Pituitary

Question 1

Confirmation of DI suspicion after as libitum oral fluid intake X 24 h

Answer 1

Urine tests:
Urine volume >50 mL/day
Osmolarity

Question 2

Decrease of 75% or more in the secretion and action of AvP

Answer 2

Diabetes insipid us

Question 3

MC pituitary hormone hyper secretion

Answer 3

Hyperprolactinemia

Question 4

Oral dopamine agonists

Answer 4

Cabergoline

Bromocriptine

Question 5

Hallmarks of hyperprolactinemia in women

Answer 5

Amenorrhea
Galactorrhea
Infertility

Question 6

Combinations of functioning pituitary tumors

Answer 6

GH and PRL

ACTH and PRL

Question 7

Dopamine agonist preferred when pregnancy is desired

Answer 7

Bromocriptine

Question 8

MC cause of GHRH mediated acromegaly

Answer 8

Chest or abdominal carcinoid tumor

Question 9

Treatment of choice for both microadenomas and macroadenomas

Answer 9

Transsphenoidal surgical resection

Question 10

Somatostatin analogue which binds through SSTR2 and SSTR5 receptor
Causes gallbladder hypocontractility, suppresses again motility

Answer 10

Ocreotide

Question 11

ACTH hormone replacement

Answer 11

Hydrocortisone 10-20 mg AM
5-10 mg PM

Prednisone 5 mg AM

Question 12

Hormone replacement TSH

Answer 12

0.75-0.15 daily

Question 13

What is the most common presenting symptom of adult hypopituitarism

Answer 13

Hypogonadism

Question 14

Most abundant anterior pituitary hormone

Answer 14

Growth hormone

Question 15

SIADH to raise plasma osmolarity and/or plasma sodium

Answer 15

at a rate approximating 1% an hour until they reach levels of about 270 mOsmoL/L or 130 meq/L

Question 16

Mode of action TOLVAPTAN in SIADH

Answer 16

TOLVAPTAN blocks the antiduiretic effect of AVP and increases UO

Question 17

Prominent pituitary mass that often resembles an adenoma
Most often seen in postpartum women
(+) pituitary failure due to diffuse lymphocytic infiltration

Answer 17

Lymphocytic hypophysis is

Question 18

Median dose radiation for acquired hypopituitarism

Answer 18

50 Gy

Question 19

Pattern of hormone loss in cranial irradiation

Answer 19

GH> GnRH> ACTH

Question 20

Acute ihtrapituitary vascular event causes substantial damage to the pituitary and surrounding seller structures

Answer 20

Pituitary apoplexy

Question 21

Hyperplastic enlargement of pituitary in pregnancy

Answer 21

Sheehans

Question 22

Severe headache with signs of meningeal irritation
Bilateral visual changes
Ophthalmoplegia
Severe hypoglycemia
Hypotension

Answer 22

Sheehans

Question 23

Management of sheehans syndrome

Answer 23

Manage conservatively if no visual loss: high dose GC

If yes, surgical decompression

Question 24

The most validated test to distinguish pituitary sufficient patients from those with AGHD

Answer 24

Insulin induced hypoglycemia

Question 25

Contraindications to growth hormone replacement

Answer 25

Active neoplasm
Intracranial HTN( GH can cause inc ICP)
Uncontrolled DM
Retinopathy

Question 26

Evoked GH <3
Patient treated with GH 0.1-0.3
What test to check on follow up to titrate GH dose

Answer 26

IGF

Question 27

Explain the “stalk section” phenomenon

Answer 27

Pituitary stalk compression of vassals disrupting access to hypothalamic hormones and dopamine —> early hyperprolactinemia and later concurrent loss of other pituitary hormones

Question 28

Reason for the pituitary bright spot in MRI

Answer 28

High phospholipid content of the posterior pituitary

Question 29

Normal size of pituitary

Upper aspect is flat except

Answer 29

6 mm child
8 mm adults

In pregnancy and puberty upper aspect may be concave

Question 30

Aim of SIADH therapy

Answer 30

To raise plasma osmolarity or plasma sodium at a rate approximately 1% an hour until they reach the levels of 270 mOSmol/L or 130 mEqs respectively

Which can be accomplished by hypertonic saline at a rate of 0.05 mL/ kg body weight it
AVP receptor 2 agonist