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Y2 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? What is the pituitary stimulated by to produce ACTH?

A

Cortisol

CRH

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4
Q

Production of which peripheral hormone is stimulated by LH and FSH? What is the pituitary stimulated by to produce LH and FSH?

A

Testosterone
Estradiol
GnRH

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5
Q

Production of which peripheral hormone is stimulated by TSH? What is the pituitary stimulated by to produce TSH?

A

Thyroxine

TRH

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6
Q

Production of which peripheral hormone is stimulated by GH? What is the pituitary stimulated by to produce GH?

A

IGF-1

GHRH

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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 (synacthen test)

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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? What other classes of drugs can cause excess prolactin?

A

Metoclopramide

Antipsychotics, antidepressants,

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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

List the main pathological causes of elevated prolactin

A

Hypothyroidism
Stalk lesions
Prolactinoma

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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 which produces excess IGF1 leading to the growth of tissues

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19
Q

List clinical features of acromegaly

A 
Thickened soft tissues (shoe size, rings)
Joint pains/ proximal muscle weakness
Lethargy
Hypertension
Vascular headaches
Sleep apnoea
Hypopituitary
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20
Q

What is the main treatment for acromegaly?

A

Trans-sphenoidal surgery to excise tumour/pituitary

External radiotherapy to pituitary fossa

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21
Q

What drugs can be used if surgery for acromegaly fails? Give an example of each

A 
Dopamine agonist (cabergoline)
Somatostatin analogue (actreotide, pasireotide)
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22
Q

What causes Cushing’s syndrome?

A

Excess cortisol

23
Q

What are the clinical effects of cortisol on protein in the body, leading to features in Cushing’s syndrome?

A

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

24
Q

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

A

True

25
Q

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

A

Lowers serum cortisol by inhibiting hypothalamic-pituitary-adrenal axis

26
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

27
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

28
Q

What are the 3 origins of Cushing’s?

A

Pituitary
Adrenal
Ectopic ACTH

29
Q

Which origin of Cushing’s is ACTH-independent?

A

Adrenal Cushing’s

adenoma, carcinoma

30
Q

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

A

True

It will suppress pituitary Cushing’s

31
Q

What is the pituitary treatment for Cushing’s?

A

Hypophysectomy + external radiation if recurs

32
Q

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

A

Excise source

Adrenalectomy

33
Q

List possible drug treatment for Cushing’s

A

Metyrapone
Ketaconazole
Pasireotide

34
Q

List some causes of hypopituitarism

A 
Tumours (primary and mets)
Granulomatous disease (TB)
Trauma
Vascular disease (polyarteritis)
Autoimmune disease
Infection (syphillus, meningitis)
35
Q

List clinical features of hypopituitarism

A 
Menstrual irregularity
Infertility/impotence
Gynaecomastia
Obesity
Hair loss
Dry skin
Growth defects
36
Q

What is the main hormone secreted by pituitary adenoma?

A

Prolactin (30%)

37
Q

What is the most common functional pituitary adenoma?

A

Prolactinoma

38
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

39
Q

What is diabetes insipidus? How is it diagnosed and managed?

A

ADH deficiency/resistance causing lack of water reabsorption
Water deprivation test
Desmopressin (nasal or oral)

40
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion, usually from an ectopic tumour

41
Q

A non-functioning pituitary adenoma can cause…

A 
Hypoadrenal/thyroid/gonadism
Diabetes insipidus
GH deficiency
CN 3,4,6 palsy (cavernous sinus compression)
Bitemporal haemanopia
42
Q

List the main drug class used to treat elevated prolactin

A

Dopamine agonists

43
Q

List investigations for elevated prolactin

A

Prolactin concentration
MRI pituitary
Visual fields
Pituitary function tests

44
Q

List investigations for acromegaly

A 
IGF1 level
Glucose tolerance test (+ if glucose unchanged)
CT/MRI pituitary
PFTs/Visual field
ECHO
45
Q

What is the main complication of acromegaly to be aware of?

A

Heart failure

46
Q

What are the clinical effects of cortisol on carb/lipid metabolism in the body, leading to features in Cushing’s syndrome?

A

DM

Obesity

47
Q

What are the clinical effects of cortisol on psyche, leading to features in Cushing’s syndrome?

A

Psychosis

Depression

48
Q

What are the clinical effects of excess mineralocorticoid, leading to features in Cushing’s syndrome?

A

Hypertension

Oedema

49
Q

What are the clinical effects of excess androgen, leading to features in Cushing’s syndrome?

A

Virulism
Hirsutism
Acne
Oligo/amenorrhea

50
Q

What is the characteristic appearance of someone with Cushing’s syndrome?

A

Moon face
Buffalo hump
‘Lemon and matchsticks’: central obesity

51
Q

Outline treatment for hypopituitarism

A 
REPLACEMENT THERAPY
Thyroxine
Hydrocortisone
ADH
GH
Sex steroids
52
Q

What is the most common site of ectopic ACTH release in Cushing’s?

A

Lung tumour

53
Q

What other investigations can be carried out in Cushing’s?

A

MRI pituitary
Imaging for ectopic ACTH
Inferior petrosal sinus sampling
Adrenal vein sampling

Y2 ENDOCRINOLOGY (19 decks)

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