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DAQ1 - MBBS III S2 > Pituitary Adenoma > Flashcards

Pituitary Adenoma Flashcards

1
Q

FSH target organ

A

Gonads

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2
Q

LH target organ

A

Gonads

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3
Q

ACTH target organ

A

Adrenal glands

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4
Q

TSH target organ

A

Thyroid gland

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5
Q

Prolactin target organ

A

Mammary tissue

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6
Q

Which hormones are released in response to FSH/LH secretion?

A

Males - testosterone
Females - oestrogen

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7
Q

Which hormone is released in response to ACTH secretion?

A

Cortisol

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8
Q

Which hormones are released in response to TSH secretion?

A

T3 and T4

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9
Q

Which hormone is released in response to GH secretion?

A

IGF1

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10
Q

Which hypothalamic hormone is responsible for stimulating FSH/LH release?

A

GnRH

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11
Q

Which hypothalamic hormone is responsible for inhibiting FSH/LH release?

A

Prolactin

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12
Q

Which hypothalamic hormone is responsible for stimulating ACTH release?

A

CRH

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13
Q

Which hypothalamic hormone is responsible for stimulating TSH release?

A

TRH

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14
Q

Which hypothalamic hormone is responsible for stimulating prolactin release?

A

TRH

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15
Q

Which hypothalamic hormone is responsible for inhibiting prolactin release?

A

Dopamine

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16
Q

Which hypothalamic hormone is responsible for stimulating GH release?

A

GHRH

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17
Q

Primary action of FSH:

A

Women: stimulates growth of ovarian follicle.
Men: acts on Sertoli cells to assist in spermatogenesis.

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18
Q

Primary action of LH:

A

Women: triggers ovulation.
Men: acts on Leydig cells to release testosterone.

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19
Q

Primary action of ACTH:

A

Stress response, increase SNS activity, catabolic processes.

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20
Q

Primary action of TSH:

A

Increased metabolism.

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21
Q

Primary action of prolactin:

A

Breast development and breast milk production.

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22
Q

Primary action of GH:

A

Growth and repair.

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23
Q

Effects of FSH/LH hypersecretion:

A

Women: ovarian cysts (due to stimulation of growth of multiple follicles), increased risk of all oestrogen-dependent cancers

Men: increased number of aberrant sperm, decreased fertility, gynaecomastia

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24
Q

Effects of ACTH hypersecretion:

A

Cushing’s syndrome

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25
Q

Effects of TSH hypersecretion:

A

Hyperthyroidism

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26
Q

Effects of prolactin hypersecretion:

A

Women: galactorrhoea, amenorrhoea.
Men: galactorrhoea, gynaecomastia, decreased libido

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27
Q

Effects of GH hypersecretion:

A

Acromegaly

In children: disproportionate growth, significant growth spurts.

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28
Q

Effects of FSH/LH hyposecretion

A

Women: infertility, amenorrhoea, increased risk of osteoporosis, increased cardiovascular risk, decreased libido

Men: increased risk of osteoporosis, infertility, erectile dysfunction, decreased libido

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29
Q

Effects of ACTH hyposecretion:

A

Hypotension, hypoglycaemia, bradycardia, decreased SNS stimulation

30
Q

Effects of TSH hyposecretion:

A

Hypothyroidism

31
Q

Effects of GH hyposecretion:

A

Bone pain, joint pain, muscle aches, osteoporosis, muscle weakness, hypercholesterolaemia

Children: stunted growth

32
Q

Pituitary adenoma is associated with which autosomal dominant mutation?

A

MEN1

33
Q

The most common type of pituitary adenoma is:

A

prolactinoma

34
Q

Non-endocrine symptoms and signs of a pituitary adenoma include:

A

Mass effect Sx (headache, bitemporal hemianopia, diplopia)

35
Q

MOA of cabergoline

A

Stimulates dopamine receptors, inhibiting prolactin secretion. Reduces size of prolactinomas. Decreases GH concentration in people with acromegaly.

36
Q

Indications for cabergoline use

A

Parkinson’s disease
Hyperprolactinaemia, including prolactinomas

37
Q

Cabergoline contraindications

A

Cardiac valvulopathy
Respiratory fibrosis
Breastfeeding (inhibits lactation)

38
Q

Adverse effects of cabergoline

A

Cardiac fibrosis, orthostatic hypotension, nasal congestion

39
Q

MOA of inhaled corticosteroids

A

Reduce airway inflammation and bronchial hyperreactivity via local immunosuppression.

40
Q

Indications for ICS treatment

A

Maintenance treatment of asthma and COPD

41
Q

Adverse effects of ICS

A

Oral candidiasis, dysphonia

42
Q

MOA of ACE inhibitors

A

Block conversion of angiotensin I to angiotensin II and also inhibit the breakdown of bradykinin by inhibiting the enzyme ACE.

