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MS4 - Endocrine > Pituitary > Flashcards

Pituitary Flashcards

1
Q

Hormones secreted by anterior pituitary

A

GH

FSH and LH

PRL

TSH

ACTH

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2
Q

Hormones released by posterior pituitary

A

ADH

Oxytocin

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3
Q

Hormones synthesised in the hypothalamus

A

Oxytocin

ADH

CRH

GnRH

TRH

GHRH

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4
Q

Order in which anterior pituitary hormone secretion decreases in hypopituitarism

A

GH

FSH and LH

PRL

TSH

ACTH

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5
Q

Causes of hypopituitarism

A

Hypothalamus

Pituitary stalk

Pituitary

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6
Q

Hypothalamus causes of hypopituitarism

A

Kallman’s syndrome

Tumour

Infection (TB, meningitis)

Ischaemia

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7
Q

Pituitary stalk causes of hypopituitarism

A

Trauma

Surgery

Mass lesion (craniopharyngioma)

Carotid artery aneurysm

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8
Q

Pituitary causes of hypopituitarism

A

Tumour

Irradiation

Autoimmune

Ischaemia (eg. Sheehan’s)

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9
Q

Features of GH hypopituitarism

A

Central obesity

Atherosclerosis

Weakness

Osteoporosis

Hypoglycaemia

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10
Q

Features of gonadotropin hypopituitarism in females

A

Oligomenorrhoea

Infertility

Reduced libido

Osteoporosis

Dyspareunia

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11
Q

Features of gonadotrpin hypopituitarism in males

A

Erectile dysfunction

Reduced libido

Reduced muscle bulk

Hypogonadism

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12
Q

Features of thyroid hypopituitarism

A

Hypothyroidism

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13
Q

Features of ACTH hypopituitarism

A

Adrenal insufficiency

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14
Q

Microadenoma definition

A

Tumour < 1 cm across

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15
Q

Macroadenoma definition

A

Tumour > 1 cm across

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16
Q

Histological types of pituitary tumour

A

Chromophobe

Acidophil

Basophil

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17
Q

Features of chromophobe pituitary tumours

A

Many non secretory

Half produce prolactin

Some cause hypopituitarism

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18
Q

Features of acidophil

A

15% Secrete GH or PRL

10% Local pressure effects

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19
Q

Features of basophil pituitary tumour

A

15% secrete ACTH

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20
Q

Negative effects exerted by pituitary tumours

A

Hypopituitarism

Sx caused by pressure

Hormones secreted

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21
Q

Sx of local pressure from pituitary tumours

A

Headache

Visual field

CN palsy

Disturbance to hypothalamus

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22
Q

Mx of pituitary tumours

A

Hormone replacement

Surgery (usually trans-sphenoidal)

Radiotherapy

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23
Q

Pituitary apoplexy definition

A

Rapid pituitary enlargement from bleed into tumour

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24
Q

Pituitary apoplexy sx

A

Acute onset:

Headache

Meningism

Low GCS

Visual field defects

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25
Q

Consequences of pituitary apoplexy

A

Mass effects

CVS collapse

Death

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26
Q

Mx of pituitary apoplexy

A

Hydrocortisone 100mg

Fluid

Surgery

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27
Q

Craniopharyngioma definition

A

Originates from Rathke’s pouch

(between pituitary and 3rd ventricle floor)

