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Pituitary Flashcards

(85 cards)

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1
Q

What hormone is in excess in Cushing’s syndrome?

A

Cortisol

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2
Q

What hormone is in excess in Cushing’s syndrome?

A

Cortisol

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3
Q

Which hormone pre-empts cortisol production?

A

ACTH

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4
Q

Where does ACTH come from?

A

Anterior pituitary

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5
Q

What characterises Cushing’s syndrome?

A 
Moon shaped face
Buffalo hump
Central obesity
Frontal balding in women
Proximal myopathy
Striae
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6
Q

True or False

Osteoporosis is associated with Cushings

A

True

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7
Q

True or False

Hypertension is associated with Cushings

A

True

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8
Q

True or False

Decreased appetite is associated with Cushing’s

A

False

Increased!

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9
Q

How is Cushing’s tested for?

A

High dose exogenous oral steroid should lead to low serum cortisol

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10
Q

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

A

> 100nmol/L is abnormal.

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11
Q

What other test can be done to measure cortisol?

A

24hr urine collection.

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12
Q

What values are expected in the 24hr urine collection?

A

Less than 250 is normal

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13
Q

What diurnal variation is present with cortisol?

A

Drops at midnight.

Peaks at 9AM

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14
Q

What is the definitive test for Cushing’s?

A

2 day 2mg/day dexamethosone

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15
Q

What value indicates a negative result in the definitive test?

A

More than 500

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16
Q

What is the main cause of Cushing’s syndrome?

A

Pituitary gland dysfunction

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17
Q

A cancer of where can also simulate Cushing’s?

A

Adrenal glands.

Usually an adenoma

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18
Q

What is the treatment for Cushing’s?

A

Removal of hypothalamus (hypophysectomy)

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19
Q

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

A

Metyrapone

Ketoconazole

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20
Q

What is an important factor to remember about ketoconazole?

A

Hepatotoxic

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21
Q

What is Pan Hypopituitarism?

A

failure of both anterior and posterior pituitary to produce hormones

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22
Q

What happens when the posterior pituitary is insufficient?

A

Diabetes Insipidus

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23
Q

What is the most common cause of hypopituitarism?

A

Pituitary tumours

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24
Q

True or False

Menstrual irregularities are a sign of anterior hypopituitarism

A

True

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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

Endocrine (20 decks)

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