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MB2: Endocrinology > Pituitary gland > Flashcards

Pituitary gland Flashcards

1
Q

what is a pituitary microadenoma

A

<1cm

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2
Q

what is a pituitary macroadenoma

A

> 1cm

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3
Q

what are some of the complications of a non functional adenoma

A

compression on optic chiasma to cause bilateral hemianopia
compression on CN3,4,V1,V2,6
pushes out other pituitary cells to cause hypoadrenalism, hypogonadism, hypothyroidism, diabetes insipidus, GH deficiency

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4
Q

physiological causes raised prolactin

A

breast feeding
stress
lack sleep
pregnancy

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5
Q

pathological causes rasied prolactin

A

stalk lesions
hypothyroidism
prolactinoma

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6
Q

pharmacological causes raised prolactin

A

dopamine antagonists
antipsychotics
antidepressants
oral contraceptives, oestrogens, cocaine

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7
Q

prolactinoma presentation in men

A

impotence
visual field defect
anterior pituitary malfunction

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8
Q

prolactinoma presentation in women

A 
galactorrohea 
menstrual irregularity 
infertility 
amenorrhoea 
visual field abnormality
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9
Q

investigation of prolactinoma?

A

serum prolacitn
MRI pituitary
visual fields for bilateral hemianopia
pituitary function testing

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10
Q

management of prolactinoma

A

cabergoline
dopamine agonist drugs
surgery rarely required as cabergoline can control symptoms and can cause tumour shrinkage

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11
Q

side effects cabergoline

A

low mood
nausea/vomiting
heart valve/retropritoneal fibrosis

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12
Q

clinical features acromegaly

A 
giant before episeal fusion 
thickened skin, jaw
sweaty, large hands 
sleep apnoea 
HTN and HF 
headaches 
diabetes 
visual field defects 
colonic polyps
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13
Q

what causes headaches in acromegaly

A

vascular growth

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14
Q

diagnosis of acromegaly?

A 
IGF1
OGTT - expect glucose to suppress GH to <0.4ug/L after glucose dose but in acromegaly there is uncontrolled rise or unchanged 
visual field check 
CT/MRI
serum pituitary check
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15
Q

first line treatment of acromegaly

A

surgery, radiotherapy can be considered

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16
Q

2nd line treatment of acromegaly

A

octreotide to reduce GH and tumour

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17
Q

side effects of octreotide

A 
stinging locally 
flatulence 
diarrhoea 
abdo pain 
gallstones
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18
Q

what can be used if a growth hormone tumour is co secreting prolactin

A

cabergoline for some

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19
Q

what can be used last line for acromegaly

A

pegvisomant

binds to GH receptor to block GH

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20
Q

causes of panhypopituitism

A 
tumours 
local brain tumours 
iatrogenic/surgery 
sarcoid/tb 
polyarteritis 
trauma 
secondary mets
hypothalamic disease 
sheenan syndrome 
infection/meningitis
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21
Q

what are the possible causes sheenan syndrome

A

blood loss in pregnancy causes hypotension and pituitary infarct
autoimmune

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22
Q

signs/symptoms of panhypopituitism

A 
menstrual irregularities 
infertility/impotence 
gynaecomastia 
obesity 
loss facial hair 
loss axillary/pubic hair 
dry skin/hair 
hypothyroid faces 
growth retardation
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23
Q

diagnosis panhypopituitism

A

check pituitary function tests
sex hormones, TFT, growth hormones and prolactin
cortisol/ACTH - do cortisol 8/9am or a synacthen
in post menopause LH/FSH should be high
testosterone at 9am

24
Q

features of familial diabetes insipidus

A 
DIDMOAD 
diabetes insipidus 
diabetes mellitus 
optic atrophy 
deafness
25
Q

causes of acquired diabetes insipidus

A

idiopathic
trauma, surgery, fracture, RTA
tumour, sarcoid, meningitis, external radiation

26
Q

describe the water deprivation test

A

NBM for 8-12 hours

check serum and urine osmolalities for 8 hr then give DDAVP and if urine/serum osmol ratio>2 the not DI

