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2MB Endocrinology > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

1
Q

List the hormones secreted from the anterior pituitary

A 
ACTH
LH/FSH
TSH
GH
Prolactin
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2
Q

List the hormones secreted from the posterior pituitary

A

ADH

Oxytocin

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3
Q

Production of which peripheral hormone is stimulated by ACTH?

A

Cortisol

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4
Q

Production of which peripheral hormone is stimulated by LH and FSH?

A

Testosterone

Estradiol

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5
Q

Production of which peripheral hormone is stimulated by TSH?

A

Thyroxine

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6
Q

Production of which peripheral hormone is stimulated by GH?

A

IGF-1

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7
Q

If too much hormone is produced, what kind of test is done?

A

Suppression test

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8
Q

If too little hormone is produced, what kind of test is done?

A

Stimulation test

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9
Q

Give examples of pituitary stimulation tests

A

Insulin stress test
Prolonged glucagon test
Water deprivation test
Synthetic ACTH injection

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10
Q

A pituitary tumour less than 1cm is called a macroadenoma. True/False?

A

False

Microadenoma

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11
Q

What is the most common visual defect caused by pituitary adenoma?

A

Bitemporal hemianopia

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12
Q

Dopamine inhibits production of prolactin. True/False?

A

True

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13
Q

Which drug is a dopamine antagonist that can cause excess prolactin?

A

Metoclopramide

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14
Q

List the main physiological causes of elevated prolactin

A

Breast feeding
Pregnancy
Stress
Sleep

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15
Q

Hypothyroidism causes elevated prolactin. True/False?

A

True

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16
Q

List some early clinical features of elevated prolactin

A

Galactorrhoea
Menstrual irregularity
Amennorhoea
Infertility

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17
Q

List some late clinical features of elevated prolactin

A

Impotence
Visual impairment
Headache

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18
Q

What is acromegaly?

A

Excess production of growth hormone

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19
Q

List clinical features of acromegaly

A 
Thickened soft tissues
Hypertension
Headaches
Sleep apnoea
Hypopituitary
20
Q

What is the main treatment for acromegaly?

A

Trans-sphenoidal surgery to excise tumour/pituitary

21
Q

What dopamine agonist can be used if surgery for acromegaly fails?

A

Cabergoline

22
Q

Somatostatin analogues are useful for acromegaly. True/False?

23
Q

What causes Cushing’s syndrome?

A

Excess cortisol

24
Q

What are the clinical effects of cortisol on protein in the body?

A

Protein loss, causing:
(proximal) Muscle waisting
Osteoporosis
Thin skin

25
Q

Cushing’s can cause frontal balding in women. True/False?

26
Q

What is the effect of exogenous high-dose steroid (dexamethasone) on cortisol?

A

Lowers serum cortisol by inhibiting hypothalamic-pituitary-adrenal axis

27
Q

What is the main screening test for Cushing’s syndrome?

A

Low-dose (1mg) dexamethasone test overnight

Cortisol should be less than 50 nmol/L next morning

28
Q

What is the definitive test for diagnosing Cushing’s syndrome?

A

2 day 2mg/day dexamethasone test

Cortisol should be less than 50 nmol/L after last dose

29
Q

What are the 3 origins of Cushing’s?

A

Pituitary
Adrenal
Ectopic ACTH

30
Q

What is the characteristic facial change in Cushing’s?

31
Q

Which origin of Cushing’s is ACTH-independent?

A

Adrenal Cushing’s

adenoma, carcinoma

32
Q

A high-dose dexamethasone suppression test will not suppress adrenal or ectopic Cushing’s. True/False?

33
Q

What is the pituitary treatment for Cushing’s?

A

Hypophysectomy + external radiation if recurs

34
Q

What is the treatment for adrenal and ectopic Cushing’s?

A

Excise source

Adrenalectomy

35
Q

List possible drug treatment for Cushing’s

A

Metyrapone

Pasireotide

36
Q

List some causes of hypopituitarism

A 
Tumours
Granulomatous disease (TB)
Trauma
Autoimmune disease
Infection
37
Q

List clinical features of hypopituitarism

A 
Menstrual irregularity
Infertility/impotence
Gynaecomastia
Obesity
Hair loss
Dry skin
Growth defects
38
Q

What is the main hormone secreted by pituitary adenoma?

A

Prolactin (30%)

39
Q

What is the most common functional pituitary adenoma?

A

Prolactinoma

40
Q

ACTH-secreting pituitary adenomas are the 2nd most common functional pituitary adenoma. True/False?

A

False

Probably 3rd most; GH-secreting are 2nd most common

41
Q

What is diabetes insipidus?

A

ADH deficiency/resistance causing lack of water reabsorption

High plasma osmolarity + urine osmolarity is low

42
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion, usually from an ectopic tumour

43
Q

What is the definitive test for diabetes insipidus?

A

Water deprivation test

44
Q

How would you decipher between central (neurogenic) and nephrogenic diabetes insipidus?

A

Vasopressin, if they respond to the vasopressin then its central DI

45
Q

How to calculate osmolality?

A

2[Na + K] + urea + glucose

46
Q

What is a normal osmolality?

A

Normal = 285-295

HHS > 320

2MB Endocrinology (21 decks)

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