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28
Q

Sx of craniopharyngioma

A

Amenorrhoea

Reduced libido

Mass effect

Sleep disturbance

Diabetes insipidus

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29
Q

Mx of craniopharyngioma

A

Surgery

+/- radiotherapy post op

30
Q

Relationship between PRL and dopamine

A

Dopamine from hypothalamus inhibits PRL release

31
Q

Causes of hyperprolactinaemia

A

Prolactinoma

Pituitary stalk compression - reduced DA inhibition

DA antagonist

32
Q

Mx of hyperprolactinaemia

A

Dopamine agonist

Eg, Bromocriptine or Cabergoline

33
Q

Cause of Acromegaly

A

Increased GH

34
Q

Sx of acromegaly

A

Amenorrhoea

Headache

Reduced libido

Sweating

Snoring

Rings / Shoes no longer fitting

35
Q

Signs of acromegaly

A

Growth of (spade) hands, feet and jaw

Macroglossia

Widely spaced teeth

Acanthosis nigricans

Wide nose

36
Q

Acromegaly vs Gigantism

A

Acromegaly - after bone epiphyses fuse

Gigantism - before bone epiphyses fuse

37
Q

Complications of acromegaly

A

Impaired glucose tolerance

HTN

LVH

Increased risk of colorectal cancer

38
Q

Ix for acromegaly

A

Hyperglycaemia

High Ca and PO4

OGTT

39
Q

Diagnosis of acromegaly

A

OGTT

Collect GH at 0, 30, 60, 90, 120 and 150 mins

If lowest GH > 1 microg/L then diagnose acromegaly

40
Q

Mx of acromegaly

A

Tumour excision

Somatostatin analogues

Radiotherapy

GH antagonist

41
Q

Somatostatin analogue examples

A

Octreotide

Lanreotide

42
Q

GH antagonist example

A

Pegvisomant

43
Q

Diabetes insipidus definition

A

Impaired water reabsorption in the kidney

Passing large volumes of dilute urine

44
Q

Sx of diabetes insipidus

A

Polyuria

Polydipsia

Dehydration

Hypernatraemia

45
Q

Types of diabetes insipidus

A

Cranial DI

Nephrogenic DI

46
Q

Cranial DI definition

A

Reduced ADH secretion from posterior pituitary

47
Q

Nephrogenic DI definition

A

Impaired response of kidney to ADH

48
Q

Causes of cranial DI

A

Idiopathic

Congenital

Tumour

Trauma

Haemorrhage

Infection

49
Q

Tumour causes of cranial DI

A

Pituitary

Craniopharyngioma

Mets

50
Q

Causes of nephrogenic DI

A

Inherited

Low K

High Ca

Lithium

CKD

51
Q

Diagnosis of diabetes insipidus

A

8 hr water deprivation test

Desmopressin

52
Q

Water deprivation test for DI

A

Tests ability to concentrate urine or not

If urine osmolality low, diabetes insipidus likely

53
Q

Desmopressin test for diabetes insipidus

A

Determines whether cranial or nephrogenic DI

Urine output decreases after desmopressin = Cranial

Urine output still high after desmopressin = Nephrogenic

54
Q

Mx of cranial DI

A

MRI - find cause

Desmopressin

55
Q

Desmopressin

A

Synthetic ADH

56
Q

Mx of nephrogenic DI

A

Treat cause

Bendroflumathiazide

NSAIDs

57
Q

Use of NSAIDs for nephrogenic DI

A

NSAIDs inhibit prostaglandin synthase

Prostaglandins locally inhibit action of ADH

NSAIDs lower urine volume and plasma Na

58
Q

Definition of hypogonadism

A

Failure of testes to produce testosterone, sperm or both

59
Q

Features of hypogonadism

A

Small testes

Reduced libido

Erectile dysfunction

Reduced muscle bulk

Gynaecomastia

Osteoporosis

60
Q

Primary hypogonadism definition

A

Testicular failure

61
Q

Causes of primary hypogonadism

A

Trauma

Torsion

Post-orchitis

Renal / liver failure failure

EtOH excess

Chromosomal abnormalities

62
Q

Mechanism by which renal failure, liver failure or alcohol excess cause primary hypogonadism

A

Toxic to Leydig cells

63
Q

Chromosomal abnormalities causing primary hypogonadism

A

Klinefelter’s syndrome

(47 XXY)

64
Q

Features of Klinefelter’s syndrome

A

Delayed sexual development

Small testes

Gynaecomastia

65
Q

Secondary hypogonadism definition

A

Low gonadotropins

(FSH and LH)

66
Q

Causes of secondary hypogonadism

A

Hypopituitarism

Prolactinoma

Kallman’s syndrome

Systemic illness

Prader-Willi syndrome

Age

67
Q

Kallman’s syndrome definition

A

Isolated GnRH deficiency

68
Q

Feautures of Kallman’s syndrome

A

Secondary hypogonadism

Anosmia

Colour blindness

69
Q

Prader-Willi syndrome definition

A

Congenital disorder

Chromosome 15

70
Q

Sx of Prader-Willi syndrome

A

Excessive appetite - obesity

Learning difficulties

Hypotonia

Lack of sexual development

Short stature

MS4 - Endocrine (7 decks)

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