Pituitary & Adrenal Disease

Question 1

what is craniopharyngioma?

Answer 1

childhood, above pituitary, mass effect, hypothalamic syndrome: obesity

Question 2

features of pituitary headache?

Answer 2

cracking headache Right between the eyes

apyplexy: bleed into the pituitary
Acute ACTH deficiency

Question 3

70% of pituitary adenomas are?

Answer 3

non functioning tumours

Question 4

3 most common hormone secreting pituitary adenomas

Answer 4

prolactinoma (most common)
acromegaly
cushing’s

Question 5

what inhibits prolactin?

Answer 5

dopamine

Question 6

what affects prolactin release?

Answer 6

dopamine modifiers like psychiatric meds etc.

Question 7

symptoms of prolactinoma?

Answer 7

negative preg tests

galactorrhoea

Question 8

with prolactinomas, usually secrete what two things?

Answer 8

IGF-1 and prolactin

Question 9

how to best test for thyroid hormone?

Answer 9

TSH levels

Question 10

how to test for thyroid pituitary problems?

Answer 10

TSH T3 T4

Question 11

what is stalk effect?

Answer 11

pituitary mass that pushes up and cuts off the connection from hypothalamus to pituitary

Question 12

dopamine agonists for prolactinomas? side effects?

Answer 12

bromocriptine
cabergoline (weekly)

SFx: nausea, GI upset

Question 13

How to test suppress growth hormone?

Answer 13

oral glucose challenge,

grelin levels decrease when nutrients

Question 14

how to measure growth hormone?

Answer 14

IGF-1

Question 15

how to look for body’s ability to make ACTH and IGF-1?

Answer 15

insulin induced hypoglycaemia

both should raise

Question 16

acromegaly most common causes?

Answer 16

growth hormone secreting adenoma

Question 17

how to ask for acromegaly re: hands/feet?

Answer 17

are your rings still fitting?

need to buy new shoes?

Question 18

acromegaly and cancer?

Answer 18

increase risk of colonic cancers, accelerating growth of existing

Question 19

macroadenoma in pituitary symptoms?

Answer 19

bitemporal hemiopnopia

Question 20

acromegaly treatment?

Answer 20

surgery
radiotherapy
octreotide - SFx: gallstones
bromocriptine

Question 21

Synacthin test?

Answer 21

give synthetic ACTH to stim the adrenals, expect rise, if don’t see a big rise then adrenals not responding

Question 22

ACTH independent cushing’s syndrome are?

Answer 22

adrenal adenoma/carcinoma

micro/macronodular hyperplasi

Question 23

ACTH dependent cushing syndrome

Answer 23

Cushing’s
ectopic ACTH
ectopic CRF

Question 24

cushing’s syndrome signs?

Answer 24

wounds not healing
myopathy
striae
osteoporosis (spinal), kyphosis
rapid weight gain

Question 25

cushing's syndrome dx? 2

Answer 25

free cortisol from 24 hour collection | dexamethasone suppression test

Question 26

what is inferior petrosal sinus sampling for?

Answer 26

pituitary drainage has higher level of ACTH than peripheral | confidence for treatment

Question 27

Adrenals: which enzyme important to know about

Answer 27

21 hydroxylase deficiency

Question 28

why pigmentaion in addisons disease?

Answer 28

high POMC levels, increase melanocyte production

Question 29

addison's cause?

Answer 29

autoimmune infection of the adrenals

Question 30

addison's symptoms?

Answer 30

hyperkalaemia hyponatraemia hypoglycaemia

Question 31

key modulator in addison's?

Answer 31

potassium

Question 32

addisonian crisis rx?

Answer 32

fluid hydrocortisone Glucocorticoid (more if times of stress) mineralcorticoids too

Question 33

Conn's syndrome need 2 things to consider?

Answer 33

hypokalaemia | uncontrolled hypertension

Question 34

common cause of Conn Syndrome?

Answer 34

adrenal adenoma

Question 35

best test to do for Conn Syndrome?

Answer 35

saline infusion test, aldosterone should be suppressed from all the Na+, if not then it's independent and a problem

Question 36

pheochromocytoma where?

Answer 36

in adrenal medulla

Question 37

pheochromocytoma symptoms?

Answer 37

massive episodes of panic attacks, palpitations, hypertension

Question 38

metanephrines are what?

Answer 38

degredation product of epinephrines

Question 39

how to dx pheochromocytoma?

Answer 39

24 hour collection of catecholamines | imaging: adrenals or paragangliomas in cervical/thoracics

Question 40

pre-operative in pheochromocytoma?

Answer 40

alpha blockers | not beta blockers before alpha blockers

Question 41

multiple endocrine neoplasia syndromes (MEN1 causes?)

Answer 41

3 Ps pituitary parathyroid pancreas

Question 42

MEN 2 lead to? | autosomal dominant

Answer 42

medullary thyroid cancers, very deadly | pheochromocytoma

Question 43

most common pituitary mass?

Answer 43

pituitary adenoma craniopharyngioma Meningioma