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Endocrinology > Pituitary gland > Flashcards

Pituitary gland Flashcards

1
Q

Name hormones of pituitary gland

A

Anterior pituitary: Adenohypophysis (80%)
1. ACTH
2. TSH
3. FSH
4. LH
5. GH
6. Prolactin

Posterior pituitary: Neurohypophysis
1. Oxytocin
2. ADH
3. Stored oxytocin
4. Stored diuretic

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2
Q

Hormones released by hypothalamus

A
  1. TRH
  2. GRH
  3. GHRH (Growth hormone)
  4. CRH (Corticotropin)
  5. Dopamine
  6. Somatostatin
  7. Vasopressin
  8. Oxytocin
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3
Q

Melatonin is released by which gland

A

Pineal gland

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4
Q

Melanocyte stimulating hormone is released by

A

Intermediate pituitary gland

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5
Q

Causes of Hyper-prolatinaemia

A

BPP* MAA MOO (most drugs inhibit dopamine)
B- Breast feeding
P- Pregnancy
*P- Pituitary gland adenoma

Drugs
M- Marijuana
A- Antidepressants (SSRI)
A- Antipsychotics

M- Metaclopromide (antiemetic)
O- Oestrogen
O- Opiates

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6
Q

Symptoms of Hyper-prolatinaemia

A

Females:
Galactorrhoea
Amenorrhoea
Osteopenia
Osteoporosis

Males:
Gynecomastia
Hypogonadism
Erectile dysfunction
Decreased libido

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7
Q

Mechanism of amenorrhoea due to Hyper-prolatinaemia

A

Prolactin inhibits:
1. GnRH … Decreased LH and FSH
2. LH surge … no ovulation

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8
Q

Effect of dopamine on prolactin production

A

Dopamine has inhibitory effect on prolactin production

Drugs decreasing dopamine … Increase prolactin
1. Antipsychotics
2. Metoclopramide
3. Phenothiazine
4. Alpha methyl dopa
5. Reserpine
6. Tricyclic antidepressants
7. Narcotics
8. Cocaine
9. Risperidone

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9
Q

Thyroid effect on prolactin

A

HYPOthyroid … increased TRH production … HYPERprolactineamia
Check TSH levels always

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10
Q

Manage a case with complaints of galactorrhoea and amenorrhoea > 2 months

A
  1. Check prolactin levels <100ng/ml is normal
  2. Check TSH, pregnancy, lactation, drugs causing prolactin increase
  3. MRI - ?Pituitary adenoma (mc - micro in women, macro in male)

Initial Rx is medication in pituitary adenoma
4. Cabergoline&raquo_space; Bromocriptine (increase dopamine)
5. Surgery if neurological symptoms occur
6. Radiotherapy if drugs and Sx not effective

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11
Q

When is surgery required in pituitary adenoma. Is it more effective for micro/macro adenoma

A

When neurological symptoms occur

More effective for micro adenomas
Macro tend to recur

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12
Q

C/F of Acromegaly

A
  1. Increase in size of hands, feet, jaw, lips, nose
  2. Sleep apnoea
  3. CVS - hypertension, Hypertonic cardiomyopathy, arrhythmias, atherosclerosis
  4. Impaired GTT, Diabetes in 20%
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13
Q

Diagnosis of Acromegaly

A
  1. Initial -
    IGH measurement (Insulin like growth hormone)
  2. Confirmatory -
    100mg glucose given and GH levels
    checked. If GH not decreased, confirm
    acromegaly
  3. MRI - Macroadenoma
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14
Q

Management of Acromegaly

A
  1. Primary - Surgery
  2. Octreotide > Lanriotide (Somatostatin analogues)
  3. Cabergoline > Bromocriptine (Dopamine agonists)

*Drugs if Sx not enough

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15
Q

Pegvisomant

A

GH analogue
Antagonizes endogenic GH by blocking peripheral GH
By binding to its receptor in the liver
Second-line agent.

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16
Q

Diabetes insipidus is dysfunction of which hormone

A

Decreased ADH/Vasopressin of posterior pituitary

17
Q

In DI, what happens to urine osmolarity, serum sodium

A

Diuresis (Urine osm - decreases)
Hypernatraemia

18
Q

Types of DI

A

Central - ADH decreased production
Nephrogenic - ADH cannot work on kidneys (ADH levels increased)

19
Q

Causes of nephrogenic DI

A
  1. Idiopathic
  2. *Lithium, colchicine, demeclocycline
  3. Pyelonephritis
  4. Hypercalcemia, Hypokalemia
  5. Sjogrens
  6. Sarcoidosis
  7. Amyloidosis
  8. Sickle cell disease
20
Q

Diagnosis of DI

A

Water deprivation test
Urine volume remains high in ID
Central ID - Low ADH
Nephrogenic ID - High ADH

21
Q

Mx of DI

A

Hormonal replacement
Vasopressin sc
Desmopressin sc, intranasally, oral

ADH releasing
1. Chlorpropamide
2. Chlorfibrate
3. Carbamazepine

Nephrogenic - HCTZ, Amiodarone, Chlorthalidone

22
Q

SIADH water and sodium levels?

A

Euvolemic Hyponatremia

Inc ADH … Water retention … Heart releases ANP, BNP
… Inc GFR … Water and Na lost

Hence euvolemic but hyponatremia

23
Q

Drugs causing SIADH

A

1*Carbamazepine
2. Chlorpropamide
3. Clofibrate
4. Cyclophosphamide
5. Vincristine
6. Vinblastin

24
Q

Causes of SIADH other than drugs

A
  1. Small cell CA
  2. Pancreatic CA
  3. Lung - TB, Abscess, Pneumonia
  4. CVA
  5. Encephalitis
  6. Head injury
25
Q

Key features/Diagnosis of SIADH

A
  1. Hyponatremia
  2. Dec blood osmolarity
  3. Inc urine osmolarity
  4. Low BUN, Creatinine, serum uric acid, albumin
26
Q

Mx of SIADH

A
  1. Rx underlying cause
  2. Fluid restriction (NS life threatening)
  3. Hypertonic saline - confused, convulsion, coma

Endocrinology (4 decks)

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