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Y4 Gen Med > Pituitary > Flashcards

Pituitary Flashcards

1
Q

What hormones are secreted by the anterior pituitary?

A 
FLAT PIG
FSH
LH
ACTH
TSH
PRL
MSH
GH
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2
Q

What is hormones are secreted by the posteriorly pituitary?

A

ADH vasopressin

Oxytocin

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3
Q

Why does hypopituitarism present earlier in pre-menopausal women?

A

Since get secondary amenorrhea

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4
Q

Hypopituitarism is a deficiency of 1 or more hormones produced by the pituitary gland - true or false

A

True

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5
Q

What are trophic hormones?

A

Produced by anterior pituitary

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6
Q

What is the commonest cause of hypopituitarism?

A

Pituitary adenoma

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7
Q

How does a pituitary adenoma cause hypopituitarism?

A

Pituitary adenoma secretes excess of 1 type of hormone which causes deficiency of other hormones

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8
Q

Name 2 iatrogenic causes of hypopituitaism

A

Head irradiation

During surgery

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9
Q

What is a macro and microadenoma?

A

Micro <1cm

Macro >1cm

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10
Q

What visual field defect can a pituitary adenoma cause?

A

Bitemporal hemianopia

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11
Q

What visual field defect can a craniopharyngioma cause?

A

?

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12
Q

In hypopituitarism, what is the general order for loss of pituitary hormone function?

A

GGAT

Gonadotrophins > GH > ACTH > TSH

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13
Q

What is Sheehan’s syndrome?

A

Vascular cause of hypopituitarism - to severe hypotension eg in obstetric blood loss

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14
Q

What is pituitary apoplexy?

A

Infarction or haemorrhage of pituitary gland

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15
Q

TB, syphilis and AIDS can all cause hypopituitarism - true or false

A

True

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16
Q

A craniopharyngioma can cause hypopituitarism - true or flase

A

True (compression)

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17
Q

When investigating hypopituitarism, measure pituitary hormones + those that they stimulate. Which 2 hormones are less useful to measure since they have variable release?

A

Cortisol, growth hormone

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18
Q

What type of imaging is best to visualise the pituitary?

A

MRI

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19
Q

When investigating hypopituitarism, measure pituitary hormones + those that they stimulate. Which hormones are measured?

A

TSH, fT4, LH/FSH, estrogen/ testosterone

all low

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20
Q

ITT insulin tolerance: give _____, causes _____, should see rise in _____ + _____

A

ITT insulin tolerance: give INSULIN, causes HYPOGLYCAEMIA, should see rise in CORTISOL + GROWTH HORMONE

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21
Q

ACTH-oma is also known as what?

A

Cushing’s disease

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22
Q

GH-oma is also known as what?

A

Acromegaly

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23
Q

Acromegaly causes gigantism in children if onset before _____

A

epiphyseal fusion

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24
Q

What effect does Cushing’s disease have on

  • face shape
  • mood
  • energy levels
  • body composition
  • BMI
  • glucose
  • hair
  • menstruation
A 
Moon face
Depression
Low energy
Lemon on sticks
High BMI
Hyperglycaemia
Thin hair / hirsutism
Oligomenorrhea

(Also: frequent infections, poor concentrations, buffalo hump, poor wound healing, hypertension)

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25
Q

What is seen on an ABG in Cushing’s disease?

A

Hypokalaemic metabolic alkalosis

26
Q

What features of Cushing’s disease are specific and help differentiate it from obesity?

A

Osteoporosis
Proximal myopathy
Frontal balding
Striae stretch marks (purple)

27
Q

Name 3 causes of Cushing’s syndrome

A

Cushing’s disease
Exogenous steroids
Adrenal tumour/hyperplasia
Exogenous ACTH from SCLC

28
Q

What is the initial investigations for Cushing’s?

A

Low dose overnight dexamethasone suppression test

29
Q

What is the low dose overnight dexamethasone suppression test?

