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Endocrine SB > Pituitary > Flashcards

Pituitary Flashcards

1
Q

what hormones are produced in anterior pituitary

A 
ACTH
TSH
LH/FSH
GH
Prolactin
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2
Q

what are the peripheral counterparts of the hormones of the anterior pituitary

A

ACTH – Cortisol
TSH – Thyroxine
LH/FSH – Testosterone or Estradiol
GH – IGF-1

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3
Q

what are hormones are baseline tests done on

A 
TSH, fT4
LH/FSK
Testosterone 
GH
IGF-1 
PRL
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4
Q

what is the principle of dynamic tests

A

too much hormone - try to suppress it

too little hormone - try to stimulate it

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5
Q

what are the Dynamic Pituitary Function Stimulation Tests

A

Synacthen (synthetic ACTH)

Insulin stress test or
Prolonged Glucagon test

Water deprivation test

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6
Q

what are the two classifications of pituitary tumours

A

≤ 1cm: Microadenoma

> 1cm: Macroadenoma

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7
Q

what can a non functioning pituitary adenoma cause

A 
Compression on optic chiasma
Compression on other structures 			eg cranial nerve 3,4,6
Hypoadrenalism
Hypothyroidism
Hypogonadism
(Diabetes Insipidus)
GH deficiency
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8
Q

what is the typical vision loss associated with a pituitary adenoma

A

Bitemporal hemianopia

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9
Q

what can cause raised prolactin

A

Physiological

  • breast feeding + pregnancy
  • stress
  • sleep

Drugs

Hypothyroidism

Stalk lesions - iatrogenic, road accident

Prolactinoma

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10
Q

what drugs cause raised prolactin

A
  • Dopamine antagonists eg metoclopramide
  • Antipsychotics e.g. phenothiazines
  • Antidepressants
  • others e.g. estrogens, cocaine
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11
Q

what affect does dopamine have on prolactin

A

negative feedback

e.g. increase dopamine, decrease prolactin and vice versa

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12
Q

Sx of raised prolactin

A

Female

  • early presentation
  • galactorrhoea
  • menstrual irregularity
  • amenorrhoea
  • infertility

Male

  • late presentation
  • impotence
  • visual field abnormal
  • headache
  • anterior pituitary malfunction
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13
Q

what is a Prolactinoma

A

benign tumour (adenoma) of the pituitary gland that produces prolactin

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14
Q

Ix for prolactinoma

A

Serum prolactin
MRI pituitary
Visual fields Ex
Pituitary function test

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15
Q

Mx of prolactinoma

A

Dopamine Agonists

  • Cabergoline (first choice)
  • Bromocriptine
  • Quinagolide
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16
Q

what is acromegaly also known as if it is before epiphyseal fusion

A

gigantism

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17
Q

what are features of acromegaly

A 
thickened soft tissue
hypertension
cardiac failure
headaches
snoring/sleep apnoea
DM
Visual field loss
Hypopituitarism 
Early CV death
Colonic polyps and colon cancer
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18
Q

Diagnosis of acromegaly

A

IGF-1 will be raised

Oral glucose tolerance test (suppression test)

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19
Q

other Ix of acromegaly

A

visual fields
CT/MRI pituitary
Pituitary function tests

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20
Q

when is drug therapy used in acromegaly

A

either in-operably tumour
OR
post surgery, GH > 1

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21
Q

what does GH antagonist Pegvisomant do

A

binds to GH receptor and blocks GH activity
does not decrease tumour size
last line in therapy

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22
Q

what are the hormone imbalances seen in Cushing’s Syndrome

A

excess Cortisol
excess mineralocorticoid
excess androgen

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23
Q

what does excess cortisol cause

A

Protein loss

  • Myopathy; wasting
  • Osteoporosis; fractures
  • Thin skin; striae, bruising

Altered Carbohydrate/Lipid metabolism; Diabetes mellitus, Obesity

Altered psyche; psychosis, depression

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24
Q

what does excess mineralocorticoid cause

A

hypertension

oedema

25
Q

what does excess androgen cause

A

Virilism
Hirsutism
Acne
oligo/amenorrhoea

26
Q

what is Cushing’s characterised by

A 
Thin Skin
Proximal myopathy
Frontal balding in women
Conjunctival oedema (chemosis)
Osteoporosis
27
Q

what is the SCREENING test for Cushing’s

A

Overnight 1mg dexamethasone suppression test (oral)

