PITUITARY STUFF Flashcards
what 2 hormones are stored in the pituitary?
vasopress and OXT
if there is too much hormone what sort of dynamic test should you do?
do a test that tries to suppress it
if there is too little hormone what sort of dynamic test should you do?
do a test that tries to stimulate the hormone
pituitary tumour less than or equal to 1cm
microadenoma
pituitary tumour more than 1cm
macroadenoma
causes of raised prolactin
breast feeding
pregnancy
stress
sleep
dopamine antagonists
antidepressents
coccaine
pathologic causes of raised prolactin
hypothyroidism
stalk lesion -RTA
prolactinoma
clinical signs and symptoms of increased prolactin in females?
early presentation
menstrual irregularity
infertility
ammenorrhoea
clinical signs and symptoms of increased prolactin in females?
late presentation impotence visual field abnormal headache anti pit malfunction
investigations for prolactinoma ?
prolactin conc
MRI pituitary
visual fields
pituitary function tests
medial treatment for prolactinoma?
dopamine agonists:
- bromocriptine -3x day
- Quinagolide- 1x day
- Cabergoline-the best 2x week
excess GH
acromegaly
thickened soft tissues large jaw massive hands and feet headaches hypertension heart failure snoring sleep apnoea diabetes
acromegaly
how do you diagnose acromegaly?
IGF-1- age and sex matched
GTT- suppression test- no suppression= positive
treatment for acromegaly?
surgery (most successful)
external radiotehrapy
retest GTT
if GH>1ug/L then need drug therapy:
- dopamine agonist-cabergoline
- somatostatin analogues-octreotide
- GH antagonist-pegvisomant
what type of drug is cabergoline?
dopamine antagonist
what type of drug is octreotide
somatostain analogue
what type of drug is pegvisomant?
GH antagonist
do somatostatin analogues shrink the tumour?
yes
what are the side effects of somatostatin analogues?
local stinging
flatulence
diarrhoea
abdominal pain
gastritis
gall stones!!
how are GH antagonists given?
SC injection every day
do G antagonists shrink tumour size?
no
excess cortisol
cushings syndrome
signs/symptoms of cushings?
protein loss proximal myoptahy central obesity moon face buffalo hump depression/psych problems axcess androgen-acne, funny periods frontal balding in women conjunctival odema osteoporosis poor wound healing easy bruising thin skin
definitive test for cushing?
low dose dexamethasone
what other screening tests can you do for cushings?
overnight 1mg dexamethasone suppression test
urine free cortisol
diurinal cortisol variation
causes of cushings?
pituitary problems
adenoma of adrenal
ectopid-thymus, lung, pancreas
pseudo-alcohol depression
steroid medication
what is this cause of cushings?
low dose dexa test- abnormal
ACTH
pituitary
what is this cause of cushings?
low dose dexa test- abnormal
ACTH
adrenal
what is this cause of cushings?
low dose dexa test- abnormal
ACTH >300
high dose dexam suppression- nil
ectopic
surgery options for cushings?
pituitary-hypophysectomy and external radiation
adrenal- adrenalectomy
ectopic- remove source or bilateral adrenalectomy
drug treatment fro cushings?
metyrapone (if all other treatments fail)
ketoconazole
pasireotide
signs/symptoms of anterior hypopituitarism?
menstrual irregularities infertility gynaecomastia abdominal obesity loss of facial hair loss of pubic and armpit hair dry skin and hair growth retardation
replacement therapy for hypopituitarism?
thyroxine hydrocortisone ADH GH sex steroids
how is testosterone replacement therapy given?
IM injection every 3-4 weeks
risks of testosterone replacement therapy?
prostate enlargement
hepatitis
polycythaemia
what test do you do to diagnose diabetes insipidus?
water deprivation test
treatment for diabetes insipidus?
desmospray
desmopressin oral tablets
desmopressin sublingual tablets
desmopressin injection
