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Hugh's MD2 Intersession 2 > Pituitary and Adrenal Disease (core) > Flashcards

Pituitary and Adrenal Disease (core) Flashcards

1
Q

How does Conn’s present? Why?

A

Hypertension

Hypokalaemia

Metabolic alkalosis

Aldosterone overproduction

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2
Q

How can Conn’s be treated?

A

Adrenal surgery

Aldactone - competitive antagonist

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3
Q

What is the best test for GH levels?

A

IGF-1 levels

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3
Q

How do you diagnose phaeochromocytoma

A

Metanephine levels (a metabolite of epinephrine)

24hour urine collection for catacholamines

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4
Q

What are the main signs of acromegaly?

A

Enlarged jaw, hands, and feet

Course facial features

Thickened skin

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4
Q

How does 21 hydroxylase deficiency present?

A

Over production of testosterone

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4
Q

How might mineralocorticoid hyposecretion present?

A

Hyperkalaemia

Hyponatremia

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5
Q

Why do you get pigmentation in Addisons?

A

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

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6
Q

How might prolactinomas present? Why?

A

Amenorrhoea - negative feedback on FSH and LH

Galactorrhea (milk production) - overproduction of prolactin

Hypogonadism

Loss of libido

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7
Q

What is the name of a dopamine agonist?

A

Cabergoline

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7
Q

What is MEN2? What does it cause?

A

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

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9
Q

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

A

ACTH-dependent

  • Cushing disease
  • Ectopic ACTH or CRF

ACTH-independent

  • Adrenal adenoma or carcinoma
  • Micro/Macronodular hyperplasia
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10
Q

What are some causes of sellar masses?

A

Benign tumours

  • Pituitary adenoma
  • Craniopharyngioma
  • Meningioma

Malignant

  • Primary
  • Metastatic tumour

Rathke’s cleft Cyst

Carotid aneurysm

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11
Q

What is the key modulator of mineralocorticoid release?

A

K

(renin-angiotensin)

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11
Q

How is Addison’s disease managed long term?

A

Glucocorticoids - cortisone acetate

  • Dexamethasone
  • Pred

Mineralocorticoids

  • Fludrocortisone
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11
Q

What must be done before surgery in Pheochromocytoma?

A

Alphablockage to prevent hypertensive crisis

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12
Q

Which drugs increase prolactin?

A

Anti-psychotics

Anti-emetics

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12
Q

How do you supress GH levels clinically? Why?

A

75g of glucose orally

Ghrelin release from stomach in response to glucose suppresses GH

13
Q

What are the side effects of octreotide?

A

Gall stones

GI upset

14
Q

What is Inferior petrosal sinus sampling for?

A

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

16
Q

How does dopamine effect prolactin levels?

A

It’s inhibitory to its production

16
Q

What causes Acromegaly?

A

GH secreting pituitary adenoma

GH secreting tumour elsewhere (rare)

17
Q

How is Addisonian crisis managed?

A

Hydrocortisone

Fluid replacement

19
Q

What are the complications of acromegaly?

A

Increased heart disease

Diabetes

Colonic adenoma

21
Q

What are the clinical features of Phaeochromocytoma?

A

Headache

Vision changes

Tremors

Palpitations

Panic attacks

22
Q

What are the characterists of a pituitary based headache?

A

Pain is right between the eyes

24
Q

What are clinical features of Cushing syndrome?

A

Rapid weight gain (>20kg in 1-2 years)

Striae

Ease of bruising

Poor wound healing

Myopathy

Osteoporosis (particularly spinal)

Buffulo hump

Moon face

26
Q

What are symptoms of hyperthalamic syndromes?

A

Energy dysregulation and obesity

28
Q

What is the pathophysiology of Addison’s disease?

A

Autoimmune destruction of the adrenal gland

29
Q

What is the treatment regimen for prolactinoma?

A

Dopamine agonist for a few years until to the tumour reduces in size

Monitor prolactin levels to monitor for return

30
Q

What is the difference between Cushing syndrome and disease?

A

Syndrome - State of high glucocorticoids

Disease - ACTH hypersecreting adenoma

31
Q

How is Conn’s diagnosed?

A

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

Aldosterone/renin ratio

32
Q

How is acromegaly treated?

A

Transphenoidal hypophysectomy to remove tumour

Medically:

  • Octreotide (somatostatin analogue)

Radiotherapy

34
Q

How do you simulate GH production clinically?

A

Insulin induced hypoglycaemia - in adults

Exercise - in kids

35
Q

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

A

Dependent - ACTH will be normal or elevated

Independent - ACTH will be suppressed

36
Q

What are the best tests for Cushing Syndrome?

A

24 hour urine free cortisol (if possible)

Overnight dexamethasone suppression test

37
Q

How are prolactinomas treated?

A

Dopamine agonist - Cabergoline, bromocriptine

38
Q

What is MEN1?

A

Autonosomal dominant gene mutations that causes predisposes people to endocrine tumours of the:

Pituitary, pancreas and parathyroid

39
Q

What causes phaeochromocytoma?

A

Tumour of chromaffin cells in adrenal medulla

Paragangliomas

40
Q

What are the most common hormone phenotypes for pituitary adenomas?

A
  1. Non functioning

Prolactin secreting

Growth hormone secreting

ACTH secreting

41
Q

What are the side effects of dopamine agonists?

A

Nausea

GI upset

Personality changes - risk taking behaviour

42
Q

The synacthen test is for the diagnosis of what?

A

Addison’s

43
Q

What are the polyglandular autoimmune disorders?

A

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

Hugh's MD2 Intersession 2 (14 decks)

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