Pituitary

Question 1

name all the hypothalamic hormones for…

• ACTH
• TSH
• LH / FSH
• GH
• PRL

Answer 1

CRH stimulates ACTH

TRH stimulates TSH

GnRH stimulates LH + FSH

GHRH stimulates GH

Dopamine inhibits PRL !!

Question 2

what do you give to stimulate cortisol + GH together?

expected levels if normal?

Answer 2

insulin - controlled injection, non diabetics
cortisol over 100
GH over 7mg

Question 3

what do you give to stimulate ADH?

Answer 3

desmopressin

expect serum osmolarity to rise to > 2

Question 4

what classification is used for pituitary tumours?

Answer 4

macroadenoma = > 1cm 
micro = < 1 cm

Question 5

name 3 functional pituitary tumours

Answer 5

1 - prolactimoma
2 - GH secreting (benign, 99% of acromegaly)
3 - ACTH secreting - cause cushings

only 1% are benign functional tumours

Question 6

how do men present with prolactinoma classically?

Answer 6

late presentation
bitemporal hemianopia
headaches
erectile dysfunction

Question 7

what drug can cause high levels of PRL?

Answer 7

Dopamine antagonists - less inhibition of PRL
eg. Metoclopramide anti-emetic.

also some anti pyschotics + anti despressants + cocains + oestrogen

Question 8

when would it be normal to have high PRL?

Answer 8

pregnancy / breast feeding
sleeping
stressed

Question 9

apart from prolactimoma - give another pathological cause of high PRL

Answer 9

pit stalk affected by trauma / surgery
tumour compression
hypothyroidism

Question 10

“solid tumour in parastellar area which is cystic + calcified” who am I ??

Answer 10

Craniopharyngioma

Question 11

who gets craniopharyngiomas?

are the benign or metastatic ?

Answer 11

children 
the elderly (70-80s) - "papillary"

they are non functional. They can become metastatic

Question 12

symptoms of craniopharyngiomas

Answer 12

in children - early morning headache +visual + delayed puberty + slow growth