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Endocrinology > Pituitary > Flashcards

Pituitary Flashcards

1
Q

What is the medical term for the anterior pituitary?

A

adenohypophis

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2
Q

Where is the ant pit derived from?

A

rathke’s pouch

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3
Q

What are the trophic hormones secreted from the ant. pit?

A

TSH
ACTH
FSH
LH

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4
Q

What are the non trophic hormones secreted from the ant. pit?

A

GH

PRL

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5
Q

What are the three cell types of cells seen under the the microscope of ant. pit?

A

Acidophils
Basophils
Chromophobe

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6
Q

What hormones are secreted from Acidophils?

A

Somatotrophs (GH)

Mammotrophs (PRL)

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7
Q

What hormones are secreted from basophils?

A

Corticotrophs (ACTH)
Thyrotrophs (TSH)
Gonadotrophs (FSH/LH)

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8
Q

What is the medical term for posterior pituitary?

A

neurohypophis

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9
Q

Where is the post. pit derived from?

A

extension of neural tissue and modified glial cells and axonal processes

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10
Q

What hormones are secreted by the post. pit

A

ADH

Oxytocin

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11
Q

What is the histological appearance of the post. pit?

A

Non myelinated axons of neurosecretory neurons

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12
Q

What is the PRL axis?

A

Hyp: DA-
Pit: PRL
To rest of body

(NB, DA has a negative control PRL)

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13
Q

What are the physiological causes of a raised PRL?

A

Breast feeding
Pregancy
Stress
Sleep

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14
Q

What drugs can increase PRL?

A

Dompamine agonists (metaclopramide)
Antipsychotics
Antidepressants

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15
Q

What are the pathological causes of raised PRL?

A

Hypothyroidism
Stalk lesions (iatrogenic,RTA)
Prolactinoma

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16
Q

What are the syptoms of raised PRL in Females?

A 
Early presentation
Galactorrhoea (30-80%)
Menstrual irregularity
Ammenorrhoea
Infertility
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17
Q

What are the symptoms of raised PRL in Males?

A 
Late presentation
Galactorrhoea(<30%)
Visual field abnormalities
Headache
Impotence 
Ant pit malfunction
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18
Q

What investigations can be done to assess for Prolactinoma?

A

PRL concentration
MRI pituitary
Visual feilds
PFTs (other hormones)

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19
Q

What is being assessed in MRI pituitary for prolactinoma?

A

Macro/Micro (>1cm/<1cm)
Pituitary stalk involvement
optic chiasm involvement

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20
Q

What visual field defect presents in prolactinoma?

A

Bitemporal heminopia

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21
Q

What is the treatment for prolactinoma?

A

Dopamine agonist

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22
Q

Give an example of medication used to treat prolactinoma

A

Cabergoline (2x week)
Quinagolide (OD)
Bromocriptine (TD)

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23
Q

What dopamine agonist has least side effects?

A

cabergoline

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24
Q

What are the aims when using a dopamine agonist in prolactinoma?

A

normal prolactin
menstruation regained
pregnancy achievable
tumour shrinkage

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25
Q

What is the GH axis?

A

Hyp: GHRH+
Pit: GH
To rest of body

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26
Q

What condition is caused by GH excess?

A

Acromegaly

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27
Q

What are the symptoms and signs in acromegaly?

A 
Thickened soft tissues (skin, large jaw, sweaty large hands)
Hypertension
Cardiac Failure
Headaches (vascular)
Snoring
Sleep apnoea
Diabetes mellitus
Local pituitary effects (visul feilds, hypopituitism)
Early CV death
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28
Q

How is acromegaly diagnosed?

A 
IIGF1*
GTT* (glucose tolerance test)
Visual feilds
CT/MRI pituitary
PFTs
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29
Q

What happens in a GTT test?

A

75g oral glucose

Check GH every 30 mins for 2 hours

30
Q

What should happen in a normal GTT test?

A

GH suppresses to<0.4ug/l after glucose

31
Q

What happens in an acromegaly GTT?

A

GH unchanged/no suppression
Paradoxical rise
GH remains >1ug/l after glucose

32
Q

How is acromegaly treated?

A 
Pituitary surgery
external radiotherappy to pit. fossa
Retest GTT (GH1 needs drugs)
33
Q

What drugs are used to treat acromegaly?

A

Dopamine agonist
Somatostatin analogue
GH antagonist (last line)

34
Q

What use do somatostatin analogues have in acromegaly?

A

Reduces GH
Tumour shrinkage (30-50%, can reexpand)
Pre-op (relieve headache in 1 hr, improved outcome)

35
Q

What are the side effects of somatostatin analogues?

A

Local stinging
Short term: flatulence, diarrhoea, abdo pain
Long term: Gastritis, gallstones

36
Q

Give examples of somatostatin analogues and administration

A 
Octreotide (SC TDS)*
Sandostatin LAR (IM 1/28 days)
Lanreotide autogel (IM 1/28 days)
37
Q

What dopamine agonist is used in acromegaly and what doseage is given?

A

Cabergoline

>3g weekly

38
Q

What is the efficacy of cabergoline in acromegaly?

A

GH <2ug in 15%

better if co-secreting prolactin

39
Q

Give an example of a GH antagonist

A

Pegvisomant

40
Q

What is the tumour response to pegvisomant?

A

Tumour does not decrease

May increase in size

41
Q

What is the IGF-1 response in pegvisomant?

