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Endo finals > Pituitary > Flashcards

Pituitary Flashcards

1
Q

Describe the hormones produced by the pituitary gland

A

Anterior:

  • TSH
  • ACTH
  • FSH/LH
  • GH
  • Prolactin

Posterior:

  • ADH/vasopressin
  • Oxytocin
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2
Q

Describe the hormones produced by the hypothalamus (in relation to pituitary)

A
  • TRH
  • ACTH-RH
  • GnRH
  • GHRH
  • Dopamine**
  • Technically posterior hormones are produced by hypothalamic nuclei projecting into pit.
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3
Q

Describe the presentation of a pituitary tumour

A

General:

  • Headache
  • Visual field loss: bitemporal hemianopia

Specific: (most common)

  • Prolactin: Galactorrhoea, amenorrhoea/ED
  • GH: acromegaly
  • ACTH: Cushing’s syndrome
  • Hypopituitarism (non-functioning)
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4
Q

Describe the causes of hypopituitarism

A
  • Pituitary tumour eg. stalk
  • Sheehan’s syndrome: post-partum
  • Infiltrative disease: TB, sarcoid, amyloid
  • Iatrogenic: surgery, radiotherapy
  • Apoplexy
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5
Q

Describe the investigations for hypopituitarism

A
  • After history and examination
  • Bloods: FBC, CRP, U+Es, LFTs
  • TFTs, prolactin, FSH + LH, cortisol and ACTH, IGF1
  • Pituitary function tests: insulin, GnRH, TRH
  • Imaging: CT/MRI head
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6
Q

Describe the management of hypopituitarism

A

Replace missing:

  • Levothyroxine
  • HRT/testosterone or fertility treatments
  • Corticosteroids
  • GH injections
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7
Q

Name the commonest pituitary tumours

A
  1. Non-functioning adenoma
  2. Prolactinoma
  3. ACTH-secreting
  4. GH-secreting
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8
Q

Describe the management of pituitary tumours

A

Medical:

  • Radiotherapy
  • Somatostatin analogues: octreotide
  • Dopamine agonists (prolactinoma): cabergoline

Surgical:
-Trans-sphenoidal excision

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9
Q

Name some causes of hyperprolactinaemia

A
  • Tumours: prolactinoma, non-functioning compressing stalk
  • Pregnancy + lactation
  • Hypothyroidism
  • Drugs: metoclopramide, antipsychotics
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10
Q

How high would you expect prolactin levels to be in prolactinoma?

A

1000s eg. >5000

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11
Q

Describe the presentation of acromegaly

A

Insidous growth of soft tissues ->

  • Coarse facies (large nose, enlarged glabella, large lips)
  • Macroglossia
  • Increased shoe size
  • Carpal tunnel syndrome
  • Snoring + OSA

Headache, visual field loss

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12
Q

Describe the investigations for acromegaly

A
  • Bloods: IGF-1, other pituitary hormones, HbA1c
  • ECG + echo
  • OGTT (impaired glucose tolerance)
  • Imaging: MRI head
  • Visual field testing
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13
Q

Describe the presentation of hypogonadism

A

-Low libido, ED, dryness
-Infertility
-Amenorrhoea
-Fatigue
-Decreased muscle bulk (men)
+/- menopausal symptoms: hot flushes, sleep disturbance, memory difficulties

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14
Q

Describe the management of hypogonadism

A

Depends on fertility goals

  • Not wishing to conceive: HRT/COCP, testosterone replacement
  • Wishing to conceive: IVF (FSH + LH)
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15
Q

Describe some causes of hypogonadism

A

Hypothalamic + pituitary:

  • Kallman’s
  • Tumours
  • Iatrogenic
  • Infiltrative disease
  • Hypothalamic amenorrhoea
  • Ischaemia: Sheehan’s, apoplexy

Primary-ovarian/testicular:

  • POI
  • Iatrogenic: chemo, radiation, surgery
  • Congenital
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16
Q

Describe the presentation of diabetes insipidus

A 
Presents like DM:
-Polyuria
-Polydipsia
-Nocturia
Severe: dehydration, hypovolaemic shock, hypernatraemia
17
Q

Describe the causes of DI

A

Cranial:

  • Tumours
  • Iatrogenic
  • Infiltrative disease
  • Ischaemia

Nephrogenic:

  • Lithium
  • Metabolic: high Ca, low K
18
Q

Describe the investigations for DI

A
  • After history and examination
  • Urine dip (DDx- DM)
  • Bloods: FBC, CRP, U+Es, glucose, HbA1c, paired osm
  • Water deprivation test
  • Imaging: MRI head
19
Q

Describe how a water deprivation test is done and what the results indicate

A 
Measure: 
-Weight
-Urine output 
-Paired urine + plasma osm 
For 8 hours, no water
After that time, give ADH

Normal person: over 8 hours of deprivation, plasma osm stays normal + urine osm ^^/ UO decrease
DI: over 8 hours, plasma osm ^^ + urine does not concentrate
Cranial: after ADH admin, urine concentrates
Nephrogenic: after ADH, no change

20
Q

Describe the management of DI

A

Conservative:
-Fluid restriction

Medical:
-Vasopressin (desmopressin), intranasal

Endo finals (6 decks)

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