43
Q

Indications for ACE inhibitors

A

Hypertension, CHF with reduced EF, diabetic nephropathy

44
Q

Precautions for ACE inhibitors

A

Volume/sodium depletion, primary hyperaldosteronism

45
Q

Adverse effects of ACE inhibitors

A

Hypotension, headache, cough, hyperkalaemia, renal impairment

46
Q

Adverse effects of ACE inhibitors

A

Hypotension, headache, cough, hyperkalaemia, renal impairment

47
Q

MOA of metformin

A

Reduces hepatic glucose production; increases peripheral utilisation of glucose.

48
Q

Metformin indications

A

T2DM, PCOS

49
Q

Metformin indications

A

T2DM, PCOS

50
Q

Metformin adverse effects

A

Nausea, vomiting, anorexia, diarrhoea, B12 malabsorption

51
Q

Pituitary adenomas >10mm in diameter are known as:

A

Macroadenomas

52
Q

Surgical intervention for prolactinomas is generally reserved for patients who:

A

cannot tolerate or are resistant to dopamine agonists.

53
Q

The optimal treatment for Cushing’s disease is:

A

Transsphenoidal hypophysectomy

54
Q

A pituitary screen includes the following Ix:

A

Prolactin, TSH, free T4, morning cortisol, testosterone, LH, FSH, oestrogen, IGF-1

55
Q

Gold-standard imaging for investigation of a pituitary adenoma is:

A

MRI with IV contrast

56
Q

Mechanism of Cushing’s disease

A

Pituitary adenoma → increased ACTH secretion → bilateral adrenal gland hyperplasia → secondary hypercortisolism

57
Q

Skin features of Cushing’s syndrome

A

Thin, easily bruisable skin with ecchymoses
Hirsutism
Acne
Hyperpigmentation
Facial flushing

58
Q

Neuropsychological features of Cushing’s syndrome

A

Anxiety, irritability, lethargy, fatigue, sleep disturbance, depression

59
Q

Musculoskeletal features of Cushing’s syndrome

A

Osteopenia, osteoporosis, pathological fractures, muscle atrophy

60
Q

Endocrine and metabolic features of Cushing’s syndrome

A

Insulin resistance, hyperglycaemia, dyslipidaemia, weight gain (central obesity, moon facies, buffalo hump), decreased libido, amenorrhoea

61
Q

Side effects of corticosteroids (MNEMONIC)

A

CUSHINGOID

Cataracts
Ulcers
Striae/Skin thinning
Hypertension/Hirsutism
Infections
Necrosis (of femoral head)
Glucose elevation
Osteoporosis/Obesity
Immunosuppression
Depression/Diabetes

62
Q

Indications for dexamethasone suppression test

A

To confirm diagnosis of Cushing’s syndrome
To identify the cause of Cushing’s syndrome

63
Q

Which two parameters are measured in a dexamethasone suppression test?

A

Cortisol and ACTH

64
Q

What dosage is given in a low dose dexamethasone suppression test?

A

1mg dexamethasone

65
Q

Purpose of the low dose dexamethasone test

A

Diagnostic of Cushing’s syndrome, but does not give information about the underlying aetiology.

66
Q

What dosage is given in the high dose dexamethasone suppression test?

A

8mg dexamethasone

67
Q

The purpose of the high dose dexamethasone suppression test is:

A

to identify the underlying cause of Cushing’s syndrome.

68
Q

Mechanism of low dose dexamethasone suppression test in the absence of pathology

A

Dexamethasone acts on hypothalamus to suppress CRH and pituitary to suppress ACTH → reduction in cortisol

69
Q

Mechanism of low dose dexamethasone suppression test in the presence of Cushing’s syndrome

A

Cortisol is already significantly elevated so 1mg of dexamethasone is not enough to cause any hypothalamic/pituitary suppression.

70
Q

Mechanism of high dose dexamethasone suppression test in the presence of Cushing’s disease

A

8mg of dexamethasone is enough to suppress pituitary secretion of ACTH, therefore ACTH and cortisol are lowered.

71
Q

Mechanism of high dose dexamethasone suppression test in the presence of adrenal adenoma

A

8mg dexamethasone suppresses hypothalamus (CRH), pituitary (ACTH) but has no effect on adrenal gland so cortisol remains elevated.

72
Q

Mechanism of high dose dexamethasone suppression test in the presence of ectopic ACTH production (from neoplasm)

A

Dexamethasone suppresses hypothalamic release of CRH and pituitary release of ACTH, but does not suppress ectopic production of ACTH → elevated ACTH and cortisol

DAQ1 - MBBS III S2 (5 decks)

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