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Year 5 Endocrine > Pituitary Pathology > Flashcards

Pituitary Pathology Flashcards

1
Q

What is diabetes insipidus?

A

↓ADH secretion OR
↓Sensitivity of kidney to ADH
Leads to impaired water resorption in kidneys
Excretion of large vols of urine >3L/day
Low urine osmolality <300 AND high serum osmolality >300

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2
Q

What are the types of diabetes insipidus?

A

Cranial = post-pituitary
Nephrogenic
Gestational= Degeneration of vasopressin by placenta

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3
Q

What are the causes of cranial DI?

A 
50% Idiopathic 
Congenital
Tumour
Trauma
Haemorrhage
Meningo-encephalitis
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4
Q

What are the causes of nephrogenic DI?

A 
Inherited
Metabolic
Drugs: Li
CKD
Post-obstructive uropathy
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5
Q

What are the Sx of DI?

A

Polyuria & Nocturia
Polydipsia
Dehydration
HYPERNATRAEMIA

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6
Q

How is DI investigated?

A

WATER DEPRIVATION TEST- DIAGNOSTIC
Bloods: Glucose, U&Es (↓K+↑Na+↑Ca2+)
Serum osmolality: >300
Urine osmolality: <700

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7
Q

What is a water deprivation test?

A

Tests ability of kidneys to concentrate urine & localise cause
Deprive fluids for 8hrs then test urine osmolality
Repeat with 2mcg desmopressin
NEPHROGENIC = <300 before & after desmopressin
CRANIAL - <300 before >800 after desmopressin

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8
Q

What is desmopressin?

A

Synthetic ADH

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9
Q

How is cranial DI treated?

A

1) MRI to find cause

2) Desmopressin

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10
Q

How is nephrogenic DI treated?

A

1) Treat cause
2) Bendroflumethazide 5mg PO
3) NSAIDs- lower urine vol & plasma Na+

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11
Q

What is SIADH?

A

Excessive secretion of ADH from post-pituitary or ectopic source
Leads to reabsorption of water at collecting duct
Leads to hypervolaemia & ↓Na+

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12
Q

What are the causes of SIADH?

A

S: SCLC
I: Infection (meningitis, atypical pneumonia, TB)
A: Abscess
D: Drugs (SSRI, TCA, Opiates, Carbamezapine)
H: Head injury (Stroke, SAH, subdural)

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13
Q

What are the features of HypoNa?

A

Mild: N&V, headache, anorexia
Mod: Cramps, weakness, irritable, confusion, ataxia
Severe: Drowsy, seizure, ↓GCS

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14
Q

What are the Sx of SIADH?

A

Signs of hyponatraemia

Signs of hypervolaemia: Pulmonary dyspnoea, peripheral oedema, ascites, ↑JVP

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15
Q

How is SIADH investigated?

A

Both parts required for diagnosis:

1) Urine: Concentrated urine, osmolality >100 AND Na+ >20
2) Bloods: Na+ <125 AND osmolality <260 in absence of hypoV/oedema/diuretics

Urine osmolality > plasma osmolality

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16
Q

How is SIADH managed?

A

1) Fluid restriction- correction of hypoNa must be done slowly
2) Demeclocycline

17
Q

What is a major complications of SIADH?

A

Central pontine myelinolysis

Caused by rapid correction of hypoNa

18
Q

Describe pituitary tumours

A

Mostly benign, curable pituitary adenomas

19
Q

How are symptoms caused by pituitary tumours?

A

Local pressure
Hormones
Hypopituitarism

20
Q

What are the histological types of pituitary tumours?

A

Chromophobe 70%- most are non-secretory, 50% secrete prolactin
Acidophil- Secrete GH (Acromegaly) or prolactin
Basophil- Secrete ACTH (Cushing’s disease)

21
Q

What are the clinical features of a pituitary tumour?

A

Pressure features: Headache, visual field defects (B/L temporal hemianopia due to compression of optic chiasm), CN 3,4, 6 palsy, diabetes insipidus,
Sx of acromegaly
Sx of prolactinoma

22
Q

What are the features of acromegaly?

A 
Coarse facial features: Wide nose, puffy lips &amp; eyelids
Excess sweating
↑Growth of hands (spade-like), jaw, feet, tongue 
Dark skin
Acanthosis nigerians
Amenorrhoea/ ↓Libido
Sleep apnoea
Proximal weakness &amp; arthropathy
23
Q

What are the features of a prolactinoma?

A

Women: ↑Oestrogen + ↓GRH
Amenorrhoea/oligomenorrhoea, infertility, galactorrhea, ↓libido, dry vagina, ↑ Weight
Men: ↑Testosterone + ↓GRH
Erectile dysfunction, ↓facial hair, galactorrhea, osteoporosis

24
Q

What drugs can cause a prolactinoma?

A 
Metoclopramide
Domperidone
Haloperidol
Chlorpromazine
Antipsychotics
25
Q

How is acromegaly caused by a pituitary tumour treated?

A

1) Surgery: Trans-sphenoid surgery

2) Octreotide

26
Q

How is a pituitary tumour investigated?

A

PRIOR TO MRI:

1) Hormones: PRL, IGF1, ACTH, Cortisol, TFTs, LH/FSH, Testosterone
2) Synacthen test
3) Glucose tolerance test
4) Water deprivation test
5) MRI head

27
Q

How is a pituitary tumour managed?

A

1) Treat deficiency
2) ↑PRL = DA antagonist
3) Surgery + Hydrocortisone
4) ↑GH = Somatostatin analogues

28
Q

What is hypopituitarism?

A

↓secretion of anterior pituitary hormones

29
Q

What are the symptoms of ↓GH?

A

Central obesity
Dry, wrinkly skin
↓strength, ↓balance, ↓exercise ability
LATE= Atherosclerosis, Osteoporosis, ↓Glucose

30
Q

What are the symptoms of ↓FSH & LH?

A 
Oligomenorrhoea/amenorrhoea
↓Fertility, ↓Libido
Breast atrophy
Dyspareunia
Erectile dysfunction
↓Muscle bulk
Hypogonadism

Year 5 Endocrine (6 decks)

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