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endocrinology > Pituitary gland and Disorders > Flashcards

Pituitary gland and Disorders Flashcards

1
Q

\ant pituitary blood supply?

A

no arterial blood supply but receives blood through a portal venous circulation from the hypothalamus

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2
Q

pituitary thyroid axis

A

hypothalamus releases TRH , causes pituitary to release TSH, causes thryoid to release T3 +T4 -ve feedback loop

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3
Q

if you remove thyroid what would happen to TSH Levels ?

A

increase

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4
Q

what happens to levels of FSH and LH during menopause

A

increase due to a lack of negative feedback mechanism

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5
Q

HPA AXIS?

A

hypothalamus releases crth , pituitary releases ACTH
negative feedback cause adrenals to release cortisol

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6
Q

what hormones does the hypothalamus control

A

GHRH sms
GnRH
CRH
TRH
Dopamine

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7
Q

what hormones do the pituitary control

A

GH
LH FSH
ACTH
TSH
Prolactin

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8
Q

common examples of pituitary diseases ?

A

Benign pituitary adenoma
* Craniopharygioma
* Trauma
* Apoplexy / Sheehans
* Sarcoid / TB

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9
Q

Tumours cause ?

A

1- Pressure on local structure ie optic nerves would show bitemporal hemianopia
2 -Pressure on normal pituitary- hypopituitarism
3-Functioning tumour- is it producing hormones

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10
Q

why does pituitary tumoir cause bi temporal hemianopia

A

, pressure on the optic chiasm , visual field defects

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11
Q

how to differentiate snot and CSF

A

CSF- has glucose

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12
Q

what colour would a patient not be able to see if they had a visual defect

A

RED

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13
Q

hypopituitary in men would present as …?

A

PALE
no body hair
central obesity

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14
Q

functioning pituitary tumours?

A

prolactinoma
acromegaly and gigantism
cushings disease

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15
Q

why would gigantism occur

A

pituitary tumour is pressing on the pituitary gland causing hypopituitary
do not go through puberty

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16
Q

WHAT is a prolactin

A

a hormone made by lactotrophs by the ant pit
causes breasts to grow and make milk during pregnancy and after birth

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17
Q

presentation of prolactinoma in men

A

low testosterone
erectile dysfunctioj
reduced facial hair
low libido

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18
Q

presentation of prolactinoma in females

A

amenorrhoea
oligomenorrohoea
infertility
galactorrhoea
low libido

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19
Q

INVESTIGATIONS for prolactinoma

A

1st line- serum prolactin if elevated
2nd line- pituitary MRI

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20
Q

TREATMENT for prolactinoma

A

1st- dopamine agonist ORAL cabergoline
2nd line - HRT

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21
Q

what is thelarche

A

start of puberty caused by oestrogen

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22
Q

what occurs during thelarche

A

ductal proliferation
site specific adipose deposition
enlargement of the areola and nipple

