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Endocrine Y2 JC > Pituitary and adrenal conditions > Flashcards

Pituitary and adrenal conditions Flashcards

1
Q

What is the most common tumour of the pituitary gland?

A

Prolactinoma

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2
Q

What are some physiological causes of increased prolactin levels?

A 
Pregnancy 
Breast feeding 
Stress
Metoclopramide (anti-nausea medicaiton due to suppressing dopamine)
Phenothiazine (antipsychotic)
Amytriptyline (antidepressants)
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3
Q

Women presents with inability to get pregnant with a lack of libido, amenorrhoea and galactorrhoea. What investigations would you run? Most likely diagnosis?

A

Serum prolactin if >5000 then diagnostic of tumour

Prolactinoma

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4
Q

What is the treatment for a prolactinoma? What are some of the side effects?

A

Cabergoline (dopamine agonist that inhibits prolactin production)

  • nausea and vomiting, low mood, fibrosis
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5
Q

Child of 10 years presents with incredible growth for his age was off the decile chart for his age. He has abnormally large hands, headaches and is quite sweaty. Likely diagnosis? What investigations would you run?

A

Gigantism due to excessive growth hormone

Glucose tolerance test and growth hormone levels

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6
Q

Male adult presents with proximal muscle weakness, cough, orthopnoea, polydipsia and pain in the dental region. Upon examination he has a high blood pressure , has dullness and crackles in both lung fields and significant interdental separation. What is the likely diagnosis?

A

Acromegaly (high growth hormone secondary to tumour)

Due to heart failure symptoms from left ventricular hypertrophy
Proximal muscle weakness and especially pain in the dental region

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7
Q

What are some of the common complications of acromegaly?

A

Hypertension
Type 2 diabetes from increased circulatory glucose
Carpal tunnel syndrome (due to increaed soft tissue growth compressing the median nerve in the hand)
Growth of polyps in the colon

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8
Q

If someone is positive for acromegaly what results would you expect on a glucose tolerance test?

A

As glucose should inhibit GH production then would expect GH levels to fall to <0.4 micrograms/l if no change then acromegaly present

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9
Q

What is the first line treatment for acromegaly and gigantism?

A

Pituitary resection of the tumour

Transphenoidal usually

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10
Q

What is second line treatment for acromegaly? What are some of its side effects??

A

Somatostatin analogues injections to suppress growth hormone production like sandostatin and lanreotide

Flatulence, diarrhoea, abdo pains, can stop gallbladder contracting so gallstones

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11
Q

What is the indicication for use of dopamine gonsits in acromegaly?

A

Most likely to work when the tumour co-secretes prolactin

E.g bromocriptine and cabergoline

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12
Q

What is the long term monitoring for acromegaly?

A

Check thyroid function
If acromegaly then colonscopy every 3yrs to check for adenomas
CV risk so check BP/lipids/glucose

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13
Q

If a pituitary tumour swells into the optic chiasm what symptom may you expect to see?

A

Bitemporal hemianopia (temporal field loss)

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14
Q

Man presents with homonymous hemianopsia of the left visual fields of the left eye. Diagnosis?

A

Stroke

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15
Q

Man presents with weight loss, recent tanning, a passion for salt and vinegar crisps and feels very dehydrated. What is the likely diagnosis? Investiations? Treament?

A

ADDISIONS DISEASE

DONT INVESTIGATE IF SUSPECT JUST TREAT

IV hydrocortisone 100mg
1000 ml/hr saline

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16
Q

Man presents with low sodium and high potassium along with abdo discomfort, fatigue and dizziness. Likely diagnosis and treatment?

A

Addisons disease

IV hydrocortisone 100mg then 200mg oral next day

1000ml/hr saline

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17
Q

After emergency treatment for addisons what is the diagnostic test ?

A

Synacthen test

Dose of ACTH to see if adrenal cortex makes cortisol

Then antibodies for adrenal cortex

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18
Q

Bloods come back for a patient and they have a high sodium and a low potassium. In addition, they have hypertension. What is the likely diagnosis? investigation?Treatment?

A

Conns syndrome
Measure renin and aldosterone (should have high aldosterone compared to renin)

Surgery to remove the adenoma taht is causing the excessive aldosteorne secretion

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19
Q

Women aged 30 years presents with polydipsia, polyuria, a moon face, and obesity. What is the likely diagnosis? What is the definitive diagnostic test for this condition?

A

Cushing syndrome

Low dose dexamethasone suppression test over 2 days with 2mg/day to see if cortisol goes to below 50nmol/l indicating normal

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20
Q

Women 25 years presents with hypertension, thin skin, easy bruising and difficulty getting upstairs. She has been having irregular periods and recently been feeling a bit under the weather. On examination she has an interscapular fat pad. Likely diagnosis?

A

Cushing syndrome

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21
Q

What is the pathology of cushing syndrome?

A

Excess cortisol production that binds to mineralocorticoid hormones causeing hypertension and oedema

Can be due to cushings disease (adenoma in pituitary)
Adenoma of adrenal gland
Ectopic ACTH production from cancers
Steroid use

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22
Q

What is the screening test for cushings syndorme?

A

Overnight 1mg dexamethasone suppression test

23
Q

What is the treatment for cushings syndrome?

A

Surgical hypophysectomy if recurs then radiotherapy

Metryapone to prevent steroid production (before surgery given in order to reduce harmful steorid level )

24
Q

Man presents with abdominal obesity, loss of facial and pubic hair, dry skin, and gynaecomastia. What investigations would you run? Likely diagnosis?

