Pituitary and Adrenal Disease (core)

Question 1

How does Conn’s present? Why?

Answer 1

Hypertension

Hypokalaemia

Metabolic alkalosis

Aldosterone overproduction

Question 2

How can Conn’s be treated?

Answer 2

Adrenal surgery

Aldactone - competitive antagonist

Question 3

What is the best test for GH levels?

Answer 3

IGF-1 levels

Question 3

How do you diagnose phaeochromocytoma

Answer 3

Metanephine levels (a metabolite of epinephrine)

24hour urine collection for catacholamines

Question 4

What are the main signs of acromegaly?

Answer 4

Enlarged jaw, hands, and feet

Course facial features

Thickened skin

Question 4

How does 21 hydroxylase deficiency present?

Answer 4

Over production of testosterone

Question 4

How might mineralocorticoid hyposecretion present?

Answer 4

Hyperkalaemia

Hyponatremia

Question 5

Why do you get pigmentation in Addisons?

Answer 5

Addisons - low cortisol production > ACTH hypersection > POMC (ACTH precursor) also made into melanocyte stimulating factor > pigmentation

Question 6

How might prolactinomas present? Why?

Answer 6

Amenorrhoea - negative feedback on FSH and LH

Galactorrhea (milk production) - overproduction of prolactin

Hypogonadism

Loss of libido

Question 7

What is the name of a dopamine agonist?

Answer 7

Cabergoline

Question 7

What is MEN2? What does it cause?

Answer 7

Autosomal dominant mutation of RET proto oncogene that predisposes to medullary carcinoma of thyroid and other endocrine tumours

Question 9

How are the causes of Cushing syndrome divided? What are some examples of each?

Answer 9

ACTH-dependent

• Cushing disease
• Ectopic ACTH or CRF

ACTH-independent

• Adrenal adenoma or carcinoma
• Micro/Macronodular hyperplasia

Question 10

What are some causes of sellar masses?

Answer 10

Benign tumours

• Pituitary adenoma
• Craniopharyngioma
• Meningioma

Malignant

• Primary
• Metastatic tumour

Rathke’s cleft Cyst

Carotid aneurysm

Question 11

What is the key modulator of mineralocorticoid release?

Answer 11

K

(renin-angiotensin)

Question 11

How is Addison’s disease managed long term?

Answer 11

Glucocorticoids - cortisone acetate

• Dexamethasone
• Pred

Mineralocorticoids

• Fludrocortisone

Question 11

What must be done before surgery in Pheochromocytoma?

Answer 11

Alphablockage to prevent hypertensive crisis

Question 12

Which drugs increase prolactin?

Answer 12

Anti-psychotics

Anti-emetics

Question 12

How do you supress GH levels clinically? Why?

Answer 12

75g of glucose orally

Ghrelin release from stomach in response to glucose suppresses GH

Question 13

What are the side effects of octreotide?

Answer 13

Gall stones

GI upset

Question 14

What is Inferior petrosal sinus sampling for?

Answer 14

Demonstrating the ACTH levels are higher close to the pituitary to confirm that it is the source of the ACTH hypersecretion

Question 16

How does dopamine effect prolactin levels?

Answer 16

It’s inhibitory to its production

Question 16

What causes Acromegaly?

Answer 16

GH secreting pituitary adenoma

GH secreting tumour elsewhere (rare)

Question 17

How is Addisonian crisis managed?

Answer 17

Hydrocortisone

Fluid replacement

Question 19

What are the complications of acromegaly?

Answer 19

Increased heart disease

Diabetes

Colonic adenoma

Question 21

What are the clinical features of Phaeochromocytoma?

Answer 21

Headache Vision changes Tremors Palpitations Panic attacks

Question 22

What are the characterists of a pituitary based headache?

Answer 22

Pain is right between the eyes

Question 24

What are clinical features of Cushing syndrome?

Answer 24

Rapid weight gain (\>20kg in 1-2 years) Striae Ease of bruising Poor wound healing Myopathy Osteoporosis (particularly spinal) Buffulo hump Moon face

Question 26

What are symptoms of hyperthalamic syndromes?

Answer 26

Energy dysregulation and obesity

Question 28

What is the pathophysiology of Addison's disease?

Answer 28

Autoimmune destruction of the adrenal gland

Question 29

What is the treatment regimen for prolactinoma?

Answer 29

Dopamine agonist for a few years until to the tumour reduces in size Monitor prolactin levels to monitor for return

Question 30

What is the difference between Cushing syndrome and disease?

Answer 30

Syndrome - State of high glucocorticoids Disease - ACTH hypersecreting adenoma

Question 31

How is Conn's diagnosed?

Answer 31

Infusion of 2L N/Saline over 4hours - look for aldosterone suppresion Aldosterone/renin ratio

Question 32

How is acromegaly treated?

Answer 32

Transphenoidal hypophysectomy to remove tumour Medically: - Octreotide (somatostatin analogue) Radiotherapy

Question 34

How do you simulate GH production clinically?

Answer 34

Insulin induced hypoglycaemia - in adults Exercise - in kids

Question 35

What will the result of a dexamethasone test in ACTH dependent and independent Cushings?

Answer 35

Dependent - ACTH will be normal or elevated Independent - ACTH will be suppressed

Question 36

What are the best tests for Cushing Syndrome?

Answer 36

24 hour urine free cortisol (if possible) Overnight dexamethasone suppression test

Question 37

How are prolactinomas treated?

Answer 37

Dopamine agonist - Cabergoline, bromocriptine

Question 38

What is MEN1?

Answer 38

Autonosomal dominant gene mutations that causes predisposes people to endocrine tumours of the: Pituitary, pancreas and parathyroid

Question 39

What causes phaeochromocytoma?

Answer 39

Tumour of chromaffin cells in adrenal medulla Paragangliomas

Question 40

What are the most common hormone phenotypes for pituitary adenomas?

Answer 40

1. Non functioning Prolactin secreting Growth hormone secreting ACTH secreting

Question 41

What are the side effects of dopamine agonists?

Answer 41

Nausea GI upset Personality changes - risk taking behaviour

Question 42

The synacthen test is for the diagnosis of what?

Answer 42

Addison's

Question 43

What are the polyglandular autoimmune disorders?

Answer 43

Genetic conditions that cause increased autoimmune attack of endocrine structures and cells