Pituitary Hyper and Hyposecretion

Question 1

describe the functions of

hypothalamus
pituitary gland
thyroid gland
parathyroids
adrenal glands
testis

Answer 1

Question 2

which hormone stimulate and act on thyroid?

Answer 2

TSH
thyroid hormones

Question 3

which hormones act on adrenal gland?

Answer 3

ACTH
adenocorticosteroids

Question 4

which hormones act on ovaries?

Answer 4

FSH, LH
estrogen

Question 5

what hormones act on corpus luteum?

Answer 5

FSH, LH
progesterone

Question 6

what hormones act on testes?

Answer 6

FSH, LH
testosterone

Question 7

what hormone stimulates bone and soft tissues?

Answer 7

GH

Question 8

what hromone stimulates breasts?

Answer 8

PRL

Question 9

what hormone stimulates kidneys?

Answer 9

ADH

Question 10

what hormone stimulates breasts and kidneys?

Answer 10

oxylocin

Question 11

what does hypersecretion of GH cause?

Answer 11

acromegaly (Gitantasism)

Question 12

what does hypersecretion of ACTH cause?

Answer 12

cushings disease

Question 13

what does hypersecretion of prolactin cause?

Answer 13

hyperprolactinaemia

Question 14

what does hyposecretion of anterior pituitary affect?

Answer 14

FSH/LH, GH, ACTH, TSH

Question 15

what does hyposecretion of posterior pituitary affect

Answer 15

vasopressin

Question 16

what can a space occupying ptuitary tumour cause?

Answer 16

optic chiasmal compression
bitemporal hemianopia

Question 17

what are clinical features of acromegaly?

Answer 17

Soft tissue overgrowth
‘spade like’ hands (rings)
wide feet (shoes)
coarse facial features
thick lips & tongue
carpal tunnel syndrome
sweating

Question 18

what are complications associated with acromegaly?

Answer 18

headache
chiasmal compression
diabetes mellitus
hypertension
cardiomyopathy
sleep apnoea
accelerated OA
colonic polyps & CA

Question 19

how is acromegaly diagnosed?

Answer 19

can GH be supressed

insulin like growth factor 1 elevated

rest of pituitary function normal

normal vision

pituitary tumour on MRI

Question 20

what is cushings syndrome?

Answer 20

excess corticosteroids

Question 21

what type of hormone is cortisol?

Answer 21

catabolic hormone

Question 22

what bodily functions is cortisol responsible for, therefore what affect might excess have?

Answer 22

Tissue breakdown
causes weakness of skin, muscle & bone

Sodium retention
may cause hypertension & heart failure

Insulin antagonism
may cause diabetes mellitus

Question 23

what are high value symptoms of cushings syndrome?

Answer 23

skin atrophy
spontaneous purpura
proximal myopathy
osteoporosis
growth arrest in children

Question 24

what are intermediate value symptoms of cushings syndrome?

Answer 24

pink striae
facial mooning & hirsutism
oedema

Question 25

what are non-specific symptoms of cushing syndrome?

Answer 25

central obesity
hypertension
diabetes mellitus

Question 26

not all cases of cushing syndrome are caused by a pituitary tumour

ACTH dependent causes may be…

Answer 26

Pituitary tumour (Cushing’s disease)

Ectopic ACTH secretion (eg lung carcinoid)

Question 27

ACTH independent causes of cushing syndrome?

Answer 27

Adrenal tumour (adenoma or carcinoma)

Corticosteroid therapy (eg for asthma, IBD)

Question 28

what are clinical manifestations of hyperprolactinaemia in women?

Answer 28

galactorrhoea 30-80%

menstrual irregularity

infertility

Question 29

what are clinical manifestations of hyperprolactinaemia in men?

Answer 29

Question 30

what are physiological causes of hyperprolactinaemia?

Answer 30

Pregnancy, lactation, stress

Question 31

what are pharmalogical causes of hyperprolactinaemia?

Answer 31

DA depleting and DA antagonist drugs

Question 32

what are pathological causes of hyperprolactinaemia?

Answer 32

Primary hypothyroidism
- Pituitary lesions (prolactinoma or pituitary ‘stalk pressure’)

Question 33

what drugs may cause hyperprolactinaemia?

Answer 33

Dopamine antagonists
neuroleptics (eg chlorpromazine)
anti-emetics (eg metoclopramide)

DA-depleting agents

Oestrogens (not in OCP dosage)

Some antidepressants

• Don’t forget to ask about homeopathic or herbal remedies!

Question 34

what are clinical features of hypopituitarism in adults?

Answer 34

Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
Skin pallor
Reduced body hair

Question 35

what are clinical features of hypopituitarism in children?

Answer 35

Reduced linear growth
Delayed puberty

Question 36

what is a water deprivation test

Answer 36

Diabetes insipidus (DI) involves deficient production or lack of effective action of antidiuretic
hormone (ADH or arginine vasopressin). ADH stimulates the kidney to conserve fluid. Deficient
production of ADH or lack of effective action of ADH causes a high urine output, thirst, dehydration,
and low blood pressure in advanced cases.

Disease of the hypothalamus/pituitary gland leading to a deficiency in ADH production is called
cranial or central DI. Disease of the kidney leading to lack of response of the kidney to fluid
conserving action of ADH is called nephrogenic DI.
The principle of the water deprivation test is to assess the ability of the patient to concentrate urine when
fluids are withheld. Water deprivation should normally cause increased secretion of ADH, resulting in the
production of small volumes of concentrated urine.

Question 37

what are differential diagnosis of cranial diabetes insipidus?

Answer 37

Idiopathic (autoimmune hypophysitis?)
Post-trauma (including pituitary surgery)
Metastatic carcinoma
Craniopharyngioma
Other brain tumours: eg. germinoma
Rare causes: eg. sarcoidosis