Pituitary

Question 1

Where are vasopressin and OXT stored?

Answer 1

posterior pituitary

Question 2

When is a pituitary tumour a microadenoma and when is it a macroadenoma?

Answer 2

1cm = macroadenoma

Question 3

non functioning pituitary adenoma may cause Compression of which cranial nerves?

Answer 3

3,4,6

Question 4

What are physiological causes of raised prolactin.

Answer 4

breast feeding, preg, sleep, stress

Question 5

What drugs cause raised prolactin?

Answer 5

dopamine antagonists eg metroclopramide
antipsychotics eg phenothiazines
antidepressants eg TCA, SSRIs
cocaine
estrogens

Question 6

Give 3 pathological causes of raised prolactin.

Answer 6

hypothyroidism
prolactinoma
stalk lesions

Question 7

In whom, men or women, is the presentation of high prolactin late?

Answer 7

men

Question 8

What are some female symptoms of high prolactin?

Answer 8

galactorrhoea
menstrual irregularity
ammenorrhoea
infertility

Question 9

What are some male symptoms of raised prolactin?

Answer 9

galactorrhoea
visual field abnormal
headache
impotence
ant pit malfunction

Question 10

What investigations should be done for prolactinoma?

Answer 10

Pregnancy test, basal PRL levels, MRI pituitary to look for micro/macro, stalk, optic chiasma
Visual fields - bitemporal hemianopia

Question 11

Most common cause of raised prolactin?

Answer 11

drugs

Question 12

Why does hypothyroidism cause increased prolactin?

Answer 12

increased TRH

Question 13

Treatment if high prolactin?

Answer 13

refer to clinic

dopamine agonists are 1st line

Question 14

In which, macro or micro may there be problems with visual acuity?

Answer 14

macro (near optic chiasm)

Question 15

Name 3 dopamine agonists.

Answer 15

bromocriptine, quinagolide, cabergoline

Question 16

What causes acromegaly?

Answer 16

GH excess

Question 17

What happens to blood pressure in acromegaly?

Answer 17

hypertension

Question 18

What are some other symptoms of acromegaly?

Answer 18

thickened soft tissues eg skin, large jaw, sweaty large hands
snoring 
diabetes
visual fields
hypopituitarism

Question 19

How is acromegaly diagnosed?

Answer 19

IGF1
GTT
also check visual fields,scan pituitary (CT/MRI)
pit function tests

Question 20

Treatment for acromegaly?

Answer 20

remove lesion (transphenoidal surgery)
if surgery fails, somatostatin analogues eg octreotide/ radiotherapy
GH antagonist called pegvisomant

Question 21

When does a acromegaly cause gigantism?

Answer 21

if occurs before bony epiphyses fuse (rare)

Question 22

What is Cushing’s?

Answer 22

excess cortisol/mineralocorticoid/androgen

Question 23

If excess androgen, what symptoms may occur?

Answer 23

virilism, hirsutism, acne, oligo/amenorrhoea

Question 24

If excess mineralocorticoid, what symptoms may occur?

Answer 24

hypertension, oedema

Question 25

If excess cortisol , what symptoms may occur?

Answer 25

protein loss - myopathy, osteoporosis, thinning of skin, bruising
altered carbohydrate/lipid metabolism, diabetes, obesity
Altered psyche eg depression

Question 26

What characterizes Cushing’s?

Answer 26

• thin skin
• proximal myopathy
• frontal balding in women
• conjunctival oedema (chemosis)
• osteoporosis

Question 27

How should pituitary Cushing’s be treated?

Answer 27

hypophysectomy

external radiotherapy

Question 28

How should adrenal Cushings be treated?

Answer 28

adrenalectomy

Question 29

How should ectopic Cushings be treated?

Answer 29

remove source or bilateral adrenalectomy

Question 30

Drug treatment of CUshings?

Answer 30

Metyrapone
Ketoconazole
Pasireotide (Somatostatin analogue)

Question 31

Pan hypopituitarism in the posterior pituitary?

Answer 31

diabetes insipidus

Question 32

Pan hypopituitarism in anterior pituitary?

Answer 32

GH - growth failure
TSH - hypothyroidism
LH/FSH - hypogonadism
ACTH - hypoadrenal

Question 33

What infection may cause hypopituitarism.

Answer 33

meningitis, TB