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Y2 Endocrine > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

1
Q

how are pituitary tumours classified?

A

by their size

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2
Q

what is a pituitary adenoma <1cm called?

A

microadenoma

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3
Q

what is a pituitary adenoma >1cm called?

A

macroadenoma

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4
Q

why can a benign pituitary adenoma still be very damaging?

A

there is very little space available to them for growth before causing problems

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5
Q

what structures can a pituitary adenoma compress?

A

optic chiasma
cranial nerves
internal carotid arteries

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6
Q

how is a pituitary adenoma managed?

A

transsphenoidal surgery to remove

hormone replacement

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7
Q

what are three physiological causes of raised prolactin?

A

pregnancy
stress
lack of sleep

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8
Q

what drugs can cause a raised prolactin?

A

anything that reduces dopamine levels

dopamine antagonists, anti-psychotics

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9
Q

what are three pathological causes of raised prolactin?

A

hypothyroidism
lesions on the pituitary stalk
prolactinoma

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10
Q

how does hypothyroidism lead to a raised prolactin?

A

TRH stimulates prolactin - elevated in hypothyroidism due to loss of negative feedback

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11
Q

what value of prolactin suggests a prolactinoma?

A

over 5000

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12
Q

do men or women with prolactinoma present earlier?

A

women

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13
Q

how does a prolactinoma present in females?

A

galactorrhoea
menstrual irregularities
infertility

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14
Q

how does a prolactinoma present in males?

A

impotence
visual field abnormalities
anterior pituitary problems

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15
Q

what medication is used to treat a prolactinoma?

A

dopamine agonists

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16
Q

name a dopamine agonist

A

cabergoline

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17
Q

what causes acromegaly?

A

GH excess

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18
Q

what does GH excess in children cause?

A

gigantism

19
Q

how is a diagnosis of acromegaly confirmed?

A

measure IGF-1

OGTT

20
Q

what is the gold standard test for diagnosing acromegaly?

A

OGTT

21
Q

how is an OGTT performed?

A

give 75g glucose orally and measure GH every 30 mins for two hours

22
Q

what is a normal response to an OGTT?

A

GH suppresses to <0.4 after glucose

23
Q

what is the response to an OGTT in acromegaly?

A

GH unchanged or raised

24
Q

what is the main treatment for acromegaly?

A

pituitary surgery

25
Q

what drugs can be used to manage acromegaly?

A

somatostatin analogues
dopamine agonists
GH antagonists

26
Q

what management for acromegaly is done if drugs fail?

A

radiotherapy

27
Q

what is cushing’s syndrome?

A

excess cortisol

28
Q

what is the gold standard test for diagnosing cushing’s syndrome?

A

low dose dexamethasone suppression test

29
Q

what is the main cause of cushing’s syndrome?

A

a pituitary adenoma - called cushing’s disease

30
Q

what factors could create a false positive when doing tests for cushing’s disease?

A

alcohol
depression
steroid medication

31
Q

how would a pituitary cause of cushing’s be diagnosed?

A

low dose dex test = abnormal

ACTH = slightly raised

32
Q

how would a adrenal cause of cushing’s be diagnosed?

A

low dose dex test = abnormal

ACTH = low

33
Q

how would a ectopic cause of cushing’s be diagnosed?

A

low dose dex test = abnormal

ACTH = very raised

34
Q

name some of the main causes of hypopituitarism

A

pituitary tumours
brain tumours invading
side effect of surgery

35
Q

name some signs and symptoms of anterior hypopituitarism

A 
menstrual irregularities
infertility
impotence
gynaecomastia 
obesity 
dry skin
36
Q

what is given in hypopituitarism to replace TSH?

A

thyroxine 100-150mcg/day

37
Q

what is given in hypopituitarism to replace ACTH?

A

hydrocortisone 10-15 split over the day - largest dose in the morning

38
Q

what is given in hypopituitarism to replace ADH?

A

desmopressin tablets or desmospray

39
Q

what is given in hypopituitarism to replace GH?

A

subcutaneous GH nightly

40
Q

what is given in hypopituitarism to replace sex steroids?

A

HRT/COCP for females

testosterone for males

41
Q

what is the test used to diagnose diabetes insipidus?

A

water deprivation test

42
Q

what is involved in the water deprivation test?

A

nil by mouth for 8-12 hours

check serum and urine osmolalities for 8h and then 4h after giving IM DDAVP

43
Q

what are the options for treating diabetes insipidus?

A

desmospray

desmopressin oral tablets

Y2 Endocrine (33 decks)

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