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SM Endocrine > Pituitary Physiology > Flashcards

Pituitary Physiology Flashcards

1
Q

What are the pituitary and peripheral steroid hormones

A

ACTH and cortisol

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2
Q

What are the pituitary and peripheral thyroid hormones

A

TSH and thyroxine

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3
Q

What are the pituitary and peripheral sex hormones

A

LH/FSH and testosterone or oestradiol

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4
Q

What are the pituitary and peripheral growth hormones

A

GH and IGF-1

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5
Q

What are the pituitary and peripheral steroid hormones

A

Only pituitary hormone which is prolactin

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6
Q

What can be compressed if a pituitary tumour grows extensively

A

Cranial nerves
Optic chiasma
Internal carotid arteries
Sphenoid sinus

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7
Q

By what route do we usually remove a pituitary tumour

A

Though the sphenoid sinus

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8
Q

If we think the pituitary is secreting too much hormone, what test do we do

A

One to try and suppress the hormone

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9
Q

If we think the pituitary is secreting too little hormone, what test do we do

A

One to try and stimulate the hormone

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10
Q

How do we know if there is a problem in a dynamic test

A

There will be no response to either suppression or stimulation of the hormone

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11
Q

How can we do a dynamic pituitary test

A

Insulin stress test

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12
Q

Describe the normal result of a stress test to insulin

A

The blood glucose will decrease dramatically for the first half hour before insulin, growth hormone and cortisol will all increase to compensate and react to the hypoglycaemic environment

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13
Q

What patients should not be subjected to an insulin stress test

A

Those with epilepsy or ischaemic heart disease

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14
Q

What should be used instead of an insulin stress test in patients with epilepsy or ischaemic heart disease

A

prolonged Glucagon test

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15
Q

How can we test ADH

A

Deprive the patient of water and make them dehydrated

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16
Q

How can we diagnose Diabetes Insipidus

A

If there is an abnormal Urine/serum Osmolality is less than 2, 8 hours after a water deprivation test

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17
Q

What is the name of a pituitary tumour

A

Microadenoma

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18
Q

What is the name of pituitary tumour >1cm

A

Macroadenoma

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19
Q

What are the chances of a non-functioning pituitary being benign

A

90%

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20
Q

Do non-funcitoning pituitary adenomas produce hormones

A

No

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21
Q

Why are non functioning adenomas a problem

A

They can wipe out the cells of the pituitary that do produce hormones

22
Q

What can a non functioning pituitary adenoma cause

A

Hypoadrenalism
Hypothyroidism
Hypogonadism
Growth hormone deficiency

23
Q

What is bitemporal hemianopia

A

When the temporal visual field is obliterated due to a pituitary tumour

24
Q

What are some physiological causes of raised prolactin

A

Breast feeding
Pregnancy
Stress
Sleep

25
Q

What drugs can cause an increase of prolactin

A

Dopamine antagonists
Antipsychotics
Antidepressants

26
Q

What is elevated in an underachieve thyroid

A

TRH and TSH

27
Q

If there is elevated, TRH what can occur

A

Increased stimulation of prolactin

28
Q

What are some examples of cases where there will be an increase in prolactin

A

Hypothyroidism

Road accidents or iatrogenic causes of stalk lesion

29
Q

What are some of the clinical signs in a female of increased prolactin

A

Galactorrhoea
Menstrual irregularity
Ammenorrhoea
Infertility

30
Q

What are some of the clinic signs in a male of increased prolactin

A

Impotence
Visual field abnormalities
Headache
Anterior pituitary malfunction

31
Q

Males will present earlier than females with increased prolactin

A

No - they always present late

32
Q

What are the main investigations for prolactinoma

A

Prolactin concentrations
MRI pituitary
Visual fields
Pituitary function tests

33
Q

What should also be checked when checking for prolactin in the serum

A

Thyroid function test

34
Q

What are the 3 main dopamine agonists to treat prolactinoma

A

Bromocriptine
Quinagolide
Cabergoline

35
Q

What do dopamine agonists do

A

reduce prolactin levels and can make tumours shrink

36
Q

What dopamine agonist is usually used in prolactinoma and why

A

Cabergoline (Dostinex)

it has the least side effects

37
Q

What is the cause of acromegaly

A

Growth hormone excess

38
Q

What are some features of acromegaly

A

thickened and soft skin, large jaw, sweaty, large hands

39
Q

What are some side effects of acromegaly

A 
Hypertension, cardiac failure 
Headaches 
Snoring/ sleep apnoea 
Diabetes mellitus 
Early CV death 
colonic polyps and colon cancer
40
Q

How can we make a diagnosis of acromegaly

A

GTT suppression test

- GH will have no change after glucose

41
Q

What other tests should be done for suspected acromegaly

A

Visual field
CT or MRI pituitary scan
Pituitary function tests

42
Q

What are the treatment options for acromegaly

A

Pituitary surgery
External radiotherapy to pituitary fossa
Rest GTT

43
Q

What are some side effects of somatostatin analogues

A

Local stinging
Short term include flatulence, diarrhoea and abdominal pains
Long term include gastritis and gallstones

44
Q

What are the 2 more commonly used somatostatin analogues in acromegaly

A

Sandostatin LAR and Lanreotide autogel

45
Q

Why is Pegvisomant hardly ever used

A

It is extremely expensive and most patients will respond to other treatment

46
Q

What should be involved in an acromegaly follow up

A

Other pituitary hormones should be checked
Cancer surveillance
Cardiovascular risk factors
Sleep apnoea

47
Q

Dopamine inhibits release of prolactin. True or false

A

True

48
Q

What does ACTH do to the adrenal glands

A

Stimulates them to produce cortisol

49
Q

What is the first line treatment for prolactinoma

A

Dopamine agonists

50
Q

What is the most common cause of an acromegalic headache

A

Vascular effects such as increased blood flow

SM Endocrine (27 decks)

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