Gh suppression test

61
Q

Stimulation tests for Chushing’s

A

CRH stimulation

62
Q

Stimulation test for TSHoma

A

TRH stimulation

63
Q

Stimulating test for gonadotrophin deficiency

A

GnRH stimulation

64
Q

Stimulation test for GH deficiency

A

Glucagon test

65
Q

List two types of MRIs we do to look at the pituitary gland

A

T1 and T2

T1 - High-signal intensity images of fat (fatty marrow and orbital show up as bright images)

T2 - Shows high water content structures like cerebrospinal fluid and cystic lesions

66
Q

Pros of MRI

A
  1. No ionising radiation

2. Good at soft tissue and vascular structures

67
Q

Pros of CT

A
  1. Visualising bony structures and calcifications within soft tissues
  2. Can be used when MRi is contraindicated
68
Q

What are CTs used for

A

Tumour staging and diagnosis

69
Q

Disadvantage of CT

A
  1. Bad at soft tissue imaging
  2. Use of intravenous contrast media
  3. Exposure to radiation
70
Q

Clinical presentation of GH deficiency

A
  1. Short stature
  2. Abnormal body composition
  3. Reduced muscle mass
71
Q

Clinical presentation of LH/FSH

A
  1. Hypogonadism
  2. Reduced sperm count
  3. Infertility
  4. Menstruation problems

Testosterone deficiency in males, oestradiol and progesterone in females

72
Q

How is primary adrenal insufficiency treated

A
  1. Hydrocortisone replacement therapy

2. Modified-Release HC

73
Q

Describe thyroxine replacement therapy

A
  1. 1.6 Micrograms/Kg/day

2. LEVOTHYROXINE

74
Q

When is a dose higher than 1.6 needed for LEVOTHYROXINE

A
  1. patients on oestrogen and pregnancy
75
Q

Describe growth replacement therapy

A
  1. <60 (0.2-0.4 mg/day)

2. >60 (0.1-0.2 mg/day)

76
Q

When do we measure IGF1 levels following GH replacement

A

6 weeks after dose is started

77
Q

What improvements do we see with people on GH replacement

A

Improves lipid profiles
Body composition
BMD

78
Q

How is hypogonadism in males be treated

A

Testosterone replacement

79
Q

Effects of testosterone replacement

A
  1. Improves BMD
  2. Libido
  3. Muscle mass
  4. Fat loss
80
Q

In what forms can we get oestrogen replacement

A
  1. Orally
  2. Combined with progesterone
  3. Tensdermal
  4. Topical gels
  5. Intravaginal creams
81
Q

benefits of oestrogen replacement

A

Stops flushes, night sweats and improves vaginal atrophy

Reduces CVD, osteoporosis and mortality

82
Q

How is desmopressin given

A
  1. SC
  2. Orally
  3. Nasally
  4. Sub-lingually

Year 2 (155 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions