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Systems: Endocrine AB > Pituitary Gland Clinical > Flashcards

Pituitary Gland Clinical Flashcards

1
Q

What condition does hypersecretion of GH cause?

A

Acromegaly (gigantism)

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2
Q

What condition does hypersecretion of ACTH cause?

A

Cushing’s disease

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3
Q

What condition does hypersecretion of prolactin cause?

A

Hyperprolactnaemia

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4
Q

What hormones can be hyposecreted by the anterior pituitary gland?

A
  • FSH/LH
  • GH
  • ACTH
  • TSH
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5
Q

What hormone can he hyposecreted by the posterior pituitary?

A

Vasopressin

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6
Q

What can a SOL of the pituitary gland lead to?

A

Optic chiasmal compression

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7
Q

What are the clinical soft tissue overgrowth features of acromegaly?

A
  • spade like hands (rings)
  • wide feet (shoes)
  • coarse facial features
  • thick lips & tongue
  • carpal tunnel syndrome
  • sweating
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8
Q

What are the possible complications of acromegaly?

A
  • headache
  • chiasmal compression
  • diabetes mellitus
  • hypertension
  • cardiomyopathy
  • sleep apnoea
  • accelerated OA
  • colonic polyps & CA
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9
Q

How is acromegaly diagnosed?

A
  • Oral glucose tolerance test
  • Can GH be suppressed?
  • Is insulin-like growth factor-1 (IGF1) elevated?
  • Is the rest of the pituitary normal?
  • Is there a pituitary tumour of MRI?
  • Is vision normal?
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10
Q

What is Cushing’s syndrome a result of?

A

Excess corticosteroids

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11
Q

What type of hormone is cortisol?

A

Catabolic

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12
Q

What physiological changes does excess cortisol lead to?

A

-Tissue breakdown (Causes weakness of skin, muscle and bone)
-Sodium retention (May cause hypertension and heart failure)
-Insulin antagonism
(May cause diabetes mellitus)

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13
Q

What are the high value signs and symptoms of Cushing’s syndrome?

A
  • Skin atrophy
  • Spontaneous purpura
  • Proximal myopathy
  • Osteoporosis
  • Growth arrest in children
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14
Q

What are the intermediate value signs and symptoms of Cushing’s syndrome?

A
  • Pink striae
  • Facial mooning and hirsutism
  • Oedema
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15
Q

What are the non-specific signs and symptoms of Cushing’s syndrome?

A
  • Central obesity

- Hypertension

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16
Q

What are the ACTH-dependent causes of Cushing’s syndrome?

A
  • Pituitary tumour (Cushing’s disease)

- Ectopic ACTH secretion (e.g. lung carcinoid)

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17
Q

What are the ACTH-independent causes of Cushing’s syndrome?

A
  • Adrenal tumour (adenoma or carcinoma)

- Corticosteroid therapy (e.g. for asthma, IBD)

18
Q

How can hyperprolactinaemia manifest itself in a women?

A
  • Galactorrhoea (30-80%)
  • Menstrual irregularity
  • Infertility
19
Q

How can hyperprolactinaemia manifest itself in a man?

A
  • Galactorrhoea (<5%)
  • Impotence
  • Visual field abnormalities
  • Headache
  • Extrocular muscle weakness
  • Anterior pituitary malfunction
20
Q

What are the physiological causes of hyperprolactinaemia?

A
  • Pregnancy
  • Lactation
  • Stress
21
Q

What are the pharmacological causes of hyperprolactinaemia?

A

DA depleting and DA antagonist drugs

22
Q

What are the pathological causes of hyperprolactinaemia?

A
  • Primary hypothyroidism

- Pituitary lesions (prolactinoma or pituitary stalk tumour)

23
Q

What drugs may cause hyperprolactinaemia?

A

-Dopamine antagonists
such as neuroleptics (e.g. chlorpromazine) and anti-emetics (e.g. metoclopramide)
-DA depleting agents
-Oestrogens (not in OCP dosage)
-Some antidepressants
-Don’t forget to ask about homeopathic or herbal remedies

24
Q

What are the clinical features of hypopituitarism in adults?

A

-Tiredness
-Weight gain
-Depression
-Reduced libido
-Impotence,
Menstrual problems
Skin pallor
-Reduced body hair

25
Q

What are the clinical features of hypopituitarism in children?

A
  • Reduced linear growth

- Delayed puberty

26
Q

Cranial Diabetes Insipidus: differential diagnosis

A
  • Idiopathic (autoimmune hypophysitis)
  • Post trauma including pituitary surgery
  • Metastatic carcinoma
  • Craniopharnygioma
  • Other brain tumours (germinoma)
  • Rare causes (sarcoidosis)
27
Q

What investigation can be carried out for cranial diabetes insipidus?

A

Water deprivation test

28
Q

How should pituitary hypersecretion be managed?

A
  • Dopamine agonists (prolactinoma)
  • Somatostatin analogues (acromegaly)
  • GH receptor antagonist (acromegaly)
29
Q

How should pituitary hyposecretion be managed?

A
  • Cortisol, T4, sex steroids, GH

- Desmopressin

30
Q

How should pituitary tumours be managed?

A
  • Surgery (most transsphenoidal)

- Radiotherapy

31
Q

When is pituitary surgery usually an option?

A

Non-functional pituitary tumours and Cushing’s disease

32
Q

What are the beneficial effects of somatostatin analogues in acromegaly?

A
  • Improve soft tissue overgrowth, sweating, headache, sleep apnoea in most patients
  • Normalise GH and IGF-1 levels in over 50% of patients
  • Induce tumour shrinkage in the majority
  • Reduce morbidity and mortality from acromegaly
33
Q

What are the adverse effects of somatostatin analogues?

A
  • Nausea, cramps, diarrhoea, flatulence (often transient)
  • Cholesterol gallstones occur in 20-30% (mostly asymptomatic)
  • Slow release preparations require monthly IM/SC injections
  • High cost (£6-12,000 annually)
34
Q

Why is pituitary radiotherapy use declining?

A
  • Acts slowly

- Cause hypopituitarism

35
Q

What is the size range for micoprolactinoma?

A

<10mm

36
Q

What is the treatment for micoprolactinoma?

A

Dopamine agonists

37
Q

What can cabergoline restore in micoprolactinoma?

A
  • Normoprolactinaemia
  • Ovulatory cycles
  • Fertility restored in 70-90%
38
Q

What is the usual presentation of someone with micoprolactinoma?

A

Usually women with: -galactorrhoea,

  • amenorrhoea
  • infertility
  • serum PRL <5000mU/I (N<500)
39
Q

What happen to most microprolactinomas?

A

Most shrink

40
Q

What is the size range for macroprolactinomas?

A

> 10mm

41
Q

What is the typical response of a macroprolactinoma to a dopamine agonist?

A

80-90% tumours show these responses and most will shrink by at least one half

  • Rapid fall in serum PRL (hours)
  • Tumour shrinkage (days/weeks)
  • Visual improvement (often within days)
  • Often recovery of pituitary function
42
Q

What is the management for acromegaly?

A

Monthly injections of slow-release octreotide and lanreotide

Systems: Endocrine AB (25 decks)

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