w4 - cushings, hypopituiarism, diabetes insipidus

Question 1

cushings syndrome causes excess ___, which leads to 1)protein loss -> myopathy = ____, osteoporosis=___, thin skin = ___,___

2) altered carb/lipid metabolism = ___ ___, ___
3) altered psyche = ___,___
4) excess mineralocrticoid= ___, ___
5) excess androgen = __,___,__,___

Answer 1

cortisol

1) wasting, fracture, striae, bruising (cortisol)
2) diabetes mellitius, obesity (cortisol)
3) psychosis, depression (cortisol)
4) hypertension, oedeoma (Mineralo)
5) virilism , hirsutism, acne, oligo/amenorrhoea (androgen)

Question 2

markers to help differentiate cushing vs obesity

Answer 2

thin skin 
proximal myopathy 
frontal balding in women 
conjunctival oedema (chemosis) 
osteoporosis

Question 3

tests to screen for cushings

Answer 3

overnight 1mg dexamethasone suppression test - Cortisol<50 = normal

urine free cortisol (24hr urine collection)

• total <250 is normal
• cortisol/creatinine ration of <25 = normal

diurnal cortisol variation (midnight/8am)

Question 4

definitive test for cushings

Answer 4

2d 2mg/d dexamethasone suppression test
cortisol <50nmol/l 6hrs after last dose = no cushings

if cortisol >130 - definitely cushings

Question 5

aetiology of cushings

Answer 5

pituitary

adeoma of adrenal

ecotpic ACTH - thymus, lung, pancrreas

pseudo

• alcohol and depression
• steroids

Question 6

high dose dexam is used to determine

Answer 6

which type of cushings

-pit or non-pit

Question 7

CRH test causes 50% inc in ACTH and 20% inc in cortisol, this suggests

Answer 7

pit disease

Question 8

drug treatment for ushings

Answer 8

metyrapone (if other treatment fails/waiting for radio)

ketoconazole (hepatotoxic)

pasireotide LAR
-somatostatin anaglosue

Question 9

causes of hypopituitarism

Answer 9

pit tumours
secondary metastatic lesions (lung,breast)
local brrain tumours
granulomatous disease (TB,sarcoidosis, Histiocytosis)
vasuclar disease
trauma
syphilis, meningitis

Question 10

Symptoms and signs of anterior hypopituitarism

Answer 10

Menstrual irregularities (F)
Infertility, impotence
Gynaecomastia (M)
Abdominal obesity
Loss of facial hair (M)
Loss of axillary and pubic hair (M&F)
Dry skin and hair
Hypothyroid faces
growth retardation (children)

Question 11

low thyroxine and low tsh indicatees

Answer 11

pituitary disease

Question 12

if giving testosterone replacement, what are the risks

Answer 12

prostate enlargement (bad if have prost cancer)
polycythaemia - monitor FBC
hepatitis (oral tabs only) - monitor LFTs

Question 13

causes of cranial diabetes insipidus can be familial, acquired, or rare (tumours, sarcoid..)
DIDMOAD is used to remember familial , outline

Answer 13

DI
Diabetes melitus
Optic atrophy
deaf

Question 14

how to check for diabetes insipidus

Answer 14

water deprivation test

Question 15

a baseline urine o serum osmolality >2 usually avoids the need for a water dep test t.f

Answer 15

true