Pituitary Disease

Question 1

List the hormones secreted from the anterior pituitary

Answer 1

ACTH
LH/FSH
TSH
GH
Prolactin

Question 2

List the hormones secreted from the posterior pituitary

Answer 2

ADH

Oxytocin

Question 3

Production of which peripheral hormone is stimulated by ACTH?

Answer 3

Cortisol

Question 4

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

Answer 4

Testosterone

Estradiol

Question 5

Production of which peripheral hormone is stimulated by TSH?

Answer 5

Thyroxine

Question 6

Production of which peripheral hormone is stimulated by GH?

Answer 6

IGF-1

Question 7

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

Answer 7

Suppression test

Question 8

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

Answer 8

Stimulation test

Question 9

Give examples of pituitary stimulation tests

Answer 9

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

Question 10

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

Answer 10

False

Microadenoma

Question 11

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

Answer 11

Bitemporal hemianopia

Question 12

Dopamine inhibits production of prolactin. True/False?

Answer 12

True

Question 13

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

Answer 13

Metoclopramide

Question 14

List the main physiological causes of elevated prolactin

Answer 14

Breast feeding
Pregnancy
Stress
Sleep

Question 15

Hypothyroidism causes elevated prolactin. True/False?

Answer 15

True

Question 16

List some early clinical features of elevated prolactin

Answer 16

Galactorrhoea
Menstrual irregularity
Amennorhoea
Infertility

Question 17

List some late clinical features of elevated prolactin

Answer 17

Impotence
Visual impairment
Headache

Question 18

What is acromegaly?

Answer 18

Excess production of growth hormone

Question 19

List clinical features of acromegaly

Answer 19

Thickened soft tissues
Hypertension
Headaches
Sleep apnoea
Hypopituitary

Question 20

What is the main treatment for acromegaly?

Answer 20

Trans-sphenoidal surgery to excise tumour/pituitary

Question 21

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

Answer 21

Cabergoline

Question 22

Somatostatin analogues are useful for acromegaly. True/False?

Answer 22

True

Question 23

What causes Cushing’s syndrome?

Answer 23

Excess cortisol

Question 24

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

Answer 24

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

Question 25

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

Answer 25

True

Question 26

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

Answer 26

Lowers serum cortisol by inhibiting hypothalamic-pituitary-adrenal axis

Question 27

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

Answer 27

Low-dose (1mg) dexamethasone test overnight | Cortisol should be less than 50 nmol/L next morning

Question 28

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

Answer 28

2 day 2mg/day dexamethasone test | Cortisol should be less than 50 nmol/L after last dose

Question 29

What are the 3 origins of Cushing's?

Answer 29

Pituitary Adrenal Ectopic ACTH

Question 30

What is the characteristic facial change in Cushing's?

Answer 30

Moon-face

Question 31

Which origin of Cushing's is ACTH-independent?

Answer 31

Adrenal Cushing's | adenoma, carcinoma

Question 32

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

Answer 32

True

Question 33

What is the pituitary treatment for Cushing's?

Answer 33

Hypophysectomy + external radiation if recurs

Question 34

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

Answer 34

Excise source | Adrenalectomy

Question 35

List possible drug treatment for Cushing's

Answer 35

Metyrapone | Pasireotide

Question 36

List some causes of hypopituitarism

Answer 36

``` Tumours Granulomatous disease (TB) Trauma Autoimmune disease Infection ```

Question 37

List clinical features of hypopituitarism

Answer 37

``` Menstrual irregularity Infertility/impotence Gynaecomastia Obesity Hair loss Dry skin Growth defects ```

Question 38

What is the main hormone secreted by pituitary adenoma?

Answer 38

Prolactin (30%)

Question 39

What is the most common functional pituitary adenoma?

Answer 39

Prolactinoma

Question 40

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

Answer 40

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

Question 41

What is diabetes insipidus?

Answer 41

ADH deficiency/resistance causing lack of water reabsorption

Question 42

What is SIADH?

Answer 42

Syndrome of inappropriate ADH secretion, usually from an ectopic tumour