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Flashcards in Pituitary Deck (85)
1

What hormone is in excess in Cushing's syndrome?

Cortisol

2

What hormone is in excess in Cushing's syndrome?

Cortisol

3

Which hormone pre-empts cortisol production?

ACTH

4

Where does ACTH come from?

Anterior pituitary

5

What characterises Cushing's syndrome?

Moon shaped face
Buffalo hump
Central obesity
Frontal balding in women
Proximal myopathy
Striae

6

True or False
Osteoporosis is associated with Cushings

True

7

True or False
Hypertension is associated with Cushings

True

8

True or False
Decreased appetite is associated with Cushing's

False
Increased!

9

How is Cushing's tested for?

High dose exogenous oral steroid should lead to low serum cortisol

10

What values are expected in a positive Cushing's test?

>100nmol/L is abnormal.

11

What other test can be done to measure cortisol?

24hr urine collection.

12

What values are expected in the 24hr urine collection?

Less than 250 is normal

13

What diurnal variation is present with cortisol?

Drops at midnight.
Peaks at 9AM

14

What is the definitive test for Cushing's?

2 day 2mg/day dexamethosone

15

What value indicates a negative result in the definitive test?

More than 500

16

What is the main cause of Cushing's syndrome?

Pituitary gland dysfunction

17

A cancer of where can also simulate Cushing's?

Adrenal glands.
Usually an adenoma

18

What is the treatment for Cushing's?

Removal of hypothalamus (hypophysectomy)

19

What drug treatments can be given for Cushing's syndrome?

Metyrapone
Ketoconazole

20

What is an important factor to remember about ketoconazole?

Hepatotoxic

21

What is Pan Hypopituitarism?

failure of both anterior and posterior pituitary to produce hormones

22

What happens when the posterior pituitary is insufficient?

Diabetes Insipidus

23

What is the most common cause of hypopituitarism?

Pituitary tumours

24

True or False
Menstrual irregularities are a sign of anterior hypopituitarism

True

25

True or False
Excessive sweating is a sign of anterior hypopituitarism

False.

26

True or False
Loss of facial and pubic hair is a sign of hypopituitarism

True

27

True or False
Growth retardation is a sign of anterior hypopituitarism

True

28

If there was an excess of GH before puberty what would be the result?

Giantism

29

What is the Synacthen test?

ACTH stimulation

30

Which hormone pre-empts cortisol production?

ACTH

31

Where does ACTH come from?

Pituitary gland

32

What characterises Cushing's syndrome?

Moon shaped face
Buffalo hump
Central obesity
Frontal balding in women
Proximal myopathy
Striae

33

True or False
Osteoporosis is associated with Cushings

True

34

True or False
Hypertension is associated with Cushings

True

35

True or False
Decreased appetite is associated with Cushing's

False
Increased!

36

How is Cushing's tested for?

High dose exogenous oral steroid should lead to low serum cortisol

37

What values are expected in a positive Cushing's test?

>100nmol/L is abnormal.

38

What other test can be done to measure cortisol?

24hr urine collection.

39

What values are expected in the 24hr urine collection?

less than 250 is normal

40

What diurnal variation is present with cortisol?

Peaks at 9AM
Drops around midnight

41

What is the definitive test for Cushing's?

2 day 2mg/day dexamethosone

42

What value indicates a negative result in the definitive test for Cushing's?

Over 500

43

What is the main cause of Cushing's syndrome?

Pituitary gland dysfunction

44

A cancer of where can also simulate Cushing's?

Adrenal glands.
Usually an adenoma

45

What is the treatment for Cushing's?

Removal of hypothalamus (hypophysectomy)

46

What drug treatments can be given for Cushing's syndrome?

Metyrapone
Ketoconazole

47

What is an important factor to remember about ketoconazole?

Hepatotoxic

48

What is Pan Hypopituitarism?

failure of both anterior and posterior pituitary to produce hormones

49

What happens when the posterior pituitary is insufficient?

Diabetes Insipidus

50

What is the most common cause of hypopituitarism?

Pituitary tumours

51

True or False
Menstrual irregularities are a sign of anterior hypopituitarism

True

52

True or False
Excessive sweating is a sign of anterior hypopituitarism

False.

53

True or False
Loss of facial and pubic hair is a sign of hypopituitarism

True

54

True or False
Growth retardation is a sign of anterior hypopituitarism

True

55

If there was an excess of GH before puberty what would be the result?

Giantism

56

If there was an excess of GH after puberty what would be the result?

Acromegaly

57

What is the Synacthen test?

ACTH stimulation

58

What replacements need to be given if hypopituitarism is diagnosed?

Thyroxine
Hydrocortisone
ADH
GH (sc)
Sex steroids

59

What does GH do?

Increases bone density
Decreases cholesterol
Increases muscle mass

60

How is GH given?

Subcutaneous injection

61

How is testosterone given?

IM (or IM prolonged)
Oral
Gel

62

What needs to be monitored when giving testosterone?

Prostate- may make cancer grow
FBC- increased Hb
LFTs - hepatitis (if oral)

63

What can cause Diabetes Insipidus?

Wolfram (DIDMOAD)
Idiopathic in 50%
Trauma

64

How is diabetes insipidus diagnosed?

Water deprivation tests

65

Which hormone does GH produce?

Insulin like growth factor 1
(IGF1)

66

What is the difference in a microadenoma and a macroadenoma?

Micro 1cm

67

What are physiological causes of prolactin in become raised?

Breastfeeding
Pregnancy
Stress
Sleep

68

What drugs can cause a raise in prolactin?

Metoclopramide
SSRI
oestrogens
cocaine

69

What pathological reasons can cause raised prolactin?

Hypothyroidism
Prolactinoma

70

What are signs of hyperprolactinaemia in women?

Galactorrhoea
Menstrual irregularity
Amenorrhoea
Infertility

71

What are signs of hyperprolactinaemia in men?

Impotence
Visual field abnormalities
Headache

72

What investigations need to be undertaken considering hyperprolactinaemia?

MRI
Pituitary function tests

73

What class of drug is used to treat hyperprolactinaemia?

Dopamine agonists

74

What drug is mainly used to treat hyperprolactinaemia?

Cabergoline

75

What are the side effects of cabergoline?

Nausea
Constipation
Headaches

76

What causes acromegaly?

GH excess

77

What causes giantism?

GH excess before epiphyseal fusion

78

What are common signs of acromegaly?

Thickened soft tissues e.g. skin, jaw and hands
Headaches
sleep apnoea
DM

79

What tests are done to diagnose acromegaly?

IGF1- normal against sex/age
GTT

80

Where does GH come from?

Anterior pituitary

81

What is the treatment for acromegaly?

Pituitary surgery

82

What is diabetes insipidus?

Reduced ADH secretion from posterior pituitary

83

What symptoms are present in diabetes insipidus?

Polyuria
Polydipsia
Dehydration

84

When could GH levels be low?

Pregnancy

85

What is the definitive test for acromegaly?

Oral glucose tolerance test