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23
Q

incidence of precocious puberty

A

90% patients female
IF BOY- REFER IMMEDIATELY MIGHT BE BRAIN TUMOUR

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24
Q

treatment for precocious puberty

A

GnRH super agonist to supress pulsatility of GnRH secretion

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25
what is acromegaly
endo disorder resulting from excessive growth hormone
26
physical signs of acromegaly
bitemporal hemianopia acral enlargement big lips rigid eyebrows tall wide nasal bone large hands profuse sweating
27
pathophysiology of acromegaly
-GHRH released from hypothalamus and stimulates the release of GH from the ant pit -excess gh from ant pitresults in excessive production of IGF-1 which is responsible for inappropiate growth
28
what can cause acromegaly
pituitary tumor that releases GH - causes THE RELEASE OF IGF1 in liver
29
what inhibits the release of GH
SOMATOSTATIN high levels of glucose DOPAMINE
30
epidemiology of acromegaly
3.3 per million mean age of diagnosis is 44 mean duration of symptoms is 8yrs
31
acromegaly comorbidities
arthiritis HT sleep apnea headache stroke insulin resistant diabetes
32
investigations for acromegaly
1st line- insulin like growth factor 1 test gold standard- oral glucose tolerance test
33
treatment for acromegaly
1st line - transsphenoidal resection surgery 2nd line - somatastatin analogie 3rd line- GH receptor 4th line- dopamine agonist
34
define prolactinoms
benign adenoma ( lactotroph tumor) of pituitary gland producing excess prolactin
35
causes of prolactinoma
unknown, some genetic association
36
signs and symptoms of prolactinoma
visual field defect headache menstrual integrity infertility galactorrhoea
37
most common pituitary mass
non functioning pituitary adenomas
38
what is rathkes cyst
Single layer of epithelial cells with mucoid, cellular, or serous components in cyst fluid
39
what is meningioma a complication of
radiotherapy
40
what do meningiomas usually present with
loss of visual acuity endocrine dysfunction
41
HPA AXIS
Hypothalamus releases ctrh pituitary releases acth adrenal glands release cortisol
42
describe the cortisol circadian rhythm
low in the evenings peak in the middle of night begins to dip as you wake up declines throughout the day until you sleep
43
what controls the body clock
light
44
most common cause of primary Addison's
autoimmune adrenalitis 60% of casesw
45
what is addisons disease
adrenal glands have been damaged, resulting in reduced cortisolu(ZF) and aldosterone(ZR)
46
secondary adrenal insifficiency is caused by ?
inadequate ACTH stimulating the adrenal glands resulting in low levels of cortisol being released
47
what can cause tertiary adrenal insufficiency
steroids- long period of time , stops you from producing your own sterodis inhaler creams
48
Gold standard test for adrenal insufficiency
short synacthen performed in the morning when adrenal glands are the most fresh give patient synthetic ACTH blood cortisol measured at baseline , 30 , 60 mins healthy- should produce cortisol AI- failure of cortisol to risse
49
why does adrenal insuff cause weight loss
deficient in steroids - you would lose weight as you cant make your own
50
Physical signs of adrenal insufficiency
pigmentation and pallor
51
biochemistry of adrenal insufficiency LEARN THIS
low na high k eosinophilia borderline elevated TSH
52
biochemical investigations for adrenal insufficiency
measure cortisol as soon as you wake up renin/aldo- elevated renin in primary synacthen test
53
secondary investigations for adrenal insuff
STEROIDS ? Imaging genetic
54
treatment for adrenal insuff
hydrocortisone - 2-3 times a day to replace cortisol levels 15-25mg in primary adrenal insuff also replace aldosterone with fludrocortisone
55
common presentation of adrenal crisis
hypotension and cv collapsE vomiting and diarrhoea fever hypoglycaemia hyponatraemia and hyperkalaemia
56
management for adrenal crisis
* Take bloods if possible for cortisol and ACTH * Immediate hydrocortisone 100mg IV, IM, (SC) * Fluid resuscitation (1L N/Saline 1 hour) * Hydrocortisone 50-100mg IV/IM 6 hourly * In primary start fludrocortisone 100-200ug (when HC <50mg)
57
what is Cushing’s syndrome
N Endocrine disorder caused by the chronic abnormal elevation of cortisol (a glucocortic
58
Causes of cushings
Exogenous ACTH independent , oral steroid such as prednisolone Or Adrenal adenoma ENDOGENOUS ACTH - acth and cortisol levels high Can be cushings disease , ant pituitary adenoma
59
Presentation of Cushing’s syndrome
Round moon face Central obesity Abdominal stria Proximal limb wasting Mood change Acne
60
Describe the negative feedback loop for Cushing’s syndrome
Low blood cortisol stimulates the pit to produce acth ACTH stimulates the adrenal gland to produce cortisol Once blood cortisol levels are sufficient , negative feedback prevents excess cortisol by slowing acth production
61
gold standard test for cushings
dexamethosone suppression text - low dose 1mg
62
1st line test for cushings
raised plasma cortisol
63
treatment for cushings
exogenous cause - stop steroids, or reduce if used for asthma adrenal adenoma- adrenalectomy cushings- surgery to remove the tumor
64
complocations of cushings
HT cvd osteoporosis DM
65
how does the dexamethasone test work
low dose given at night test in the morning if low cortisol then - normal high /normal cortisol- cushings
66
what four things would you look for in someone who is suspected to have addisons
lean tanned tearful tire
67
WHAT occurs in addisons disease
adrenal glands are damaged, resulting in reduced cortisol and aldosterone
68
what is SIADH
syndrome of inappropriate secretion of ADH
69
would you expect hypo or hypernatraemia in SIADH
Hyponataemia as excess adh is released - increased water in the blood plasma becomes more dilute
70
WHAT can cause siadh
idiopathic post operative infection head injury meningitis
71
pathophysiology of SIADH
- excess adh causes excess water reabsorption in the collecting ducts of kidney -water dilutes the na and you get hyponatraemia
72
presentation of SIADH
headache fatigue confusion muscle aches and cramps severe hyponatraemia
73
treatment for SIADH
establish and treat cause of SIADH if medication- stop it fluid restriction
74
what is conns syndrome
a type of primary hyperaldosteronism caused by an adrenal adenoma
75
causes of conns syndrome
bilateral adrenal hyperplasia
76
presentation of conns
hypertension headaches hypokalaemia
77
investigation of conns
FBC U&E LFT
78
Treatment for conns
aldosterone agonists
79
first line investigation for primary hyperaldosteronism
aldosterone renin ratio
80
what is a pheocromocytoma
a tumour that secretes catechoalamines derived from chromaffin cells within the adrenal medulla
81
gold standard diagnosis for phaeochromocytoma
elevated plasma free metanephrine

endocrinology (6 decks)

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