Pituitary Gland (General(

Question 1

Where is the Pituitary Gland

Answer 1

1. Surrounded by the sphenoid bone
2. Embedded in the sella turcica
3. Close to the optic chiasm and Hypothalamus

Question 2

What kind of manifestation does a tumour in the optic chiasm cause?

Answer 2

1. Bitemporal hemianopia
2. Adenohypophysis (80%)
3. Neurohypophysis (ADH and oxycontin)

Question 3

Where are the hormones produced by the Hypothalamus stored?

Answer 3

In the posterior Pituitary

Question 4

What causes galactorrhea, and what are signs in women?

Answer 4

1. Excess prolactin

2. Amenorrhea

Question 5

What are the causes of Hyperprolactinaemia in men?

Answer 5

1. Excess prolactin
2. Men can show hypogonadism
3. Can get bitemporal hemianopia due to larger adenoma

Question 6

What are the other causes of Hyperprolactaemia?

Answer 6

1. Stress
2. Stimulation
3. Drugs: haloperidol, H2 blockers, reserpine
4. Hypothyroidism

Question 7

What does blocking dopamine do to prolactin?

Answer 7

It causes hyperprolactinaemia

Question 8

What happens when thyroid releasing hormone is really high (from the hypothalamus)?

Answer 8

This increases prolactin, hyperprolactaemia and galactorrhea.

Question 9

What other ‘condition’ causes galactorrhea?

Answer 9

Pregnancy

Question 10

What is the most common adenoma in the pituitary?

Answer 10

Prolacitoma

Question 11

What things are checked in Hyperprolactinaemia?

Answer 11

1. Exclude drugs
2. Exclude hypothyroidism
3. Exclude pregnancy
4. Check prolactin levels
5. MRI

Question 12

What is the treatment for hyperprolactaemia?

Answer 12

1. Dopamine agonist
2. Bromocriptine
3. Cabergaline
4. Surgery
5. Radiation

Question 13

Which patients will need a more aggressive form of treatment and why?

Answer 13

Usually men since they develop macro adenomas

Question 14

A 32 year old women presents with milk like discharge for over 4 weeks. Her examination reveals galactorrhea but is otherwise normal

What are the next most appropriate tests

Answer 14

1. TSH
2. Medication/drug history
3. Pregnancy test

Question 15

What is the main cause of Acromegaly

Answer 15

Excess growth hormone

Question 16

What are the features of acromegaly?

Answer 16

1. Enlargement of hands, feet, tongue and mandible
2. CHF
3. Bilateral carpal tunnel syndrome
4. Diabetes
5. Hemianopia

Question 17

What are the tests for acromegaly

Answer 17

1. Insulin growth factors/ somatomedins
2. Glucose load
3. MRI

Question 18

What are the treatments for acromegaly

Answer 18

1. Octreotide
2. Dopamine agonists
3. Radiotherapy/surgery

Question 19

What causes hypopituitarism?

Answer 19

1. Lesions in the pituitary hypothalamic region
2. Craniopharyngiomas in children
3. TB sarcoidosis
4. GH, gonadotrophins, lost early
5. ACTH lost last

Question 20

What is test for hypopituitarism?

Answer 20

Give insulin and measure GH. If normal pituitary then GH increases. If hypopituitarism then suppressed levels of GH

Question 21

What is pituitary apoplexy?

Answer 21

Adenoma bleeds and wipes out pituitary. Present with confusion, headache neck stiffness.

Question 22

What is Sheehan syndrome

Answer 22

1. Postpartum necrosis of the gland

2. Inability to lactate