Pituitary

Question 1

What causes the syndrome?

Answer 1

Hypercortisolism

Question 2

Symptoms?

Answer 2

Central obesity
Striations
Skin thinning
Facial rounding
Proximal muscle weakening

Question 3

Metabolic complications of Cushing’s syndrome

Answer 3

Diabetes mellitus
Dyslipidaemia
Metabolic bone disease
Hypertension

Question 4

What is Cushing’s disease?

Answer 4

Cushing’s syndrome caused by ACTH secreting tumour in the pituitary

Question 5

2 causes other than Cushing’s disease?

Answer 5

Autonomous adrenal cortisol overproduction

Ectopic ACTH secreting tumour - adenoma/hyperplasia/carcinoma (rare)

Question 6

What is a cause of hypercortisolism that must be excluded?

Answer 6

Pregnancy

Question 7

Developmental sign of Cushing’s syndrome in children?

Answer 7

Decreasing linear growth velocity with accompanying weight gain

Question 8

More common in…

Answer 8

Women (4:1)

Question 9

Almost complete anterior pituitary failure:

Answer 9

Slightly elevated prolactin
Decreased GH
Decreased cortisol response to hypoglycaemia
Decreased testosterone
Normal thyroxine

Question 10

Test for PRL?

Answer 10

Lactation

Question 11

Test for LH?

Answer 11

Testosterone/estradiol

Question 12

Test for FSH?

Answer 12

Spermatogenesis/folliculogenesis

Question 13

Test for TSH?

Answer 13

T4/T3

Question 14

Test for GH?

Answer 14

IGF-1 and insulin tolerance test (ITT)

Question 15

Test for ACTH?

Answer 15

Cortisol - (synacthen, ITT)

Question 16

Why is prolactin high in a pituitary tumour?

Answer 16

Tumour decreases inhibitory secretion of dopamine on the pituitary lactotroph so more prolactin is released

Question 17

Mass effect of pituitary tumour?

Answer 17

Visual field defect (tumour pressing on the optic chiasm)

Question 18

Cause of acromegaly?

Answer 18

Overproduction of GH leading to stimulation of IGF-1

Question 19

Causes of gynaecomastia?

Answer 19

Androgen deficiency: Klinefelter’s, Kallman’s
Testicular failure e.g. mumps
Liver disease
Testicular cancer e.g. seminoma secreting hCG
Ectopic tumour secretion
Hyperthyroidism
Haemodialysis

Question 20

Drug causes of gynaecomastia?

Answer 20

Spirinolactone (most common)
Cimetidine
Digoxin
Cannabis
Finasteride
Gonadorelin analogues e.g. Goserelin, Buserelin
Oestrogens, anabolic steroids

Question 21

What is Sheehan’s syndrome?

Answer 21

Global hypopituitarism due to ischaemia in the pituitary following childbirth

Question 22

Symptoms of Sheehan’s syndrome?

Answer 22

Agalactorrhoea (lack of prolactin), amenorrhoea (lack of FSH and LH), cold intolerance and constipation (lack of thyroid hormones) and weight loss (lack of steroid hormones)

Question 23

Pituitary adenoma often causes what?

Answer 23

Hypopituitarism with mass effect symptoms like headache and bilateral hemianopa