Pituitary Disorders

Question 1

Where is the pituitary gland located?

Answer 1

At the base of the brain in the sella turcica within the sphenoid bone.

Question 2

What are the two parts the pituitary gland is functionally divided into?

Answer 2

Anterior and posterior pituitary.

Question 3

What type of hormones does the anterior pituitary secrete?

Answer 3

Six major trophic hormones:
* Prolactin (PRL)
* Growth hormone (GH)
* Adrenocorticotropin hormone (ACTH)
* Luteinizing hormone (LH)
* Follicle-stimulating hormone (FSH)
* Thyroid-stimulating hormone (TSH)

Question 4

What is hypopituitarism?

Answer 4

Deficiency of one or more or all anterior pituitary hormones.

Question 5

What are common causes of hypopituitarism?

Answer 5

1° pituitary disease or hypothalamic pathology.

Question 6

What is Lymphocytic Hypophysitis?

Answer 6

A rare inflammatory condition occurring peripartum and with checkpoint inhibitors therapy in some cancers.

Question 7

What is Sheehan Syndrome?

Answer 7

Postpartum pituitary necrosis with failure of lactation as an early sign.

Question 8

What does pituitary apoplexy represent?

Answer 8

An acute emergency due to infarction inside macroadenoma from hemorrhage or ischemia.

Question 9

How is hypopituitarism diagnosed biochemically?

Answer 9

Through static and dynamic pituitary function tests.

Question 10

What is the gold standard test to assess GH and ACTH reserve?

Answer 10

Insulin tolerance test.

Question 11

What are the classifications of pituitary tumors based on size?

Answer 11

Microadenomas (<1 cm) and macroadenomas (>1 cm).

Question 12

What is the most common functioning pituitary tumor?

Answer 12

Prolactinoma.

Question 13

What are the clinical features of prolactinoma?

Answer 13

• Hyperprolactinaemia
• Galactorrhoea
• Menstrual disturbances in females
• Loss of libido and/or erectile dysfunction in males
• Headaches and visual field defects (macroadenomas only)

Question 14

What is the primary treatment for prolactinomas?

Answer 14

Drug therapy with dopamine agonists.

Question 15

What condition results from prolonged excessive growth hormone secretion in adults?

Answer 15

Acromegaly.

Question 16

What are the common causes of acromegaly?

Answer 16

Pituitary adenoma (>99% of cases), hypothalamic secretion of GHRH, ectopic GHRH secretion.

Question 17

What are some clinical features of acromegaly?

Answer 17

• Coarse facial features
• Enlarged hands and feet
• Joint pains
• Increased sweating
• Headaches

Question 18

What complications are associated with acromegaly?

Answer 18

• Hypertension
• Insulin resistance
• Obstructive sleep apnoea
• CVD
• Congestive cardiac failure

Question 19

True or False: Acromegaly has a higher prevalence in males than females.

Answer 19

False.

Question 20

Fill in the blank: The anterior pituitary gland is often referred to as the _______.

Answer 20

[Master gland]

Question 21

What is the percentage of impaired glucose tolerance in acromegaly?

Answer 21

40%

Impaired glucose tolerance is a common metabolic complication in acromegaly.

Question 22

What is the percentage of diabetes mellitus (DM) occurrence in acromegaly?

Answer 22

20%

Diabetes mellitus is another significant metabolic issue associated with acromegaly.

Question 23

What condition can obstructive sleep apnoea lead to in acromegaly?

Answer 23

Colonic polyps and colonic cancer

The soft tissue swelling in the nasopharyngeal region increases the risk of these conditions.

Question 24

What is a common cause of death in patients with acromegaly?

Answer 24

Cardiovascular disease (CVD)

CVD is a significant risk factor in patients with acromegaly due to various metabolic disturbances.

Question 25

What are the clinical features of acromegaly?

Answer 25

Increased height, prognathism, enlarged hands, and feet ## Footnote These features can be visually assessed in affected individuals, particularly in identical twins.

Question 26

At what age do clinical features of acromegaly typically begin to diverge?

Answer 26

Approximately 13 years ## Footnote This divergence can be observed in identical twins with one affected by acromegaly.

Question 27

What is macroglossia?

Answer 27

Enlargement of the tongue ## Footnote It is a common clinical feature in patients with acromegaly.

Question 28

What diagnostic test is used as an initial screening for acromegaly?

Answer 28

IGF-1 ## Footnote IGF-1 levels are usually elevated in patients with acromegaly.

Question 29

What is the confirmatory test for acromegaly?

Answer 29

Oral glucose tolerance test ## Footnote In patients with acromegaly, there is a failure to suppress GH to <2 ng/ml after a glucose load.

Question 30

What imaging technique is primarily used to demonstrate a pituitary tumor in acromegaly?

Answer 30

MRI of the sella ## Footnote MRI is highly effective in detecting tumors and assessing their extension.

Question 31

What is the first line treatment for acromegaly?

Answer 31

Transsphenoidal surgery ## Footnote This approach is typically followed by drug therapy if necessary.

Question 32

What are somatostatin analogues (SSAs) used for in acromegaly treatment?

Answer 32

To normalize IGF-1 levels ## Footnote SSAs can achieve normal IGF-1 levels in 17-35% of patients.

Question 33

What is the incidence of Cushing's disease due to an ACTH-secreting pituitary tumor?

Answer 33

Approximately 2 per million annually ## Footnote Cushing's disease is a rare condition, more common in females.

Question 34

What hormones are stored and secreted by the posterior pituitary?

Answer 34

* Arginine Vasopressin (AVP or ADH) * Oxytocin ## Footnote These hormones are synthesized in the hypothalamus and transported to the posterior pituitary.

Question 35

What characterizes diabetes insipidus (DI)?

Answer 35

Production of large volumes (>3L/24 hours) of dilute urine ## Footnote This condition is marked by low urine osmolality (<300 mOsm/kg).

Question 36

What is cranial diabetes insipidus caused by?

Answer 36

Deficient AVP synthesis ## Footnote 80% of AVP-secreting neurons must be lost for cranial DI to occur.

Question 37

What is the treatment for cranial DI?

Answer 37

Desmopressin ## Footnote This synthetic AVP is used to manage cranial diabetes insipidus.

Question 38

What does SIADH stand for?

Answer 38

Syndrome of inappropriate antidiuretic hormone ## Footnote SIADH results in euvolemic hyponatremia due to inappropriate secretion of ADH.

Question 39

What is the management for acute symptomatic hyponatremia?

Answer 39

IV hypertonic saline (3% NaCl) ## Footnote This treatment is crucial in the ICU setting.

Question 40

What is the main symptom of SIADH?

Answer 40

Neurological symptoms due to hyponatremia ## Footnote Symptoms can include headache, confusion, and seizures.