Endo- pituitary disorders

Question 1

what is pituitary adenoma

Answer 1

benign tumour derived from cells of anterior pituitary

Question 2

pituitary adenoma can be sporadic or associated with what disorder

Answer 2

MEN1

Question 3

what size are micro-adenomas

Answer 3

<1cm

Question 4

what size are macroadenomas

Answer 4

> 1cm

Question 5

what symptom can macroadenomas cause due to their size

Answer 5

visual field defects due to compression of optic chiasma

Question 6

what is the most common type of functioning pituitary adenomas

Answer 6

prolactin-secreting adenoma

Question 7

what does excess GH cause in children and adults

Answer 7

children- gigantism
adults- acromegaly

Question 8

what syndrome is caused by ACTH producing tumours

Answer 8

cushings syndrome

Question 9

which visual field defect is commonly associated with pituitary adenomas

Answer 9

bitemporal hemianopia

Question 10

what is the first line surgery treatment for pituitary adenomas

Answer 10

transphenoidal surgery

Question 11

what is a craniopharyngioma

Answer 11

benign tumour that arises from the sellar/suprasella region

Question 12

clinical features of craniopharyngioma

Answer 12

headaches and visual disturbances
hormonal imbalances
children may have growth retardation

Question 13

what is hypopituitarism

Answer 13

inadequate production of one or more pituitary hormone as a result of damage to the pituitary gland and/or hypothalamus

Question 14

most common cause of hypopituitarism amongst adults

Answer 14

pituitary tumours- nonfunctioning pituitary macroadenomas

Question 15

hypopituitarism becomes symptomatic when what percentage of pituitary cells are damaged

Answer 15

more than 80%

Question 16

in the posterior pituitary, decreased ADH causes what-

Answer 16

diabetes insipidus

Question 17

what is panhypopituitarism

Answer 17

refers to deficiency of all anterior pituitary hormones

Question 18

most common causes of panhypopituitarism

Answer 18

pituitary tumours
surgery
radiotherapy

Question 19

what is diabetes insipidus

Answer 19

kidneys are unable to concentrate urine due to impaired ADH function

Question 20

what does ADH stand for, where is it produced, and where is it stored

Answer 20

anti-diuretic hormone
produced in hypothalamus
stored in posterior pituitary

Question 21

clinical features of diabetes insipidus

Answer 21

polydipisia
polyuria with dilute urine

Question 22

main investigation for diabetes insipidus

Answer 22

water deprivation test

Question 23

first line treatment of neurogenic diabetes insipidus

Answer 23

desmospray (nasally) or desmopressin oral tablets

Question 24

when is IM desmopressin typically used in diabetes insipidus

Answer 24

in emergencies or post-pituitary surgery

Question 25

what is the cause of cranial (central) diabetes insipidus

Answer 25

insufficient levels of circulating ADH

Question 26

what is the cause of nephrogenic diabetes insipidus

Answer 26

characterised by renal resistance to ADH

Question 27

what is acromegaly

Answer 27

excess of growth hormone produces gigantism in children and acromegaly in adults

Question 28

clinical features of acromegaly

Answer 28

giant thickened soft tissues- skin, large jaw, sweaty, large hands snoring/sleep apnoea hypertension, cardiac failure- early CV death headaches diabetes mellitus local pituitary effects- visual fields, hypopituitarism

Question 29

gold standard test for acromegaly

Answer 29

TT suppression test

Question 30

what is the first line medication type for acromegaly

Answer 30

somatostatin analogues

Question 31

first line investigation for acromegaly

Answer 31

IGF1

Question 32

what is hyperprolactinaemia

Answer 32

abnormally high levels of prolactin in the blood

Question 33

physiological causes of hyperprolactinaemia

Answer 33

breastfeeding pregnancy stress sleep

Question 34

drugs that can cause hyperprolactinaemia

Answer 34

dopamine antagonists eg metoclopramide antipsychotics eg phenothiazines less commonly- antidepressants

Question 35

pathological causes of hyperprolactinaemia

Answer 35

hypothyroidism pituitary adenoma damage to stalk- iatrogenic, road accident prolactinoma

Question 36

clinical features of hyperprolactinaemia in females (early presentation)

Answer 36

galactorrhea (30-80%)(milky nipple discharge) Menstrual irregulatity (25%) Decreased lipido Ammenorrhoea (absent menstruation) infertility

Question 37

clinical features of hyperprolactinaemia in males (late presentation)

Answer 37

impotence (ED) visual field abnormal headaches anterior pituitary malfunction

Question 38

which drugs are used to treat prolactinomas

Answer 38

dopamine agonists- usually cabergoline

Question 39

what is the most important hormone to replace in hypopituitarism

Answer 39

cortisol

Question 40

what is the gold standard investigation for hypopituitarism

Answer 40

insulin tolerance test