Pituitary and Adrenal Disease (core) Flashcards
How does Conn’s present? Why?
Hypertension
Hypokalaemia
Metabolic alkalosis
Aldosterone overproduction
How can Conn’s be treated?
Adrenal surgery
Aldactone - competitive antagonist
What is the best test for GH levels?
IGF-1 levels
How do you diagnose phaeochromocytoma
Metanephine levels (a metabolite of epinephrine)
24hour urine collection for catacholamines
What are the main signs of acromegaly?
Enlarged jaw, hands, and feet
Course facial features
Thickened skin
How does 21 hydroxylase deficiency present?
Over production of testosterone
How might mineralocorticoid hyposecretion present?
Hyperkalaemia
Hyponatremia
Why do you get pigmentation in Addisons?
Addisons - low cortisol production > ACTH hypersection > POMC (ACTH precursor) also made into melanocyte stimulating factor > pigmentation
How might prolactinomas present? Why?
Amenorrhoea - negative feedback on FSH and LH
Galactorrhea (milk production) - overproduction of prolactin
Hypogonadism
Loss of libido
What is the name of a dopamine agonist?
Cabergoline
What is MEN2? What does it cause?
Autosomal dominant mutation of RET proto oncogene that predisposes to medullary carcinoma of thyroid and other endocrine tumours
How are the causes of Cushing syndrome divided? What are some examples of each?
ACTH-dependent
- Cushing disease
- Ectopic ACTH or CRF
ACTH-independent
- Adrenal adenoma or carcinoma
- Micro/Macronodular hyperplasia
What are some causes of sellar masses?
Benign tumours
- Pituitary adenoma
- Craniopharyngioma
- Meningioma
Malignant
- Primary
- Metastatic tumour
Rathke’s cleft Cyst
Carotid aneurysm
What is the key modulator of mineralocorticoid release?
K
(renin-angiotensin)
How is Addison’s disease managed long term?
Glucocorticoids - cortisone acetate
- Dexamethasone
- Pred
Mineralocorticoids
- Fludrocortisone
What must be done before surgery in Pheochromocytoma?
Alphablockage to prevent hypertensive crisis
Which drugs increase prolactin?
Anti-psychotics
Anti-emetics
How do you supress GH levels clinically? Why?
75g of glucose orally
Ghrelin release from stomach in response to glucose suppresses GH
What are the side effects of octreotide?
Gall stones
GI upset
What is Inferior petrosal sinus sampling for?
Demonstrating the ACTH levels are higher close to the pituitary to confirm that it is the source of the ACTH hypersecretion
How does dopamine effect prolactin levels?
It’s inhibitory to its production
What causes Acromegaly?
GH secreting pituitary adenoma
GH secreting tumour elsewhere (rare)
How is Addisonian crisis managed?
Hydrocortisone
Fluid replacement
What are the complications of acromegaly?
Increased heart disease
Diabetes
Colonic adenoma
What are the clinical features of Phaeochromocytoma?
Headache
Vision changes
Tremors
Palpitations
Panic attacks
What are the characterists of a pituitary based headache?
Pain is right between the eyes
What are clinical features of Cushing syndrome?
Rapid weight gain (>20kg in 1-2 years)
Striae
Ease of bruising
Poor wound healing
Myopathy
Osteoporosis (particularly spinal)
Buffulo hump
Moon face
What are symptoms of hyperthalamic syndromes?
Energy dysregulation and obesity
What is the pathophysiology of Addison’s disease?
Autoimmune destruction of the adrenal gland
What is the treatment regimen for prolactinoma?
Dopamine agonist for a few years until to the tumour reduces in size
Monitor prolactin levels to monitor for return
What is the difference between Cushing syndrome and disease?
Syndrome - State of high glucocorticoids
Disease - ACTH hypersecreting adenoma
How is Conn’s diagnosed?
Infusion of 2L N/Saline over 4hours - look for aldosterone suppresion
Aldosterone/renin ratio
How is acromegaly treated?
Transphenoidal hypophysectomy to remove tumour
Medically:
- Octreotide (somatostatin analogue)
Radiotherapy
How do you simulate GH production clinically?
Insulin induced hypoglycaemia - in adults
Exercise - in kids
What will the result of a dexamethasone test in ACTH dependent and independent Cushings?
Dependent - ACTH will be normal or elevated
Independent - ACTH will be suppressed
What are the best tests for Cushing Syndrome?
24 hour urine free cortisol (if possible)
Overnight dexamethasone suppression test
How are prolactinomas treated?
Dopamine agonist - Cabergoline, bromocriptine
What is MEN1?
Autonosomal dominant gene mutations that causes predisposes people to endocrine tumours of the:
Pituitary, pancreas and parathyroid
What causes phaeochromocytoma?
Tumour of chromaffin cells in adrenal medulla
Paragangliomas
What are the most common hormone phenotypes for pituitary adenomas?
- Non functioning
Prolactin secreting
Growth hormone secreting
ACTH secreting
What are the side effects of dopamine agonists?
Nausea
GI upset
Personality changes - risk taking behaviour
The synacthen test is for the diagnosis of what?
Addison’s
What are the polyglandular autoimmune disorders?
Genetic conditions that cause increased autoimmune attack of endocrine structures and cells
