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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
Q

what is acromegaly

A

endo disorder resulting from excessive growth hormone

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26
Q

physical signs of acromegaly

A

bitemporal hemianopia
acral enlargement
big lips
rigid eyebrows
tall
wide nasal bone
large hands
profuse sweating

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27
Q

pathophysiology of acromegaly

A

-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

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28
Q

what can cause acromegaly

A

pituitary tumor that releases GH -
causes THE RELEASE OF IGF1 in liver

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29
Q

what inhibits the release of GH

A

SOMATOSTATIN
high levels of glucose
DOPAMINE

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30
Q

epidemiology of acromegaly

A

3.3 per million
mean age of diagnosis is 44
mean duration of symptoms is 8yrs

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31
Q

acromegaly comorbidities

A

arthiritis
HT
sleep apnea
headache
stroke
insulin resistant
diabetes

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32
Q

investigations for acromegaly

A

1st line- insulin like growth factor 1 test
gold standard- oral glucose tolerance test

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33
Q

treatment for acromegaly

A

1st line - transsphenoidal resection surgery
2nd line - somatastatin analogie
3rd line- GH receptor
4th line- dopamine agonist

34
Q

define prolactinoms

A

benign adenoma ( lactotroph tumor) of pituitary gland producing excess prolactin

35
Q

causes of prolactinoma

A

unknown, some genetic association

36
Q

signs and symptoms of prolactinoma

A

visual field defect
headache
menstrual integrity
infertility
galactorrhoea

37
Q

most common pituitary mass

A

non functioning pituitary adenomas

38
Q

what is rathkes cyst

A

Single layer of epithelial cells with mucoid,
cellular, or serous components in cyst fluid

39
Q

what is meningioma a complication of

A

radiotherapy

40
Q

what do meningiomas usually present with

A

loss of visual acuity
endocrine dysfunction

41
Q

HPA AXIS

A

Hypothalamus releases ctrh
pituitary releases acth
adrenal glands release cortisol

42
Q

describe the cortisol circadian rhythm

A

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
Q

what controls the body clock

A

light

44
Q

most common cause of primary Addison’s

A

autoimmune adrenalitis
60% of casesw

45
Q

what is addisons disease

A

adrenal glands have been damaged, resulting in reduced cortisolu(ZF) and aldosterone(ZR)

46
Q

secondary adrenal insifficiency is caused by ?

A

inadequate ACTH stimulating the adrenal glands resulting in low levels of cortisol being released

47
Q

what can cause tertiary adrenal insufficiency

A

steroids- long period of time , stops you from producing your own sterodis
inhaler
creams

48
Q

Gold standard test for adrenal insufficiency

A

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
Q

why does adrenal insuff cause weight loss

A

deficient in steroids - you would lose weight as you cant make your own

50
Q

Physical signs of adrenal insufficiency

A

pigmentation and pallor

51
Q

biochemistry of adrenal insufficiency
LEARN THIS

A

low na high k
eosinophilia
borderline elevated TSH

52
Q

biochemical investigations for adrenal insufficiency

A

measure cortisol as soon as you wake up
renin/aldo- elevated renin in primary
synacthen test

53
Q

secondary investigations for adrenal insuff

A

STEROIDS ?
Imaging
genetic

54
Q

treatment for adrenal insuff

A

hydrocortisone - 2-3 times a day to replace cortisol levels 15-25mg
in primary adrenal insuff also replace aldosterone with fludrocortisone

55
Q

common presentation of adrenal crisis

A

hypotension and cv collapsE
vomiting and diarrhoea
fever
hypoglycaemia
hyponatraemia and hyperkalaemia

56
Q

management for adrenal crisis

A
  • 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
Q

what is Cushing’s syndrome

A

N
Endocrine disorder caused by the chronic abnormal elevation of cortisol (a glucocortic

58
Q

Causes of cushings

A

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
Q

Presentation of Cushing’s syndrome

A

Round moon face
Central obesity
Abdominal stria
Proximal limb wasting
Mood change
Acne

60
Q

Describe the negative feedback loop for Cushing’s syndrome

A

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
Q

gold standard test for cushings

A

dexamethosone suppression text - low dose 1mg

62
Q

1st line test for cushings

A

raised plasma cortisol

63
Q

treatment for cushings

A

exogenous cause - stop steroids, or reduce if used for asthma
adrenal adenoma- adrenalectomy
cushings- surgery to remove the tumor

64
Q

complocations of cushings

A

HT
cvd
osteoporosis
DM

65
Q

how does the dexamethasone test work

A

low dose given at night
test in the morning

if low cortisol then - normal
high /normal cortisol- cushings

66
Q

what four things would you look for in someone who is suspected to have addisons

A

lean
tanned
tearful
tire

67
Q

WHAT occurs in addisons disease

A

adrenal glands are damaged, resulting in reduced cortisol and aldosterone

68
Q

what is SIADH

A

syndrome of inappropriate secretion of ADH

69
Q

would you expect hypo or hypernatraemia in SIADH

A

Hyponataemia
as excess adh is released - increased water in the blood
plasma becomes more dilute

70
Q

WHAT can cause siadh

A

idiopathic
post operative
infection
head injury
meningitis

71
Q

pathophysiology of SIADH

A
  • excess adh causes excess water reabsorption in the collecting ducts of kidney
    -water dilutes the na and you get hyponatraemia
72
Q

presentation of SIADH

A

headache
fatigue
confusion
muscle aches and cramps
severe hyponatraemia

73
Q

treatment for SIADH

A

establish and treat cause of SIADH
if medication- stop it
fluid restriction

74
Q

what is conns syndrome

A

a type of primary hyperaldosteronism caused by an adrenal adenoma

75
Q

causes of conns syndrome

A

bilateral adrenal hyperplasia

76
Q

presentation of conns

A

hypertension
headaches
hypokalaemia

77
Q

investigation of conns

A

FBC
U&E
LFT

78
Q

Treatment for conns

A

aldosterone agonists

79
Q

first line investigation for primary hyperaldosteronism

A

aldosterone renin ratio

80
Q

what is a pheocromocytoma

A

a tumour that secretes catechoalamines derived from chromaffin cells within the adrenal medulla

81
Q

gold standard diagnosis for phaeochromocytoma

A

elevated plasma free metanephrine

endocrinology (6 decks)

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