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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
Effects of TSH hypersecretion:
Hyperthyroidism
26
Effects of prolactin hypersecretion:
Women: galactorrhoea, amenorrhoea. Men: galactorrhoea, gynaecomastia, decreased libido
27
Effects of GH hypersecretion:
Acromegaly In children: disproportionate growth, significant growth spurts.
28
Effects of FSH/LH hyposecretion
Women: infertility, amenorrhoea, increased risk of osteoporosis, increased cardiovascular risk, decreased libido Men: increased risk of osteoporosis, infertility, erectile dysfunction, decreased libido
29
Effects of ACTH hyposecretion:
Hypotension, hypoglycaemia, bradycardia, decreased SNS stimulation
30
Effects of TSH hyposecretion:
Hypothyroidism
31
Effects of GH hyposecretion:
Bone pain, joint pain, muscle aches, osteoporosis, muscle weakness, hypercholesterolaemia Children: stunted growth
32
Pituitary adenoma is associated with which autosomal dominant mutation?
MEN1
33
The most common type of pituitary adenoma is:
prolactinoma
34
Non-endocrine symptoms and signs of a pituitary adenoma include:
Mass effect Sx (headache, bitemporal hemianopia, diplopia)
35
MOA of cabergoline
Stimulates dopamine receptors, inhibiting prolactin secretion. Reduces size of prolactinomas. Decreases GH concentration in people with acromegaly.
36
Indications for cabergoline use
Parkinson's disease Hyperprolactinaemia, including prolactinomas
37
Cabergoline contraindications
Cardiac valvulopathy Respiratory fibrosis Breastfeeding (inhibits lactation)
38
Adverse effects of cabergoline
Cardiac fibrosis, orthostatic hypotension, nasal congestion
39
MOA of inhaled corticosteroids
Reduce airway inflammation and bronchial hyperreactivity via local immunosuppression.
40
Indications for ICS treatment
Maintenance treatment of asthma and COPD
41
Adverse effects of ICS
Oral candidiasis, dysphonia
42
MOA of ACE inhibitors
Block conversion of angiotensin I to angiotensin II and also inhibit the breakdown of bradykinin by inhibiting the enzyme ACE.
43
Indications for ACE inhibitors
Hypertension, CHF with reduced EF, diabetic nephropathy
44
Precautions for ACE inhibitors
Volume/sodium depletion, primary hyperaldosteronism
45
Adverse effects of ACE inhibitors
Hypotension, headache, cough, hyperkalaemia, renal impairment
46
Adverse effects of ACE inhibitors
Hypotension, headache, cough, hyperkalaemia, renal impairment
47
MOA of metformin
Reduces hepatic glucose production; increases peripheral utilisation of glucose.
48
Metformin indications
T2DM, PCOS
49
Metformin indications
T2DM, PCOS
50
Metformin adverse effects
Nausea, vomiting, anorexia, diarrhoea, B12 malabsorption
51
Pituitary adenomas >10mm in diameter are known as:
Macroadenomas
52
Surgical intervention for prolactinomas is generally reserved for patients who:
cannot tolerate or are resistant to dopamine agonists.
53
The optimal treatment for Cushing's disease is:
Transsphenoidal hypophysectomy
54
A pituitary screen includes the following Ix:
Prolactin, TSH, free T4, morning cortisol, testosterone, LH, FSH, oestrogen, IGF-1
55
Gold-standard imaging for investigation of a pituitary adenoma is:
MRI with IV contrast
56
Mechanism of Cushing's disease
Pituitary adenoma → increased ACTH secretion → bilateral adrenal gland hyperplasia → secondary hypercortisolism
57
Skin features of Cushing's syndrome
Thin, easily bruisable skin with ecchymoses Hirsutism Acne Hyperpigmentation Facial flushing
58
Neuropsychological features of Cushing's syndrome
Anxiety, irritability, lethargy, fatigue, sleep disturbance, depression
59
Musculoskeletal features of Cushing's syndrome
Osteopenia, osteoporosis, pathological fractures, muscle atrophy
60
Endocrine and metabolic features of Cushing's syndrome
Insulin resistance, hyperglycaemia, dyslipidaemia, weight gain (central obesity, moon facies, buffalo hump), decreased libido, amenorrhoea
61
Side effects of corticosteroids (MNEMONIC)
CUSHINGOID Cataracts Ulcers Striae/Skin thinning Hypertension/Hirsutism Infections Necrosis (of femoral head) Glucose elevation Osteoporosis/Obesity Immunosuppression Depression/Diabetes
62
Indications for dexamethasone suppression test
To confirm diagnosis of Cushing's syndrome To identify the cause of Cushing's syndrome
63
Which two parameters are measured in a dexamethasone suppression test?
Cortisol and ACTH
64
What dosage is given in a low dose dexamethasone suppression test?
1mg dexamethasone
65
Purpose of the low dose dexamethasone test
Diagnostic of Cushing's syndrome, but does not give information about the underlying aetiology.
66
What dosage is given in the high dose dexamethasone suppression test?
8mg dexamethasone
67
The purpose of the high dose dexamethasone suppression test is:
to identify the underlying cause of Cushing's syndrome.
68
Mechanism of low dose dexamethasone suppression test in the absence of pathology
Dexamethasone acts on hypothalamus to suppress CRH and pituitary to suppress ACTH → reduction in cortisol
69
Mechanism of low dose dexamethasone suppression test in the presence of Cushing's syndrome
Cortisol is already significantly elevated so 1mg of dexamethasone is not enough to cause any hypothalamic/pituitary suppression.
70
Mechanism of high dose dexamethasone suppression test in the presence of Cushing's disease
8mg of dexamethasone is enough to suppress pituitary secretion of ACTH, therefore ACTH and cortisol are lowered.
71
Mechanism of high dose dexamethasone suppression test in the presence of adrenal adenoma
8mg dexamethasone suppresses hypothalamus (CRH), pituitary (ACTH) but has no effect on adrenal gland so cortisol remains elevated.
72
Mechanism of high dose dexamethasone suppression test in the presence of ectopic ACTH production (from neoplasm)
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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