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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?

25
What is the effect of exogenous high-dose steroid (dexamethasone) on cortisol?
Lowers serum cortisol by inhibiting hypothalamic-pituitary-adrenal axis
26
What is the main screening test for Cushing's syndrome?
Low-dose (1mg) dexamethasone test overnight | Cortisol should be less than 50 nmol/L next morning
27
What is the definitive test for diagnosing Cushing's syndrome?
2 day 2mg/day dexamethasone test | Cortisol should be less than 50 nmol/L after last dose
28
What are the 3 origins of Cushing's?
Pituitary Adrenal Ectopic ACTH
29
Which origin of Cushing's is ACTH-independent?
Adrenal Cushing's | adenoma, carcinoma
30
A high-dose dexamethasone suppression test will not suppress adrenal or ectopic Cushing's. True/False?
True | It will suppress pituitary Cushing's
31
What is the pituitary treatment for Cushing's?
Hypophysectomy + external radiation if recurs
32
What is the treatment for adrenal and ectopic Cushing's?
Excise source | Adrenalectomy
33
List possible drug treatment for Cushing's
Metyrapone Ketaconazole Pasireotide
34
List some causes of hypopituitarism
``` Tumours (primary and mets) Granulomatous disease (TB) Trauma Vascular disease (polyarteritis) Autoimmune disease Infection (syphillus, meningitis) ```
35
List clinical features of hypopituitarism
``` Menstrual irregularity Infertility/impotence Gynaecomastia Obesity Hair loss Dry skin Growth defects ```
36
What is the main hormone secreted by pituitary adenoma?
Prolactin (30%)
37
What is the most common functional pituitary adenoma?
Prolactinoma
38
ACTH-secreting pituitary adenomas are the 2nd most common functional pituitary adenoma. True/False?
False | Probably 3rd most; GH-secreting are 2nd most common
39
What is diabetes insipidus? How is it diagnosed and managed?
ADH deficiency/resistance causing lack of water reabsorption Water deprivation test Desmopressin (nasal or oral)
40
What is SIADH?
Syndrome of inappropriate ADH secretion, usually from an ectopic tumour
41
A non-functioning pituitary adenoma can cause...
``` Hypoadrenal/thyroid/gonadism Diabetes insipidus GH deficiency CN 3,4,6 palsy (cavernous sinus compression) Bitemporal haemanopia ```
42
List the main drug class used to treat elevated prolactin
Dopamine agonists
43
List investigations for elevated prolactin
Prolactin concentration MRI pituitary Visual fields Pituitary function tests
44
List investigations for acromegaly
``` IGF1 level Glucose tolerance test (+ if glucose unchanged) CT/MRI pituitary PFTs/Visual field ECHO ```
45
What is the main complication of acromegaly to be aware of?
Heart failure
46
What are the clinical effects of cortisol on carb/lipid metabolism in the body, leading to features in Cushing's syndrome?
DM | Obesity
47
What are the clinical effects of cortisol on psyche, leading to features in Cushing's syndrome?
Psychosis | Depression
48
What are the clinical effects of excess mineralocorticoid, leading to features in Cushing's syndrome?
Hypertension | Oedema
49
What are the clinical effects of excess androgen, leading to features in Cushing's syndrome?
Virulism Hirsutism Acne Oligo/amenorrhea
50
What is the characteristic appearance of someone with Cushing's syndrome?
Moon face Buffalo hump 'Lemon and matchsticks': central obesity
51
Outline treatment for hypopituitarism
``` REPLACEMENT THERAPY Thyroxine Hydrocortisone ADH GH Sex steroids ```
52
What is the most common site of ectopic ACTH release in Cushing's?
Lung tumour
53
What other investigations can be carried out in Cushing's?
MRI pituitary Imaging for ectopic ACTH Inferior petrosal sinus sampling Adrenal vein sampling

Y2 ENDOCRINOLOGY (19 decks)

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