Pituitary and Adrenal Disease (core) Flashcards Preview

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Flashcards in Pituitary and Adrenal Disease (core) Deck (43)
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1

How does Conn's present? Why?

Hypertension

Hypokalaemia

Metabolic alkalosis

Aldosterone overproduction

2

How can Conn's be treated?

Adrenal surgery

Aldactone - competitive antagonist

3

What is the best test for GH levels?

IGF-1 levels

3

How do you diagnose phaeochromocytoma

Metanephine levels (a metabolite of epinephrine)

24hour urine collection for catacholamines

4

What are the main signs of acromegaly?

Enlarged jaw, hands, and feet

Course facial features

Thickened skin

4

How does 21 hydroxylase deficiency present?

Over production of testosterone

4

How might mineralocorticoid hyposecretion present?

Hyperkalaemia

Hyponatremia

5

Why do you get pigmentation in Addisons?

Addisons - low cortisol production > ACTH hypersection > POMC (ACTH precursor) also made into melanocyte stimulating factor > pigmentation

6

How might prolactinomas present? Why?

Amenorrhoea - negative feedback on FSH and LH

Galactorrhea (milk production) - overproduction of prolactin

Hypogonadism

Loss of libido

7

What is the name of a dopamine agonist?

Cabergoline

7

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

9

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

10

What are some causes of sellar masses?

Benign tumours

- Pituitary adenoma

- Craniopharyngioma

- Meningioma

 

Malignant

- Primary

- Metastatic tumour

 

Rathke's cleft Cyst

Carotid aneurysm

11

What is the key modulator of mineralocorticoid release?

K

(renin-angiotensin)

11

How is Addison's disease managed long term?

Glucocorticoids - cortisone acetate

- Dexamethasone

- Pred

 

Mineralocorticoids

- Fludrocortisone

11

What must be done before surgery in Pheochromocytoma?

Alphablockage to prevent hypertensive crisis

12

Which drugs increase prolactin?

Anti-psychotics

Anti-emetics

12

How do you supress GH levels clinically? Why?

75g of glucose orally

Ghrelin release from stomach in response to glucose suppresses GH

13

What are the side effects of octreotide?

Gall stones

GI upset

14

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

16

How does dopamine effect prolactin levels?

It's inhibitory to its production

16

What causes Acromegaly?

GH secreting pituitary adenoma

GH secreting tumour elsewhere (rare)

17

How is Addisonian crisis managed?

Hydrocortisone

Fluid replacement

19

What are the complications of acromegaly?

Increased heart disease

Diabetes

Colonic adenoma

21

What are the clinical features of Phaeochromocytoma?

Headache

Vision changes

Tremors

Palpitations

Panic attacks

22

What are the characterists of a pituitary based headache?

Pain is right between the eyes

 

24

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

26

What are symptoms of hyperthalamic syndromes?

Energy dysregulation and obesity

28

What is the pathophysiology of Addison's disease?

Autoimmune destruction of the adrenal gland

29

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