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Endocrine > Pituitary physiology > Flashcards

Pituitary physiology Flashcards

1
Q

What hormone produced in the hypothalamus stimualtes the release of ACTH?

A

CRH

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2
Q

What hormone produced in the hypothalamus stimulates release of TSH?

A

TRH

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3
Q

What hormone produced by the hypothalamus stimualtes release of LH/ FSH?

A

GnRH

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4
Q

What hormone produced by the hypothalamus inhibits the release of prolactin?

A

dopamine

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5
Q

What are dynamic tests?

A

if theres too much hormone- do test that tries to suppress the hormone; is theres too little hormone- do test that tries to stimulate the hormone

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6
Q

What is synacthen?

A

synthetic ACTH

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7
Q

Who shouldnt be given an insulin stress test?

A

patients with cardiac histories or epilepsy

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8
Q

How do insulin stress tests work?

A

supposed to induce severe hypoglycaemia and stimulate growth hormone and ACTH as part of the stress mechanism

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9
Q

What is a microadenoma defined as?

A

less than or equal to 1cm

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10
Q

What is a macroadenoma defined as?

A

greater than 1cm

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11
Q

What are physiological causes of raised prolactin?

A

breast-feeding; pregnancy; stress; sleep

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12
Q

What drugs can cause a raised prolactin?

A

dopamine antagonists; antipsychotics;antidepressants

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13
Q

What are pathological causes of raised prolactin?

A

hypothyroidism; stalk lesions; prolactinoma

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14
Q

What are the symptoms of a raised prolactin in females?

A

galactorrhoea; menstrual irregularity; ammenorrhoea; infertility

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15
Q

Who has the earlier presentation, males of females?

A

females

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16
Q

What are the sympomts of raised prolactin in males?

A

impotence; visual field abnormal; headache; anterior pituitary malfunction

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17
Q

How does hypothyroidism cause a raised prolactin?

A

no thyroxine so no negative deedback so high levels of TRH which also stimualtes PRL

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18
Q

What is homonymous hemianopia?

A

complete loss of vision in one side

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19
Q

What is the treatment for prolactinoma?

A

drugs- dopamine agonist: cabergoline

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20
Q

What is acromegaly caused by?

A

GH excess

21
Q

What are the symptoms of acromegaly?

A

giant (before epiphyseal fusion); thickened soft tissues; HT; cardiac failure; headaches; snoring/sleep apnoea; DM; local pituitary effeects (visual fields ;hypopituitarism; early CV death; colonic polyps and colon cancer

22
Q

What causes the headaches in acromegaly?

A

hyperdynamic blood supply

23
Q

How is acromegaly diagnosed?

A

IGF1 meausred; GTT (suppression test)- GH should suppress to less than 0.4 after glucose but in acromegaly there is no suppession

24
Q

What is the treatment for acromegaly?

A

pituitary surgery; external radiotherpathy to ptiuitary fossa

25
Q

What are the effects of somatostatin analogues in acromegaly (octreotide)?

A

reduces GH; shrinks tumour; relieves headaches and improves op outcomes

26
Q

What are the SE of somatostatin analogues?

A

local stinging (injection); flatulence; diarrhoea; abdo pain; gastritis; gallstones

27
Q

Why do gallstones occur with somatostatin analogues?

A

inhibiti GB contraction and theres a risk of biliary colic

28
Q

What is pegvisomant?

A

a GH antagonist which binds to the GH receptor to block GH activity

29
Q

What is the follow up for acromegaly?

A

cancer surveillance-colon; CVS risk factors; sleep apnoea; check otehr pituitary hormones

30
Q

What causes Cushings syndrome?

A

excess cortisol

31
Q

What are the ymtpoms of Cushing’s syndrome?

A

protine loss- myopathy, wasting; osteoporosis- fractures; thin skin- striae, bruising; altered carbohydrate/lipid metabolism; DM; obesity; altered psyche ; hypertension and oedema; virilism; hirsutism; acne; oligo/amenorrhoea

32
Q

Why does Cushing’s syndrome cause hypertension?

A

glucocorticoids bind to mineralocorticoid receptors, usually in the kidneys, an enzyme inactivates cortisol so that it is mainly aldosterone that regulates sodium balance, but with the excess cortisol, the enzyme is overwhelmed and cortisol causes sodium retention

33
Q

What is the cause of virilism; hirsutism; acne; oligo/amenorrhoea?

A

excess androgen- small amounts of androgen are also produced in the zona fasciculata (in addition to its main source from the zona reticularis)

34
Q

How can you differentiate between Cushing’s and obesity?

A

Cushing’s patients will have in addition: thin skin; proximal myopathy; frontal balding in women; conjuctival oedema (chemosis); osteoporosis (obesity usually protects against)

35
Q

What is the tes for too much steroid?

A

suppression test- exogenous oral high dose steroid eg dexamethasone –low serum cortisol

36
Q

What is the difference between Cushing’s disease and Cushing’s syndrome?

A

cushings disease when caused by a pituitary problem

37
Q

What are the causes of Cushing’s syndrome?

A

adrenal adenoma; ectopic- thymus; lungl pancreas; pseudo- alcohol and depression and steroid medication

38
Q

What is the action of metyrapone?

A

block cortisol production

39
Q

What are the symptoms of anterior hypopituitarism?

A

menstrual irregularities; infertility; impotence; gynaecomastia; abdo obesity; loss of facial hair; loss of exillary and pubic hair; dry skin and hair; hypothyroid faces; growth retardation

40
Q

What are the functions of GH in adults?

A

improves well being and QOL; decreaases abdo fat; increases muscle mass, strength, exercise capacity and stamina; improves cardiac function; decreases cholesterol and increases LDL; increase bone density

41
Q

How is GH given?

A

daily SC injection

42
Q

What are the risks of testosterone replacement?

A

postate enlargement; polycythaemia; hepatitis (only for oral)

43
Q

Does testosterone replacement cause prostate cancer?

A

no- but may make it grow so do PR exam and PSA (prostate specific antigen)

44
Q

What are the features seen in familial diabetes insipidus?

A

diabetes insipidus; diabetes mellitus; optic atrophy; deaf

45
Q

How is DI diagnosed?

A

water deprivation test

46
Q

What is the treatment for DI?

A

desmopressin

47
Q

What are the rare causes of DI?

A

tumour; sarcoid; radiation; meningitis

48
Q

What are you trying to get in a water deprivation test?

A

a urine/serum osmolality ratio of greater than 2

Endocrine (27 decks)

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