28
Q

what values are suggestive for Cushing’s in an overnight dexamethasone suppression test

A

Cortisol > 100 = abnormal

29
Q

what is the DEFINITIVE test for Cushing’s

A

2 day 2mg/day Dexamethasone suppression test

30
Q

what result on the definitive test would suggest there is no Cushing’s

A

Cortisol

31
Q

what are some causes of Cushing’s syndrome

A

Pituitary adenoma
Adenoma of adrenal
Ectopic cancer (thymus/lung/pancreas)
Pseudo - alcohol, depression, steroids

32
Q

if the cause of Cushing’s was ectopic what would the Ix show

A

Abnormal Low dose Dexa Test

ACTH > 300

33
Q

if the cause of Cushing’s was pituitary what would the Ix show

A

Abnormal Low dose Dexa Test

ACTH

34
Q

if the cause of Cushing’s was adrenal what would the Ix show

A

Abnormal Low dose Dexa Test

ACTH

35
Q

Tx for Cushing’s

A

Pituitary cause - transsphenoidal pituitary adenomectomy

Adrenal cause - Adrenalectomy

Ectopic cause - remove source or bilateral adrenalectomy

36
Q

what can testosterone cause

A

polycythaemia

- abnormally increased concentration of haemoglobin in the blood

37
Q

what goes growth hormone do in adults

A 
decreases abdo fat
increases muscle mass, strength, exercise, capacity, stamina
improves cardiac function
decreases cholesterol and increases LDL
increases bone density
38
Q

how is GH given

A

daily SC injection

39
Q

what are the risks of testosterone replacement

A

prostate enlargement - problem if pre-existing prostate cancer

Polycythamia - monitor FBC

Hepatitis - only from oral tablets, monitor LFTs

40
Q

what is the anterior pituitary also known as

A

Adenohypophysis

41
Q

what is the neurohypophysis also known as

A

posterior pituitary

42
Q

what is the anterior pituitary gland derived from and what does it do

A

the Rathke’s pouch

area where hormones are secreted

43
Q

what are the trophic and non-trophic hormones secreted from the anterior pituitary

A

trophic - TSH, ACTH, FSH, LH

non-trophic - GH and Prolactin

44
Q

what is the posterior pituitary derived from

A

Extension of neural tissue consists of modified glial cells and axonal processes

45
Q

what hormones does the posterior pituitary secrete

A

ADH (vasopressin)

Oxytocin

46
Q

what conditions can affect the posterior pituitary

A

Diabetes insipidus

Syndrome of inappropriate ADH secretion (SIADH)

47
Q

what is diabetes insidious

A

lack of ADH secretion

can lead to life threatening dehydration

48
Q

what is SIADH

A

Ectopic secretion of ADH by tumours

Primary disorder in the pituitary

49
Q

what is pituitary adenomas associated with

A

MEN 1

50
Q

how are pituitary adenomas classified

A

by cell type and the hormone they produce

51
Q

what can a large adenoma lead to

A

visual field defects

panhypopituitarism

52
Q

what are the common functional pituitary adenoma

A

Prolactinoma
Growth hormones secreting
ACTH secreting

53
Q

what is the most common ACTH secreting tumour

A

Bilateral adrenocortical hyperplasia

54
Q

what is a craniopharyngioma and what is it derived from

A

Benign brain tumour

Derived from remnants of Rathke’s pouch

55
Q

features of a craniopharyngioma

A

slow growing, often cystic, may calcify

excellent prognosis

56
Q

symptoms of craniopharyngioma

A

headaches
visual disturbances
may cause growth retardation in children

57
Q

Tx of craniopharyngioma

A

Radiation

58
Q

when do craniopharyngioma present

A

50% in childhood

59
Q

Sx of craniopharyngioma

A

children - growth failure

adults - amenorrhea, decreased libido, Diabetes insipidus)

Endocrine SB (15 decks)

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