27
Q

management of DI

A

desmospray
desmopressin oral or injection
injection is more emergency or post surgery

28
Q

where are somatotrophs found and what do they secrete

A

ant pituitary

GH

29
Q

where are mammotrophs found and what do they secrete

A

ant pituitary

Prolactin

30
Q

where are corticotrophs found and what do they secrete

A

ant pituitary

ACTH

31
Q

where are thyrotrophs found and what do they secrete

A

ant pituitary

TSH

32
Q

where are gonadotrophs found and what do they secrete

A

ant pituitary

FSH/LH

33
Q

what is a pituitary adenoma and wehat may it secrete

A

benign pituitary tumour

can secrete any anterior pituitary homes or can be hypo/non functional

34
Q

what pituitary adenoma is most common

A

prolactinoma

35
Q

how common are poituitary carcinomas

A

very rare

36
Q

cause of panhypopituitarism

A 
primary/metastatic tumour 
apoplexy 
sheehans syndrome 
DI
hypothalamic lesions 
sarcoid, TB, meningitis 
subarachnoid haemorrhage 
surgery/radiation 
traumatic injury
37
Q

what is a craniopharyngioma

A

very rare tumour derived from remnant of rathke’s pouch

slow growing, cystic and may calcify

38
Q

cause of central DI

A

ADH deficiency

trauma, tumours and inflammatory disease of the pituitary glands

39
Q

cause of nephrogenic DI

A

peripheral renal resistance to ADH

40
Q

cause of congenital adrenocortical hyperplasia

A

autosomal recessive disorder with lack of enzyme required for biosynthesis
reduced cortisol continues to stimulate ACTH release and causes hyperplasia

41
Q

cause of acquired adrenocortical hyperplasia

A

endogenous ACTH

nodular hyperplasia is independent of ACTH but diffuse isnt

42
Q

true/false - adrenocortical adenomas are usually functional

A

false

43
Q

true/false - adrenocortical carcinomas are usually functional

A

true

44
Q

describe the pathological features of an adrenocortical adenoma

A

well circumscribed and encapsulated
small and 2/3cm
yellow/yellow brown
well differentiated with pale cytoplasm and small nuclei

45
Q

describe the features of adrenocortical carcinomas

A 
closely resemble adenoma 
metastasis is definite 
large size
haemorrhage/necrosis 
lack clear cells 
capsular/vascular invasion
46
Q

where do adrenocortical tumours spread

A

retroperitoneum/kidney
peritoneum/pleura
vascular, bone, liver, lung
regional lymph nodes

47
Q

exogenous causes of cushings

A

exogenous steroid use

48
Q

endogenous causes cushings

A

ACTH producing adenoma

ectopic ACTH

49
Q

cause of acute adrenal crisis

A

rapid withdrawal of steroid therapy
crisis in patient with chronic adrenocortical insufficiency like stress, infection or not physiologically raising steroid dose
massive adrenal haemorrhage

50
Q

risk factors for massive adrenal haemorrhagwe

A

newborn infants
anticoagulants
DIC
septicaemic infection

51
Q

causes of chronic adrenocortical insufficiency

A

AA adrenalitis
TB, histoplasma, HIV, kaposi’s sarcoma
metastatic breast/lung cancer
sarcoid, haemachromatosis, amyloid

52
Q

symptoms of addisons disease

A 
weakness 
fatigue 
pigmentation 
anorexia 
nausea/vomiting 
diarrhoea
53
Q

presentation of adrenal crisis?

A 
vomiting
abdominal pain 
hypotension 
shock 
death
54
Q

complications of phaeochromocytoma

A

heart failure, infarction, arrhythmia, CVA

55
Q

10% rules to phaeochromocytoma

A 
10% in children 
10% bilateral 
10% extra adrenal
10% FHx - more 25%
10% not HTN associated 
10% malignant
56
Q

features of MEN2A

A

phaeo, MTC, parathyroid hyperplasia

57
Q

features of MEN2B

A

phaeo, MTC, neuromas, ganglioneuromas, marfanoid habitus

MB2: Endocrinology (13 decks)

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