pituitary

Question 1

where does the anterior pituitary arise from

Answer 1

Rathke’s pouch

Question 2

where does the posterior pituitary arise from

Answer 2

neural tissue

Question 3

what does anterior pit secrete

Answer 3

ATH // TSH // GH // prolactin // FSH // LH // MSH

Question 4

what does posterior pit secrete

Answer 4

ADH + oxytonin

Question 5

size of a pituitary microadenoma vs macroadenoma

Answer 5

micro <1cm // macro >1cm

Question 6

symptoms pituitary adenomas

Answer 6

hormone excess (cushings, acromegaly, galactorrhoe) // hypopituitarism // headaches // bitemperoal hemianopia

Question 7

what type of tumours cause hypopituitarism

Answer 7

non-functioning (non-hormonal)

Question 8

how do pituitary adenomas cause visual problems

Answer 8

compress optic chiasm –> bitemporal heminopia

Question 9

invx pituitary adenomas

Answer 9

blood profile // visual field // MRI

Question 10

mx non-function pit adenomas

Answer 10

transphenoidal transnasal hypophysectomy if growing

Question 11

most common pit adenoma

Answer 11

prolcatinoma

Question 12

function prolactin

Answer 12

stimulates breast + milk // decreased GnRH –> decreased LH

Question 13

what increases secretion of prolactin

Answer 13

thyrotroptin (TRH from hypo) // pregnancy, breastfeeding // oestrogen // sleep // stress //

Question 14

what drugs increase production of prolactin

Answer 14

dopamine antagonists eg metoclopramide, haloperidol, phenothiazine

Question 15

what inhibits prolactin secretion

Answer 15

dopamine

Question 16

what conditions raised prolactin

Answer 16

prolactinoma // hypothyroid (increased TRH) // PCOS // acromegaly

Question 17

symptoms prolactinoma in women

Answer 17

amenorrhoea // infertile // galactorrhea // osteoporosis

Question 18

symptoms prolactinoma men

Answer 18

impotence // loss of libido // galactorrhea

Question 19

symptoms prolactinoma men + women

Answer 19

headache, vision, hypopituitarism

Question 20

diagnosis prolactinoma

Answer 20

MRI + serum prolactin

Question 21

1st line mx prolactinoma

Answer 21

dopamine agonist eg cabergoline, bromocriptine

Question 22

SE dopamine agonists

Answer 22

N+V // post hypotension // hallucinations // fibrosis (bromocriptine)

Question 23

2nd line mx prolactinoma

Answer 23

surgery - if cannot tolerate meds

Question 24

what hormone is secreted in acromegaly

Answer 24

growth hormone

Question 25

symptoms acromegaly

Answer 25

sharp face, big hands and feet // big tongue, bulging tongue // excessive sweating // headache, bitempotral hemianopia // galactorrhea

Question 26

what can acromegaly be assoc with

Answer 26

MEN 1

Question 27

complciations acromgealy

Answer 27

HTN // diabetes // cardiomyopathy // colorectal cancer

Question 28

first line invx acromegaly

Answer 28

serum IGF1

Question 29

invx to confirm acromegaly

Answer 29

oral glucose tolerance test // in normal patient hyperglycaemia suppresses GH <2 /// in acromegaly hyperglycaemia does not suppress GH

Question 30

what blood test can monitor acromegaly

Answer 30

serum IGF1

Question 31

imaging acromegaly

Answer 31

MRI

Question 32

1st line mx acromgealy

Answer 32

trans-sphenoidal surgery

Question 33

medication mx acromgealy (3)

Answer 33

somatostatin analogue eg ocreatide // GH receptor antagonist eg pegvisomant // dopamine agonist eg bromocriptine

Question 34

what is pituitary apoplexy

Answer 34

haemorrhage or infarction of pit tumour --> sudden enlargement of tumour

Question 35

symptoms pituitary apoplexy

Answer 35

sudden onset severe headache // vomiting // neck stiffness // visual symptoms // hypopituitary symptoms eg hypotension, hyponatraemia

Question 36

eye symptoms pituitary apoplexy

Answer 36

extraocular nerve palsy // bitemporal superior quadrant defect

Question 37

invx pituitary apoplexy

Answer 37

MRI

Question 38

mx pituitary apoplexy

Answer 38

urgent steroids (bc decreased ACTCH) // maybe fluids, maybe surgery

Question 39

causes hypopituitarism

Answer 39

compression by non-functional adenoma // pit apoplexy // Sheehans // hypothalamic tumour // trauma // radiation

Question 40

what is Sheehans syndrome

Answer 40

postpartum haemorrhage --> pituitary necrosis

Question 41

features hypopituitarism from the hormones

Answer 41

ACTH --> tired + post hypotension // FSH + LH --> amenorrhoea, infertility, low libido // TSH --> constipated, cold, slow cognition, dry skin // GH --> short stature

Question 42

invx hypopituitarism

Answer 42

hormone profiles // insulin stress test // MRI

Question 43

insulin stress test

Answer 43

give IV insulin --> GH + cortisol should rise (if they do not = hypopituitarism)

Question 44

contraindications insulin stress test

Answer 44

epilepsy, IHD, adrenal insufficiency