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Endocrine > Pituitary > Flashcards

Pituitary Flashcards

1
Q

What hormone is in excess in Cushing’s syndrome?

A

Cortisol

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2
Q

What hormone is in excess in Cushing’s syndrome?

A

Cortisol

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3
Q

Which hormone pre-empts cortisol production?

A

ACTH

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4
Q

Where does ACTH come from?

A

Anterior pituitary

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5
Q

What characterises Cushing’s syndrome?

A 
Moon shaped face
Buffalo hump
Central obesity
Frontal balding in women
Proximal myopathy
Striae
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6
Q

True or False

Osteoporosis is associated with Cushings

A

True

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7
Q

True or False

Hypertension is associated with Cushings

A

True

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8
Q

True or False

Decreased appetite is associated with Cushing’s

A

False

Increased!

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9
Q

How is Cushing’s tested for?

A

High dose exogenous oral steroid should lead to low serum cortisol

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10
Q

What values are expected in a positive Cushing’s test?

A

> 100nmol/L is abnormal.

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11
Q

What other test can be done to measure cortisol?

A

24hr urine collection.

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12
Q

What values are expected in the 24hr urine collection?

A

Less than 250 is normal

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13
Q

What diurnal variation is present with cortisol?

A

Drops at midnight.

Peaks at 9AM

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14
Q

What is the definitive test for Cushing’s?

A

2 day 2mg/day dexamethosone

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15
Q

What value indicates a negative result in the definitive test?

A

More than 500

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16
Q

What is the main cause of Cushing’s syndrome?

A

Pituitary gland dysfunction

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17
Q

A cancer of where can also simulate Cushing’s?

A

Adrenal glands.

Usually an adenoma

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18
Q

What is the treatment for Cushing’s?

A

Removal of hypothalamus (hypophysectomy)

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19
Q

What drug treatments can be given for Cushing’s syndrome?

A

Metyrapone

Ketoconazole

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20
Q

What is an important factor to remember about ketoconazole?

A

Hepatotoxic

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21
Q

What is Pan Hypopituitarism?

A

failure of both anterior and posterior pituitary to produce hormones

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22
Q

What happens when the posterior pituitary is insufficient?

A

Diabetes Insipidus

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23
Q

What is the most common cause of hypopituitarism?

A

Pituitary tumours

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24
Q

True or False

Menstrual irregularities are a sign of anterior hypopituitarism

A

True

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25
Q

True or False

Excessive sweating is a sign of anterior hypopituitarism

A

False.

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26
Q

True or False

Loss of facial and pubic hair is a sign of hypopituitarism

A

True

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27
Q

True or False

Growth retardation is a sign of anterior hypopituitarism

A

True

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28
Q

If there was an excess of GH before puberty what would be the result?

A

Giantism

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29
Q

What is the Synacthen test?

A

ACTH stimulation

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30
Q

Which hormone pre-empts cortisol production?

A

ACTH

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31
Q

Where does ACTH come from?

A

Pituitary gland

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32
Q

What characterises Cushing’s syndrome?

A 
Moon shaped face
Buffalo hump
Central obesity
Frontal balding in women
Proximal myopathy
Striae
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33
Q

True or False

Osteoporosis is associated with Cushings

A

True

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34
Q

True or False

Hypertension is associated with Cushings

A

True

How well did you know this?
1
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2
3
4
5
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35
Q

True or False

Decreased appetite is associated with Cushing’s

A

False

Increased!

36
Q

How is Cushing’s tested for?

A

High dose exogenous oral steroid should lead to low serum cortisol

37
Q

What values are expected in a positive Cushing’s test?

A

> 100nmol/L is abnormal.

38
Q

What other test can be done to measure cortisol?

A

24hr urine collection.

39
Q

What values are expected in the 24hr urine collection?

A

less than 250 is normal

40
Q

What diurnal variation is present with cortisol?

A

Peaks at 9AM

Drops around midnight

41
Q

What is the definitive test for Cushing’s?

A

2 day 2mg/day dexamethosone

42
Q

What value indicates a negative result in the definitive test for Cushing’s?

43
Q

What is the main cause of Cushing’s syndrome?