A

TSH levels and thyroxine as indicitive of pituitary disease

Hypopituitarism

25
Q

What is theh treatment for hypopituitarism? Monitoring?

A

Replacement of hormone deficiencies like GH for children,

Routine bloods for hormone levels

PR exam as testosterone can cause prostate enlargement

26
Q

What is the diagnostic investigation for Diabetes insipidus?

A

Water deprivatipn test over 8 hours to stimulate ADH release, aiming to get urine: serum osmolarity >2 . If not then ADH injection to see if then get it.

27
Q

What is the treatment for diabetes insipidus

A

Desmospray nasally

Desmopressin injetion

28
Q

What is the pathology of phaeochromocytoma?

A

Catecholamine secreting tumours either from sympathetic paraganglia cells in medulla of adrenals OR extra-adrenal like at aortic bifurcation

29
Q

Man with known MEN2 presents with sudden onset of excessive sweating, palpitations, headaches and dizziness when getting up from sitting. What is the likely diagnosis?

A

Phaeochromocytoma

Excessive adrenaline secretion

30
Q

What are the invetigations for possible phaeochromocytoma?

A

Urinary caecholamines measured over 24 hrs (3 readings on 3 separate days)

If above abnormal then MIBG test to see adrenaline emitting tissues

MRI scan of abdomen and whole body

31
Q

What is the treatment for phaeochromocytoma?

A

Surgical removal of adrenaline secreting tumour after alpha and beta blockade (A then B) using phenoxybenzamine and atenolol

32
Q

Congenital adrenal hyperplasia is a failure of what enzyme?

A

21 hydroxylase enzyme

33
Q

What conditions predispose a person to phaeochromocytoma?

A

MEN 2
Thyroid and parathyroid tumours
Von hippel lindau syndorme
Neurofirbomatosis

34
Q

What are the symptoms of addisons disease?

A

D disease;

Discomfort (abdo), Dark skin, dizziness, depleted (weight loss), Dehydrated

Fatigue, amenorhhoea, passion for salt

35
Q

What is the pathology of conns syndrome?

A

Tumour (adenoma) in zona glomerulosa causing excessive aldosterone secretion. Causes low circulating potassium

36
Q

What are some of the symptoms of Conns syndrome?

A

Hypertension

Hypokalaemia (constipation, fatigue, muscle weakness)

37
Q

What are the diagnostic test for conns syndrome?

A

Measure renin and aldosterone levels (high aldosterone compared to renin aka not being controlled)

Then adrenal CT scan and sampling of tumour

38
Q

What is the most common cause of secondary adrenal insufficiency?

A

Exogenous steroid use

Causes pale skin, weight loss, amenorrhoea, dehydrated

39
Q

What is the treatment of secondary adrenal insufficiency

A

Hydrocortisone replacement
Saline
Maintenance steroids

40
Q

What is the pathology of cushings syndrome?

A

Variety of causes most common cushings disease from adenoma in the pituitary

41
Q

What epidemiological group is most likely to get cushings?

A

Women 20-40 years

42
Q

What is hypopituitarism?

A

Where there is diminished hormone secretion from the pituitary gland

Can be from tumours, metastatic lesions, TB, sarcoidosis, trauma, meningitis, sheenan syndrome,

43
Q

What can be some of the presentations of hypopituitarism?

A 
Infertility
Menstrual irregularities
Hypothyroidism
Growth retardation
Gynaecomastia
Loss of axillary or pubic hair
44
Q

What are some of the investigations for hypopituitarism?

A

Low TSH/ thyroxine indicative of pituitary disease

Post menopausal women FSH/ LH high but this can cause it to be normal or low

45
Q

What are some of the side effects of giving testosterone replacement?

A

Prostate enlargement
Leading to urinary obstruction so need to monitor with PR exam
Polycythaemia (thickening of blood)
Hepatitis

46
Q

What is the pathology of diabetes insipidus

A

Central diabetes insipidus due to inability to produce ADH

Or

Resistance to ADH in renal collecting ducts

47
Q

What is the treatment for disabetes insipidus?

A

Desmospray nasally (10-60mcg/day)

48
Q

What is the pathology of phaeochromocytoma?

A

Rare catecholamine secreting tumours from sympathetic paraganglia cells in medulla of adrenals

49
Q

Man presents with dizziness from getting up suddenly from sitting, excessive sweating, palpitations and headaches. This occured within the last week. He has hypertension and mentions he also has MEN2. Likely diagnosis?

A

Phaeochromocytoma

Resistant hypertension, palpitations, sweating, postural hypotension, headaches all hallmarks of adrealine secreting tumour

Associated with MEN2, Thyroid and parathyroid tumours, von hippel lindau syndorme, neurofibromatosis

50
Q

You suspect phaeochromocytoma, what investigatios do you run?

A

Urinary catecholamines over 24hrs to look for excess adrenaline. (USE acid contating bottles)

Musnt eat certain nuts/ bannanas as will mess it up

Next line CT or MRI if urinary catecholamines abnormal

51
Q

What is the treatment for phaeochromocytoma?

A

Surgical removal of the tumour but first blockade its effects with

  1. Alpha blocker- phenoxybenzamine
  2. Beta blocker- atenolol

If malignant then chemo with MIBG

52
Q

What is the investigation for suspected congeintal adrenal hyperplasia?

A

Saline suppression test if aldosterone: renin is >750

When give saline expect aldosterone to fall to prevent high BP but if it doesnt then diagnostic

53
Q

What is the treatment for congenital adrenal hyperplasia?

A

Surgical resection if unilateral

Eplerenone

Endocrine Y2 JC (8 decks)

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