Week 4: Adrenal/pituitary-related hormones disease

Question 1

Which hormones are released from the anterior pituitary gland

Answer 1

1. TSH
2. ACTH
3. Growth hormone
4. Prolactin
5. LH and FSH

Question 2

Which hormones are released from the posterior pituitary gland

Answer 2

1. Vasopressin

2. Oxytocin

Question 3

Pathophysiology of diabetes insipidus

Answer 3

Lack of ADH/ vasopressin

Question 4

Symptoms of diabetes insipidus

Answer 4

1. Polyuria, nocturia
2. Dilute urine
3. Thirst, polydipsia
4. Hypernatremia

Question 5

Causes of diabetes insipidus

Answer 5

• Congenital
• Head injury
• Pituitary adenoma/ other tumour nearby
• Post pituitary surgery
• Infection/ inflammation

Question 6

Treatment for diabetes insipidus

Answer 6

Desmopressin

Question 7

Dexamethosone suppression test is used to diagnose what?

What test result is diagnostic?

Answer 7

Cushing’s disease
(high cortisol)

Test results: cortisol levels suppressed by high dose, no change with low dose

Question 8

9am Plasma cortisol is used to diagnose what

What test result is diagnostic?

Answer 8

Addison’s disease
(low cortisol)

Test results: no detectable level of cortisol

Question 9

Fludrocortisone suppression test is used to diagnose what

What test result is diagnostic?

Answer 9

Conn’s syndrome
(high aldosterone)

Test results:
Serum aldosterone >140 after test

Question 10

Water deprivation test is used to diagnose what

What test result is diagnostic?

Answer 10

Diabetes insipidus
(ADH deficiency)

Test results:
Low urine osmolality at first (<600), rising after = Cranial DI

Low urine osmolality at first (<600), still low after = Nephrogenic DI

Question 11

What investigation should be done before deciding how to manage hyperaldosteronism?

Which management options are decided from there?

Answer 11

L and R adrenal vein sampling (to compare aldosterone levels)

Similar aldosterone levels
= bilateral adrenal hyperplasia
Treat with spironolactone

Different aldosterone levels
= unilateral adenoma
Treat with surgery

Question 12

Management of phaeochromocytoma.

What is important to remember about the order of this management?

Answer 12

1. Alpha blocker
2. Beta blocker
3. Surgery

Give alpha blocker BEFORE beta blocker.
Other beta blocker will stop smooth muscle vasodilation, and worsen a hypertensive crisis

Question 13

Symptoms of adrenal crisis

Answer 13

1. Confusion, psychosis, slurred speech
2. Seizures
3. Hyperkalemia, hyponatremia
4. Acute pain in abdo/ lower back/ legs
5. Severe VnD causng dehydration

Question 14

Management of adrenal crisis

Answer 14

IV/IM Hydrocortisone 100mg

IV fluids

Question 15

Short synacthen test is used to diagnose what?

How much synacthen is given

What test result is diagnostic?

Answer 15

Addison’s (adrenal insufficiency)

Give 250micrograms synacthen IM

Test results: Cortisol levels don’t rise in response to ACTH

Question 16

What level of testosterone is considered low

Answer 16

<300ng/ dL

Question 17

In a pituitary adenoma causing compression of the optic chiasm, which nerve is the first to get affected?

Answer 17

CN 3 (oculomotor)