A

decreases but serum GH may increase

42
Q

What is assessed in an acromegaly follow up?

A

Check GH and IGF-1 are clinically safe levels
Check other pit hormones esp thyroid
Cancer surveillance (colon and tubulovillous adenoma)
CVS risk
Sleep apnoea

43
Q

What is the cortisol axis?

A 
Hyp: CRH+
Pit: ACTH+
Adrenal: Coritsol
To rest of body
NB, negative feedback
44
Q

What condition is caused by excess cortisol?

A

Cushing’s Syndrome

45
Q

What are the symptoms of Cushing’s caused by excess cortisol?

A 
Protein loss
-myopathy
-osteoporosis (fractures)
-thin skin (striae, bruising)
Altered CHO/Lipid metabolism
-DM and obesity
Altered psyche
-phycosis, depression
46
Q

What symptoms of cushing’s are caused by excess mineralocorticoid?

A

Hypertension

Oedema

47
Q

What symptoms of cushing’s are caused by excess androgen?

A

Virilism
Hirsutism
Acne
Oligo/amenorrhoea

48
Q

How is cushing’s different to obesity?

A 
Thin skin
Proximal myopathy
Frontal balding in women
Chemosis
Osteoporosis
49
Q

What are the signs of cushing’s?

A 
Moon face
red plethoric cheeks
inceased abdominal fat
easy bruising
poor wound healing
procximal myopathy
thin skin
buffalo hump
50
Q

what condition’s are those with cushing’s more prone to?

A 
Benign intracranial hypertension
Cataracts
AVN femoral head
Hypertension
Osteporosis
Hyperglycaemia
51
Q

What are the screening tests for cushing’s?

A

(High dose)overnight 1mg dexamethasone suppression test
Urine free cortisol
Diurinal cortisol variation

52
Q

How does overnight 1mg dexamethasone work in a)normal b)cushing’s?

A

a)cortisol 100nmol/l next morning

53
Q

What are the normal values for urine free cortisol?

A

24 hr urine collection

Total<25

54
Q

What is the definitive test for cushing’s?

A

Low dose dexamethasone suppression test

55
Q

How does low dose DST work?

A

2mg/day for 2 days dexamethasone

Cortisol s

56
Q

What can cause cushing’s?

A

Pituitary malfunction
Adenoma of adrenal
Ectopic thymus/lung/pancreas
Pseudo (steroid medication, alcohol and depression)

57
Q

What tests would show a pituitary origin for cushing’s?

A

Abn low dose dexa test
ACTH <300
High dose dexa test supresses by 50%

58
Q

What tests would show an adrenal origin for cushing’s?

A

Abn low dose dexa test
ACTH<1
Nil suppression high dose dexa test

59
Q

What tests would show an ectopic origin for cushing’s

A

Abn low dose dexa test
ACTH>300
high dose dexa Nil suppression

60
Q

What is the treatment for
A)pituitary cushing’s
B)Adrenal cushing’s
C)ectopic cushing’s?

A

A)hypophysectomy, external radiotherapy if reoccurs

B)adrenalectomy

C)remove source or bilateral adrenalectomy

61
Q

What drug treatment is used in chushing’s?

A

Metyrapone (waiting for radiotherapy to work, S/E common)
Ketoconazole
Pasireotide (somatostatin analogue)

62
Q

What are the characteristics of pan hypopititarism and why?

A 
Anterior:
Growth failure:GH
Hypothyroid: TSH
Hypogonadism: LH/FSH
Hypoadrenal: ACTH

Posterior:
Diabetes Insipidus

63
Q

What are some causes of pan hypopituitarism?

A 
Pituitary tumours
Secondary mets (lung, breast)
Granulomatous disease (TB, sarcoidosis)
Vascular (polyarteritis)
Trauma 
Autoimmune (Sheenan post pregnancy)
64
Q

What are the symtoms of anterior pan hypopituitarism?

A 
Menstrual irregularities F
Infertility
Impotence 
Gynaecomastia M
Abdo obesity
Loss facial hair M
Loss axillary and facial hair
Dry skin and hair
Hypothyroid faces
Growth retardation (C)
65
Q

What are the baseline pituitary function tests?

A

fT4, TSH
Oestradial/Testosterone, LH, FSH
GH, IGF-1
PRL

66
Q

What is the therapy for pan hypopituitarism?

A 
Replacement therapy
Thyroxine
Hydrocortisone
ADH
GH (daily SC injection)
Sex steroids (Oest/prog pill or Testosterone)
67
Q

What effect does GH have in adults?

A 
decreases abdo fat
increase muscle mass and exercise capacity
improves cardiac function
decreases cholesterol and increases LDL
Increases bone density
68
Q

What are the risks of testosterone replacement?

A

Prostate enlargement (NOT CANCER)-monitor by PR and PSA
Polycythaemia-FBC
Hepatitis with oral tabs-LFTs

69
Q

What disease is cause by posterior pit insufficiency?

A

Diabetes insipidus

ADH

70
Q

What are the causes of DI?

A 
Familial (DIDMOAD-DI, DM, optic atrophy, deaf)
Acquired (idiopathic, trauma)
Rare (tumour, sarcoid, meningitis)
Nephrogenic renal resistance to ADH
Paraneoplastic syndrome
71
Q

How is DI treated?

A

Desospray (nasal)
Desmopressin (oral, sublingual, IM)*

*highest to lowest dose

Endocrinology (17 decks)

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