A

Pituitary gland dysfunction

44
Q

A cancer of where can also simulate Cushing’s?

A

Adrenal glands.

Usually an adenoma

45
Q

What is the treatment for Cushing’s?

A

Removal of hypothalamus (hypophysectomy)

46
Q

What drug treatments can be given for Cushing’s syndrome?

A

Metyrapone

Ketoconazole

47
Q

What is an important factor to remember about ketoconazole?

A

Hepatotoxic

48
Q

What is Pan Hypopituitarism?

A

failure of both anterior and posterior pituitary to produce hormones

49
Q

What happens when the posterior pituitary is insufficient?

A

Diabetes Insipidus

50
Q

What is the most common cause of hypopituitarism?

A

Pituitary tumours

51
Q

True or False

Menstrual irregularities are a sign of anterior hypopituitarism

52
Q

True or False

Excessive sweating is a sign of anterior hypopituitarism

53
Q

True or False

Loss of facial and pubic hair is a sign of hypopituitarism

54
Q

True or False

Growth retardation is a sign of anterior hypopituitarism

55
Q

If there was an excess of GH before puberty what would be the result?

56
Q

If there was an excess of GH after puberty what would be the result?

A

Acromegaly

57
Q

What is the Synacthen test?

A

ACTH stimulation

58
Q

What replacements need to be given if hypopituitarism is diagnosed?

A 
Thyroxine
Hydrocortisone
ADH
GH (sc)
Sex steroids
59
Q

What does GH do?

A

Increases bone density
Decreases cholesterol
Increases muscle mass

60
Q

How is GH given?

A

Subcutaneous injection

61
Q

How is testosterone given?

A

IM (or IM prolonged)
Oral
Gel

62
Q

What needs to be monitored when giving testosterone?

A

Prostate- may make cancer grow
FBC- increased Hb
LFTs - hepatitis (if oral)

63
Q

What can cause Diabetes Insipidus?

A

Wolfram (DIDMOAD)
Idiopathic in 50%
Trauma

64
Q

How is diabetes insipidus diagnosed?

A

Water deprivation tests

65
Q

Which hormone does GH produce?

A

Insulin like growth factor 1

IGF1

66
Q

What is the difference in a microadenoma and a macroadenoma?

67
Q

What are physiological causes of prolactin in become raised?

A

Breastfeeding
Pregnancy
Stress
Sleep

68
Q

What drugs can cause a raise in prolactin?

A

Metoclopramide
SSRI
oestrogens
cocaine

69
Q

What pathological reasons can cause raised prolactin?

A

Hypothyroidism

Prolactinoma

70
Q

What are signs of hyperprolactinaemia in women?

A

Galactorrhoea
Menstrual irregularity
Amenorrhoea
Infertility

71
Q

What are signs of hyperprolactinaemia in men?

A

Impotence
Visual field abnormalities
Headache

72
Q

What investigations need to be undertaken considering hyperprolactinaemia?

A

MRI

Pituitary function tests

73
Q

What class of drug is used to treat hyperprolactinaemia?

A

Dopamine agonists

74
Q

What drug is mainly used to treat hyperprolactinaemia?

A

Cabergoline

75
Q

What are the side effects of cabergoline?

A

Nausea
Constipation
Headaches

76
Q

What causes acromegaly?

77
Q

What causes giantism?

A

GH excess before epiphyseal fusion

78
Q

What are common signs of acromegaly?

A

Thickened soft tissues e.g. skin, jaw and hands
Headaches
sleep apnoea
DM

79
Q

What tests are done to diagnose acromegaly?

A

IGF1- normal against sex/age

GTT

80
Q

Where does GH come from?

A

Anterior pituitary

81
Q

What is the treatment for acromegaly?

A

Pituitary surgery

82
Q

What is diabetes insipidus?

A

Reduced ADH secretion from posterior pituitary

83
Q

What symptoms are present in diabetes insipidus?

A

Polyuria
Polydipsia
Dehydration

84
Q

When could GH levels be low?

85
Q

What is the definitive test for acromegaly?

A

Oral glucose tolerance test

Endocrine (20 decks)

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