Pituitary conditions

Question 1

What size is a microadenoma?

Answer 1

1cm or less

Question 2

What size is a macroadenoma?

Answer 2

More than 1cm

Question 3

What cranial nerves are most likely to be damaged by a pituitary adenoma?

Answer 3

Cranial nerves 3, 4 and 6

Question 4

Name three dopamine antagonists

Answer 4

Bromocriptine (3xdaily)
Quinagolide (1xdaily)
Carbergoline (2xweek)

Question 5

How do you treat a prolactinoma?

Answer 5

Dopamine antagonists

Question 6

What is the diagnostic test for acromegaly?

Answer 6

Glucose tolerance test. Give 75g oral glucose and measure every 30 mins

Question 7

What is the result of a GTT in someone with acromegaly as opposed to a normal person?

Answer 7

Normal: Suppress to below 0.4ug after glucose. No suppression in acromegaly

Question 8

How do you treat acromegaly?

Answer 8

Surgery

Question 9

If you have performed surgery for acromegaly but there is still a positive result on the GTT what do you do?

Answer 9

Drug therapy

• Dopamine agonist
• Octreotide
• Pegvisomant

Question 10

What drugs treatment might you use pre operatively to shrink an adenoma and to relieve headache in acromegaly?

Answer 10

Somatostatin analogues

Question 11

What are the two most likely long term side effects of somatostatin analogues?

Answer 11

Gastritis

Gallstones

Question 12

Name three somatostatin analogues used in acromegaly

Answer 12

1. Octreotide SC injection 3xdaily
2. Sandostatin IM injection 1x every 28 days
3. Lanreotide autogel IM injection 1x every 28 days.

Question 13

How does pegvisomant work?

Answer 13

Binds to GH receptor and blocks its activity

Question 14

What other type of drug is useful in acromegaly?

Answer 14

Dopamine agonist eg cabergoline

Question 15

Name two screening tests used in cushings

Answer 15

Overnight 1mg dexamethasone supression test

24 hrs urine collections for cortisol measurement

Question 16

Describe the overnight dexamethasone suppression test

Answer 16

1mg dexamethasone given at night.
Normal result: Cortisol will be below 50 the next morning
Abnormal result: More than 100

Question 17

What do you calculate in the 24hr urine collection for cushings?

Answer 17

Cortisol creatinine ratio

Question 18

What is a normal urinary free cortisol?

Answer 18

Less than 250

Question 19

What is a normal cortisol creatinine ratio?

Answer 19

Less than 25

Question 20

What is the definitive test for cushings?

Answer 20

Low dose dexamethasone test

Question 21

Describe the low dose dexamethasone test?

Answer 21

2mg dexamethonse given each day for 2 days in small doses.

If the cortisol is less than 50 16 hrs after the last dose then there is no cushings.

Question 22

Is cushings is it more commonly a pituitary problem or an adrenal problem?

Answer 22

Pituitary

Question 23

What three tissues may produce ectopic ACTH?

Answer 23

Thymus
Lung
Pancreas

Question 24

What is the treatment for pituitary cushings?

Answer 24

Surgery and external radiotherapy if there is a recurrence

Question 25

What is the treatment for adrenal cushings?

Answer 25

Adrenalectomy

Question 26

Name two treatment options for ectopic ACTH secretion?

Answer 26

1. Remove source

2. Bilateral adrenalectomy

Question 27

Name three possible drug treatments that might be used in cushings?

Answer 27

Metyrapone
Ketoconazole
Pasireotide

Question 28

What is the treatment for hypopituitarism?

Answer 28

Thyroxine; 100 - 150 mcg/day
Hydrocortisone: 10 = 225mg/day
ADH: Desmospray
GH: nightly SC injection
Sex steroids (oest/prog for women and testosterone for males)

Question 29

Name some testosterone replacements

Answer 29

Sustanon IM injection every 4 weeks
Testogel skin gel
Prolonged IM injection
Restandol oral tablets

Question 30

What is the risk of testosterone replacement?

Answer 30

Prostate enlargement

Increased red blood cells in blood