Pituitary Gland

Question 1

cortisol pathway

Answer 1

CRH from hypothalamus
ACTH from pituitary
Cortisol

Question 2

thyroxine pathway

Answer 2

TRH from hypothalamus
TSH from pituitary
Thyroxine

Question 3

growth hormone pathway

Answer 3

GHRH from hypothalamus
GH from pituitary
IGF1 peripherally

Question 4

oestradiol/testosterone pathway

Answer 4

GnRH from hypothalamus
LH/FSH from pituitary
oestradiol/testosterone

Question 5

prolactin pathway

Answer 5

dopamine from hypothalamus

prolactin from pituitary

Question 6

hormones stored in posterior pituitary

Answer 6

vasopressin/ADH

oxytocin

Question 7

structures which may be compressed by an enlarged pituitary

Answer 7

optic chiasm
CN 3/5/6
internal carotid artery

Question 8

surgical intervention for pituitary tumour

Answer 8

transsphenoidal

Question 9

microadenoma

Answer 9

less than or equal to 1cm

Question 10

macroadenoma

Answer 10

bigger than 1cm

Question 11

most common visual field defect in pituitary tumours

Answer 11

bitemporal hemianopia

Question 12

causes of raised prolactin

Answer 12

breast feeding, pregnancy, stress, sleep
dopamine antagonists, antipsychotics, antidepressants
hypothyroidism 
stalk lesions 
prolactinoma

Question 13

symptoms and signs of prolactinoma

Answer 13

galactorrhoea 
menstrual irregularity/amenorrhoea 
infertility 
impotence 
headaches

Question 14

treatment for prolactinoma

Answer 14

bromocriptine, quinagolide, cabergoline (dopamine agonists)

Question 15

features of acromegaly

Answer 15

thickened soft tissues
hypertension, cardiac failure 
headaches 
snoring/sleep apnoea 
DM 
visual defects 
colonic polyps and cancer

Question 16

diagnosis of acromegaly

Answer 16

measure IGF1
glucose tolerance test
MRI pituitary

Question 17

results of GTT in acromegaly

Answer 17

usually GH suppresses with glucose, in acromegaly it doesn’t, GH is unchanged or may even rise

Question 18

treatment of acromegaly

Answer 18

pituitary surgery, radiotherapy

somatostatin analogues to shrink tumours

Question 19

features of Cushing’s syndrome

Answer 19

excess cortisol 
protein loss 
altered carb/lipid metabolism 
altered psyche 
excess mineralocorticoid 
excess androgen

Question 20

diagnosis of Cushings

Answer 20

low dose dexamethasone suppression test

urinary free cortisol

Question 21

results of dexamethasone suppression test in Cushings

Answer 21

cortisol remains high and is not suppressed

Question 22

aetiology of cushings

Answer 22

pituitary (majority)
adrenal adenoma
ectopic - thymus, lung, pancreas
pseuo - alcohol and depression, steroid medications

Question 23

treatment of cushings

Answer 23

pit - hypophysectomy and radiotherapy
adrenalectomy
remove ectopic

Question 24

drug treatment of Cushings

Answer 24

metyrapone - whilst waiting for radiotherapy to work
ketoconazole - hepatotoxic
pasireotide

Question 25

features of pan hypopituitarisim

Answer 25

``` growth failure hypothyroidism hypogonadism hypoadrenal diabetes insipidus ```

Question 26

causes of hypopituitarism

Answer 26

``` pituitary tumours mets brain tumours granulomatous disease vasuclar disease trauma hypothalamic disease iatrogenic autoimmune - Sheenan post-preg infection ```

Question 27

symptoms/signs of anterior hypopituitarism

Answer 27

``` menstrual irregularities infertility/impotence gynaecomastia abdo obesity loss of facial, axillary, pubic hair dry skin and hair growth retardation ```

Question 28

replacement therapy for hypopituitarism

Answer 28

``` thyroxine hydrocortisone desmospray (ADH) GH nightly SC sex steroids - HRT, pill for femalres, testosterone for males ```

Question 29

benefits of giving GH in adults

Answer 29

``` improves wellbeing/QoL decreases abdo fat increase strength improve cardiac function decrease cholesterol increase bone density ```

Question 30

how can testosterone be administered

Answer 30

IM skin gel oral tabs

Question 31

risks of testosterone replacement

Answer 31

prostate enlargement polycythaemia hepatitis infertility

Question 32

causes of diabetes insipidus

Answer 32

familial - DIDMOAD - insipidus, mellitus, optic atrophy and deafness acquired tumour, sarcoid, irradiation, meningitis

Question 33

diagnosis of diabetes insipidus

Answer 33

water deprivation test

Question 34

results of water deprivation test

Answer 34

urine/serum osmolality ratio should be more than two; if it is less - diagnostic

Question 35

treatment of DI

Answer 35

desmospray | desmopressin oral tabs, sub tabs, IM injection

Question 36

cells in pituitary gland

Answer 36

acidophils - somatotrophs (GH), mammotrophs (PRL) basophils - corticotrophs (ACTH), thyrotrophs (TSH), gonadtrophs (FSH/LH) chromophobes

Question 37

causes of hyperfunction in pituitary

Answer 37

adenoma | carcinoma

Question 38

most common functional pituitary adenoma

Answer 38

prolactinoma then GH secreting then ACTH secreting

Question 39

causes of hypofunction in pituitary

Answer 39

``` surgery/irradiation haemorrhage ischaemic necrosis - Sheehan tumours inflammatory conditions ```

Question 40

where is the anterior pituitary derived from

Answer 40

Rathke's pouch

Question 41

what is a craniopharyngoma

Answer 41

``` intracranial tumour (1-5%) derived from remnants of Rathke's pouch slow growth, cystic, may calcify majority are suprasellar headaches and visual disturbances with growth retardation excellent prognosis ```

Question 42

another name for the anterior pituitary

Answer 42

adenohypophysis

Question 43

another name for the posterior pituitary

Answer 43

neurohypophysis

Question 44

features of posterior pituitary

Answer 44

extension of neural tissue consisting of modified glial cells and axonal processes

Question 45

histology of posterior pituitary

Answer 45

non-myelinated axons of neurosecretory neurones

Question 46

two types of diabetes insipidus

Answer 46

central - ADH deficiency | nephrogenic - due to renal resistance to ADH effects

Question 47

what is SIADH

Answer 47

ectopic secretion of ADH by tumours, could be primary disorder in the pituitary, or part of paraneoplastic syndrome