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Endocrine 2020 > Pituitary Disorders > Flashcards

Pituitary Disorders Flashcards

1
Q

size of microadenoma

A

<1cm-1cm

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2
Q

size of macroadenoma

A

> 1cm

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3
Q

physiological causes of raised prolactin

A

breast feeding
pregnancy
stress
sleep

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4
Q

pharmacological causes of raised prolactin

A 
dopamine antagonists e..g metoclopramide
phenothiazines
TCA
SSRIs
oestrogens
cocaine
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5
Q

pathological causes of raised prolactin

A

hypothyroid
stalk lesions
prolactinoma

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6
Q

how does hypothyroidism cause raised prolactin?

A

dopamine requires tyrosine- thyroxine is made from tyrosine and iodine

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7
Q

what is a prolactinoma?

A

adenoma of the pituitary gland that overproduces prolactin

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8
Q

presentation in females with prolactinoma

A 
earlier presentation usually
galactorrhoea
menstrual irregularity
infertility
visual field abnormality
headache
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9
Q

presentation in males with prolactinoma

A

impotence
visual field abnormality
headache

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10
Q

diagnosis of prolactinoma

A

high serum prolactin
MRI
visual fields e.g. bitemporal hemianopia

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11
Q

prolactin levels in macroadenoma?

A

20,000+

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12
Q

prolactin levels in microadenoma?

A

3,000+

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13
Q

management of prolactinoma

A

dopamine agonist e.g. cabergoline causes tumour shrinkage

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14
Q

adverse of cabergoline

A

nausea
vomiting
low mood
fibrosis of heart valves and retroperitoneum

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15
Q

what is acromegaly?

A

excess of GH

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16
Q

presentation of acromegaly

A 
children gigantism (if before epiphyseal fusion)
thickened soft tissues
hypertension, early CV death
headaches
DM
sleep apnoea, snoring
carpal tunnel 
colonic polyps and colon cancer
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17
Q

thickened soft tissues examples in acromegaly

A

increased shoe size
spade hands
wedding ring too tight

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18
Q

diagnosis of acromegaly

A

measure IGF1
OGTT
visual fields
visualise the pituitary e.g. MRI

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19
Q

why do you measure IGF1 in acromegaly?

A

GH secretion is pulsatile

GH stimulates release of IGF1 from the liver

20
Q

describe the OGTT in acromegaly

A

75g PO glucose and check GH every 30 minutes

normal= <0.4ug/l after glucose whereas in acromegaly it is unchanged/risen

21
Q

management of acromegaly

A 
transsphenoidal pituitary surgery
radiotherapy
somatostatin analogues
dopamine agonists
GH antagonists
cancer surveillance, cardiovascular RF and sleep apnoea management
22
Q

what can radiotherapy on the pituitary lead to?

A

hypopituitarism

23
Q

somatostatin analogue use in acromegaly

A

sandostatin, octreotide and lareotide

relieve headaches and reduce tumour size

adverse if GI upset

24
Q

dopamine agonist use in acromegaly

A

cabergoline and bromocriptine

better if co-secreting prolactin)

25
Q

what is Cushing’s disease?

A

an excess of cortisol caused by pituitary adenoma secreting excess ACTH

26
Q

what is Cushing’s syndrome?

A

signs/symptoms of excess cortisol caused by adrenal adenomas, ectopic or pseudo causes

27
Q

ectopic production of ACTH

A

thymus
lung
pancreas

28
Q

pseudo production of ACTH

A

alcohol

steroids

29
Q

presentation of Cushing’s

A

myopathy, proximal wasting (proteolysis)
thin skin, striae, bruising
OP
hypertension, obesity, DM (stress hormone)
oedema (mineralocorticoids)
virilism, hirutism, oligo/amenorrhoea (androgen excess)

30
Q

diagnosis of Cushing’s

A

screening= urine free cortisol and diurnal variation
low dose dexamethasone test
measure ACTH

31
Q

management of Cushing’s disease

A

hypophysectomy (radiotherapy and bilateral adrenalectomy if recurs)

32
Q

management of Cushing’s if unfit for surgery?

A

metyrapone

33
Q

what is panhypopituitarism?

A

absence of pituitary hormones

34
Q

causes of panhypopituitarism

A

pituitary tumours
surgery
granulomatous disease

35
Q

presentation of panhypopituitarism

A 
hypothyroid face
abdominal obesity
infertility, menstrual irregularity
gynaecomastia
loss of facial hair
36
Q

diagnosis of panhypopituitarism

A

PFTs

can do suppression/stimulation tests

37
Q

management of panhypopituitarism

A

hormone replacement

38
Q

which hormone is abused in sport?

A

GH

39
Q

why is cortisol replaced before levothyroxine in panhypopituitarism?

A

activates sympathetics and can cause adrenal crisis

40
Q

adverse of testosterone therapy?

A

risks making cancers grow more
polycythaemia (stroke/MI)
hepatitis (LFTs)

41
Q

cranial DI

A

problem with ADH in posterior pituitary

42
Q

causes of cranial DI

A

familial (DIDMOAD)

acquired (tumour, trauma, idiopathic, inflammation)

43
Q

diagnosis of cranial DI

A

water deprivation test/ desmopressin

44
Q

water deprivation test result in cranial DI

A

osmol ratio >2 is negative

if low and improves after desmopressin, then cranial not nephrogenic

45
Q

management of cranial DI

A

desmospray or desmopressin tablets/injections

Endocrine 2020 (35 decks)

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