Pituitary & Adrenal Disease Flashcards
what is craniopharyngioma?
childhood, above pituitary, mass effect, hypothalamic syndrome: obesity
features of pituitary headache?
cracking headache Right between the eyes
apyplexy: bleed into the pituitary
Acute ACTH deficiency
70% of pituitary adenomas are?
non functioning tumours
3 most common hormone secreting pituitary adenomas
prolactinoma (most common)
acromegaly
cushing’s
what inhibits prolactin?
dopamine
what affects prolactin release?
dopamine modifiers like psychiatric meds etc.
symptoms of prolactinoma?
negative preg tests
galactorrhoea
with prolactinomas, usually secrete what two things?
IGF-1 and prolactin
how to best test for thyroid hormone?
TSH levels
how to test for thyroid pituitary problems?
TSH T3 T4
what is stalk effect?
pituitary mass that pushes up and cuts off the connection from hypothalamus to pituitary
dopamine agonists for prolactinomas? side effects?
bromocriptine
cabergoline (weekly)
SFx: nausea, GI upset
How to test suppress growth hormone?
oral glucose challenge,
grelin levels decrease when nutrients
how to measure growth hormone?
IGF-1
how to look for body’s ability to make ACTH and IGF-1?
insulin induced hypoglycaemia
both should raise
acromegaly most common causes?
growth hormone secreting adenoma
how to ask for acromegaly re: hands/feet?
are your rings still fitting?
need to buy new shoes?
acromegaly and cancer?
increase risk of colonic cancers, accelerating growth of existing
macroadenoma in pituitary symptoms?
bitemporal hemiopnopia
acromegaly treatment?
surgery
radiotherapy
octreotide - SFx: gallstones
bromocriptine
Synacthin test?
give synthetic ACTH to stim the adrenals, expect rise, if don’t see a big rise then adrenals not responding
ACTH independent cushing’s syndrome are?
adrenal adenoma/carcinoma
micro/macronodular hyperplasi
ACTH dependent cushing syndrome
Cushing’s
ectopic ACTH
ectopic CRF
cushing’s syndrome signs?
wounds not healing myopathy striae osteoporosis (spinal), kyphosis rapid weight gain
cushing’s syndrome dx? 2
free cortisol from 24 hour collection
dexamethasone suppression test
what is inferior petrosal sinus sampling for?
pituitary drainage has higher level of ACTH than peripheral
confidence for treatment
Adrenals: which enzyme important to know about
21 hydroxylase deficiency
why pigmentaion in addisons disease?
high POMC levels, increase melanocyte production
addison’s cause?
autoimmune
infection
of the adrenals
addison’s symptoms?
hyperkalaemia
hyponatraemia
hypoglycaemia
key modulator in addison’s?
potassium
addisonian crisis rx?
fluid
hydrocortisone
Glucocorticoid (more if times of stress)
mineralcorticoids too
Conn’s syndrome need 2 things to consider?
hypokalaemia
uncontrolled hypertension
common cause of Conn Syndrome?
adrenal adenoma
best test to do for Conn Syndrome?
saline infusion test, aldosterone should be suppressed from all the Na+, if not then it’s independent and a problem
pheochromocytoma where?
in adrenal medulla
pheochromocytoma symptoms?
massive episodes of panic attacks, palpitations, hypertension
metanephrines are what?
degredation product of epinephrines
how to dx pheochromocytoma?
24 hour collection of catecholamines
imaging: adrenals or paragangliomas in cervical/thoracics
pre-operative in pheochromocytoma?
alpha blockers
not beta blockers before alpha blockers
multiple endocrine neoplasia syndromes (MEN1 causes?)
3 Ps
pituitary
parathyroid
pancreas
MEN 2 lead to?
autosomal dominant
medullary thyroid cancers, very deadly
pheochromocytoma
most common pituitary mass?
pituitary adenoma
craniopharyngioma
Meningioma