A

Cortisol is too high - so try and suppress it
Giving dexamethasone should stop (suppress) cortisol production)
Give 1mg dexamethasone overnight - then measure in morning cortisol - if cortisol still high requires further testing
Patients without Cushing’s will have their morning cortisol spike suppressed

30
Q

Pituitary adenoma can cause a headache - true or false

31
Q

What test is used to differentiate between Cushing’s and pseudo-Cushing’s?

A

Insulin stress test

32
Q

The low dose 1mg dexamethasone test tests for presence of Cushing’s syndrome and the high dose dexamethasone test localises the pathology of Cushing’s syndrome - true or false

A

True (i think)

33
Q

What is the high dose 8mg dexamethasone suppression test?

A

Give higher dose of dexamethasone and then measure cortisol + ACTH

34
Q

Following high dose 8mg dexamethasone suppression test in ectopic ACTH secretion - are cortisol and ACTH suppressed?

A

Cortisol - not suppressed

ACTH - not suppressed

35
Q

Following high dose 8mg dexamethasone suppression test in Cushing’s disease - are cortisol and ACTH suppressed?

A

Cortisol - suppressed
ACTH - suppressed

(Pituitary secreting excess ACTH, so when give

36
Q

Following high dose 8mg dexamethasone suppression test in an adrenal adenoma/ hyperplasia - are cortisol and ACTH suppressed?

A

Cortisol - not suppressed

ACTH - suppressed

37
Q

What is the commonest pituitary adenoma?

A

Prolactinoma

38
Q

How is a prolactinoma diagnosed?

A

Measure PRL > MRI

39
Q

How is a micro v maro prolactinoma differentiated?

A

MRI 6mth apart

40
Q

What is the 1st line management of a prolactinoma?

A

Dopamine agonist cabergoline

41
Q

Can acromegaly cause hepatosplenomegaly?

42
Q

What is the first line investigation for acromegaly?

A

Measure IGF-1
OGGT oral glucose tolerance test
(glucose should suppress GH, +ve if stays same),
(then MRI pituitary)

43
Q

What is the first line management of acromegaly?

A

Trans-sphenoidal surgery

2nd line somatostatin analogue octreotide

44
Q

What are the 2 types of diabetes insipidus?

A

Cranial and nephrogenic

45
Q

What is the basic pathology of diabetes insipidus?

A

Too little ADH

46
Q

What drug causes nephrogenic diabetes insipidus?

47
Q

What is the presentation of diabetes insipidus?

A

Polydipsia, polyuria

48
Q

In diabetes insipidus, is plasma osmolality high or low? Is urine osmolality high or low?

A

Low urine osmolality (very dilute urine)

High plasma osmolality (high plasma Na/urea)

49
Q

What is the first line investigation for diabetes insipidus?

A

Water deprivation test

50
Q

Ambiguous results on a water deprivation test suggest what cause?

A

Psychogenic polydipsia

51
Q

What is the management of cranial diabetes insipidus?

A

Synthetic ADH vasopressin

52
Q

What is the management of nephrogenic diabetes insipidus?

A

Treat/stop cause

53
Q

For DI, in a positive water deprivation test result, following water deprivation urine osmolality _____ + plasma osmolality _____. Then give exogenous ____, in cranial DI urine osmolality _____ and in nephrogenic DI urine osmolality ______.

A

For DI, in a positive water deprivation test result, following water deprivation urine osmolality STAYS SAME + plasma osmolality INCREASES. Then give exogenous ADH, in cranial DI urine osmolality INCREASES and in nephrogenic DI urine osmolality STAYS LOW

54
Q

Is plasma osmolality low or high in SIADH?

A

Low plasma osmolality

lower than urine osmolality

55
Q

Is sodium low or high in SIADH

A

Low sodium

56
Q

What is the presentation of SIADH?

A

Confusion, lethargy, muscle cramps, N&V, oliguria, symptoms of underlying cause

57
Q

What malignancy may cause paraneoplastic SIADH?

A

SCLC

Loads of others too

58
Q

Can pneumonia cause SIADH?

59
Q

What is the first line management of SIADH?

A

Fluid restriction

60
Q

What drug can be used in the management of severe SIADH?

61
Q

Why must sodium be corrected slowly in SIADH

A

To prevent central pontine myelinolysis

Y4 Gen Med (9 decks)

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