Pituitary Disorders

Question 1

What hormones does the pituitary gland release?

Answer 1

LH, FSH, GH, TSH, ACTH

Question 2

What does ACTH do?

Answer 2

Regulates adrenal gland

Question 3

What causes pituitary dysfunction?

Answer 3

Tumour, hormone excess or deficiency

Question 4

How test pituitary dysfunction?

Answer 4

Hormonal test - if abnormal MRI pituitary

Question 5

What symptoms will you get with local mass?

Answer 5

CSF rhinorrhoea, headache, cranial nerve palsy, visual field defect

Question 6

What does deficiency GH cause?

Answer 6

Short stature - abornmal body composition

Tx: GH

Question 7

What does deficiency LG/FSH cause?

Answer 7

Hypogonadism, infertility, menstruation problems

Question 8

What does deficiency in TSH cause?

Answer 8

Hypothyroidism

Question 9

What does deficiency ACTH cause

Answer 9

Adrenal failure -decreased pigmentation

Question 10

Cause hypopituitarism?

Answer 10

Pituitary tumour, radiotherapy, infarction, Sheehan’s syndrome

Question 11

What is Sheehan’s syndrome?

Answer 11

Post partum pituitary necrosis

Question 12

What is acromegaly?

Answer 12

Excessive GH after puberty w/ high IGF-1 levels

Question 13

Clinical features acromegaly?

Answer 13

Coarse facial features, enlarged supraorbital ridge, separation of teeth, macroglossia
Other: headache, excess sweating, changes size hands/ feet

Question 14

How diagnose acromegaly?

Answer 14

IGF1, MRI pituitary

Question 15

How to tx acromegaly?

Answer 15

Somatostains/ pegvisomant

Question 16

Dental complications in acromegaly?

Answer 16

Jaw malocclusion, diff speech due macroglossia, teeth mobility, teeth separation
Thickening alveolar process and enlarged posterior roots

Question 17

What pattern do cortisol levels follow?

Answer 17

Circadian rhythm

Question 18

Cause cushings syndrome?

Answer 18

Excess glucocorticoids

Question 19

Clinical features of cushings?

Answer 19

Weight gain, moon faces, glucose intolerance, muscle weakness, acne, hyperpigementation, osteopenia

Question 20

Diagnosis cushings?

Answer 20

Hormonal test - dynamic suppression test measure cortisol and ACTH
If abnormal - MRI pituitary, CT adrenals

Question 21

Primary and secondary cause adrenal insufficiency?

Answer 21

Primary - autoimmune, adrenal haemorrhage

Secondary - exogenous glucocorticoid, hypothalamic or pituitary tumours

Question 22

Clinical features of adrenal insufficiency?

Answer 22

Skin pigmentation, weakness, loss weight, hypotension, hypoglycaemia episode, salt craving

Question 23

Investigate adrenal insufficiency?

Answer 23

Hormonal test - dynamic stimulation test

Radiological if hormonal test abnormal

Question 24

Tx adrenal insufficiency?

Answer 24

Hydrocortisone replacement

Question 25

Why is glucocorticoid cover required for those on steroids?

Answer 25

Prevent adrenal crisis - mainly double steroids before procedure

Question 26

How provide steroid cover for simple procedures?

Answer 26

Double dose one hour before surgery - double oral dose oral medication for 24 hours

Question 27

How provide steroid cover for major procedures inc GA

Answer 27

100mg hydrocortisone at induction

Double oral dose 24 hours