Pituitary Disease

Question 1

Test for too much + too little of a hormone?

Answer 1

Too much = suppression

Too little = stimulation

Question 2

What is the main cause of anterior pituitary hyperfunction?

Answer 2

Tumours

Question 3

Name causes of anterior pituitary hypofunction.

Answer 3

Tumours
Radiation
Infection
Autoimmune disease
Ischemia

Question 4

Name 3 causes of posterior pituitary dysfunction.

Answer 4

Tumours
Diabetes insipidus
SIADH

Question 5

Are pituitary adenomas functional or non-functional?

Answer 5

Non-functional

Question 6

What are the 2 types of pituitary adenoma + size?

Answer 6

Microadenoma = < 1cm
Macroadenoma = > 1cm

Question 7

What are pituitary adenomas associated with?

Answer 7

MEN 1

Question 8

Name 4 ways pituitary adenomas present + if they are functional (rare) then which 2 hormones are most common?

Answer 8

Bitemporal hemianopia
Headaches
Gland hypofunction
Diabetes insipidus
Prolactin and GH

Question 9

Compression and infarction of the pituitary gland may lead to what condition?

Answer 9

Panhypopituitarism/ Sheehan’s syndrome

Question 10

What is the treatment for pituitary adenomas?

Answer 10

Transsphenoidal surgery

Question 11

What is the most common benign pituitary tumour + what condition is it linked to?

Answer 11

Prolactinoma

MEN1

Question 12

Do prolactinomas present early or late in men/women?

Answer 12

Early in women

Late in men

Question 13

Name 2 ways prolactinomas present in women?

Answer 13

Galactorrhea

Menstrual/fertility issues

Question 14

Name 3 ways prolactinomas present in men?

Answer 14

Impotence
Headaches
Visual field abnormalities

Question 15

Name 4 times prolactin is normally raised + name a dopamine antagonist which can increase prolactin.

Answer 15

Pregnancy
Breast feeding
Stress
Sleep
Metoclopramide

Question 16

What is the treatment for prolactinomas + mechanism + side effect?

Answer 16

Carbergoline
Dopamine agonist
N and V

Question 17

2 treatments for prolactinoma if drugs are ineffective?

Answer 17

Surgery

Sellar radiotherapy

Question 18

What rare tumour derives from Rathke’s pouch and presents as headaches and growth retardation?

Answer 18

Craniopharyngioma

Question 19

What causes SIADH and what is the most common cause?

Answer 19

Excess ADH release

Ectopic tumour

Question 20

Name a condition that releases ectopic ADH?

Answer 20

Small cell lung carcinoma

Question 21

Is Na and osmolality high or low in blood/urine in SIADH?

Answer 21

Na low in blood/high in urine

Osmolality low in blood/high in urine

Question 22

Treatment for SIADH?

Answer 22

High salt intake

Restrict fluids

Question 23

What is acromegaly caused by?

Answer 23

Excess GH due to a pituitary somatotroph adenoma

Question 24

What over expressed gene is acromegaly linked to + associated condition?

Answer 24

GRP101

MEN 1

Question 25

Name 5 signs of acromegaly.

Answer 25

``` Excess bone growth Hypertension Headaches Sleep apnoea Colonic polyps ```

Question 26

Which 2 pituitary hormones increase blood glucose?

Answer 26

GH | ACTH

Question 27

What 2 tests for acromegaly?

Answer 27

IGF-1 | OGTT

Question 28

Surgical treatment for acromegaly?

Answer 28

Transphenoidal surgery

Question 29

Name 2 drugs for acromegaly?

Answer 29

Somatostatin analogue | GH antagonist

Question 30

What is the target number for GH and random blood glucose in acromegaly?

Answer 30

GH < 0.4 | Random BG < 2

Question 31

What is the difference between Cushing's disease vs. Cushing's syndrome?

Answer 31

``` Disease = pituitary origin Syndrome = other origin ```

Question 32

What is Cushing's syndrome and what 2 things does it cause a rise in?

Answer 32

Excess cortisol | Mineralocorticoids and androgens

Question 33

Name 2 causes of ACTH dependent Cushing's.

Answer 33

Pituitary tumour | Cushing's disease

Question 34

Name 2 causes of ACTH independent Cushing's?

Answer 34

Adrenal tumour | Nodular adrenal hyperplasia

Question 35

Name 4 facial/head/neck features of Cushing's.

Answer 35

Frontal balding in women Moon face Buffalo hump Eye disease

Question 36

Name 3 MSK signs of Cushing's.

Answer 36

Proximal myopathy Osteoporosis AVN of femoral head

Question 37

What is dexamethasone and what should it normally do to cortisol levels + why?

Answer 37

Glucocorticoid Reduce cortisol Inhibits HPA axis

Question 38

What are 2 screening tests for Cushing's + normal result?

Answer 38

Overnight 1mg dexamethasone suppression = < 5 | 24hr urine cortisol = no cortisol

Question 39

What is the definitive test for Cushing's + normal result + result for a pituitary cause?

Answer 39

2 day/2 mg dexamethasone suppression test Normal = < 50 Suppress by 50%

Question 40

Name 3 treatments for pituitary, adrenal and ectopic Cushing's + 3 possible drugs?

Answer 40

``` Pituitary = hypophysectomy + radiation Adrenal + ectopic = adrenalectomy Metyrapone Ketoconazole Pasireotide ```

Question 41

Treatment for ectopic cause of Cushing's with no obvious cause?

Answer 41

Bilateral adrenalectomy

Question 42

Posterior hypopituitarism can cause what disease + why?

Answer 42

Diabetes insipidus | Lack of ADH

Question 43

Name 3 types of diabetes insipidus.

Answer 43

Cranial Nephrogenic Gestational

Question 44

What is the 4 signs of familial DI?

Answer 44

DI DM Optic atrophy Deafness

Question 45

Name 4 symptoms of DI?

Answer 45

Polyuria/dipsia Nocturia Weight loss CNS disease

Question 46

What is the test for DI + how does it work?

Answer 46

Water deprivation test | No water for 6-8 hours then give desmopressin

Question 47

What is a cranial + nephrogenic DI result from a water deprivation test?

Answer 47

``` Cranial = rises significantly after desmopressin Nephrogenic = stays the same before/after ```

Question 48

Treatment for DI?

Answer 48

Desmospray or desmopressin