Pituitary Disorders

Question 1

What hormones are released from the anterior pituitary gland?

Answer 1

TSH, ACTH, GH, prolactin, LH/FSH

Question 2

What hormones are released from the posterior pituitary gland?

Answer 2

Oxytocin and ADH

Question 3

Which hormones released from the anterior pituitary gland are trophic hormones, and are released from cells known as basophils?

Answer 3

TSH, ACTH and LH/FSH

Question 4

Which hormones released from the anterior pituitary gland are non-trophic hormones, and are released from cells known as acidophils?

Answer 4

GH and prolactin

Question 5

What is the most common pituitary tumour?

Answer 5

Pituitary adenoma

Question 6

What is the definition of a microadenoma and macroadenoma?

Answer 6

Microadenoma = < 1cm, macroadenoma = > 1cm

Question 7

A non-functioning pituitary adenoma does not produce a hormone in excess but instead may cause what?

Answer 7

Generalised hypopituitarism

Question 8

Pituitary adenomas may be sporadic or they may be associated with which genetic condition?

Answer 8

MEN1

Question 9

What is the most common type of pituitary adenoma?

Answer 9

Prolactinoma

Question 10

What is the second most common type of pituitary adenoma?

Answer 10

Non-functioning

Question 11

What are the most common symptoms of a pituitary adenoma caused by a local pressure effect?

Answer 11

Headache, bitemporal hemianopia, palsy of cranial nerves III/IV/VI

Question 12

Which 3 investigations are required for everyone with a suspected pituitary adenoma?

Answer 12

Hormone profile, formal visual field testing, pituitary MRI

Question 13

When replacing hormones (in cases of panhypopituitarism for example), which hormone should be given first?

Answer 13

Hydrocortisone

Question 14

Most pituitary surgery is carried out with what approach?

Answer 14

Trans-sphenoidal

Question 15

What treatment can be used for residual or recurrent pituitary adenomas after surgery?

Answer 15

Radiotherapy

Question 16

Why may fertility be reduced after surgery to remove a pituitary adenoma?

Answer 16

Decreased gonadotrophins

Question 17

What is pituitary apoplexy?

Answer 17

Rapid pituitary enlargement from a bleed into a tumour

Question 18

How is the release of prolactin controlled?

Answer 18

It is under tonic inhibition by hypothalamic dopamine

Question 19

What are some physiological causes of hyperprolactinaemia?

Answer 19

Pregnancy, breastfeeding, stress

Question 20

What is the most common cause of hyperprolactinaemia?

Answer 20

Drugs

Question 21

What are some examples of drugs which may cause hyperprolactinaemia?

Answer 21

Metoclopramide, anti-psychotics, oestrogens, ecstasy/MDMA

Question 22

What other endocrine abnormality may cause hyperprolactinaemia as a result?

Answer 22

Hypothyroidism

Question 23

Hyperprolactinaemia tends to present earlier in which gender?

Answer 23

Females

Question 24

If the lowest GH level during an OGTT is above what value, acromegaly can be diagnosed?

Answer 24

1mcg/L

Question 25

Both bromocriptine and cabergoline are associated with what severe side effect? How should this be monitored?

Answer 25

Pulmonary/cardiac/retroperitoneal fibrosis - monitor with ECHO

Question 26

What is the second line treatment for a prolactinoma?

Answer 26

Trans-sphenoidal surgery

Question 27

When should the GH antagonist pegvisomant be used in the treatment of acromegaly?

Answer 27

In those who are intolerant of a somatostatin analogue

Question 28

What hormone, released from the hypothalamus, increases secretion of growth hormone from the anterior pituitary gland?

Answer 28

Growth hormone releasing hormone

Question 29

What hormone, released from the hypothalamus, decreases secretion of growth hormone from the anterior pituitary gland?

Answer 29

Somatostatin

Question 30

What effect does a high-dose dexamethasone suppression test have on plasma cortisol levels in those with Cushing's disease?

Answer 30

May more than halve the level

Question 31

If an increased level of growth hormone occurs before the onset of puberty, what does this cause?

Answer 31

Pituitary gigantism

Question 32

What are the main complications of acromegaly?

Answer 32

Impaired glucose tolerance/diabetes, vascular disease, cardiomyopathy, increased risk of colonic cancer

Question 33

A high glucose level usually has what effect on growth hormone?

Answer 33

Decreases GH

Question 34

If basal serum GH is increased and/or if IGF-1 is increased, what investigation is indicated?

Answer 34

OGTT

Question 35

What are the potential causes of panhypopituitarism?

Answer 35

Pituitary tumour, surgery or irradiation

Question 36

What is the first line treatment for acromegaly?

Answer 36

Trans-sphenoidal surgery

Question 37

If surgery fails to correct GH/IGF-1 levels, what are some second line options that can be tried next?

Answer 37

Somatostatin analogue (octreotide) or radiotherapy

Question 38

Is Cushing's disease more likely to be caused by a micro or macroadenoma?

Answer 38

Microadenoma

Question 39

What effect does a low-dose dexamethasone suppression test have on plasma cortisol levels in those with Cushing's disease?

Answer 39

No effect

Question 40

If the source of Cushing's disease is undetectable, what treatment can be useful?

Answer 40

Bilateral adrenalectomy

Question 41

Where does a craniopharyngioma arise from?

Answer 41

Rathke's pouch

Question 42

What is the commonest childhood intra-cranial tumour?

Answer 42

Craniopharyngioma

Question 43

How do craniopharyngiomas in childhood present?

Answer 43

Growth failure

Question 44

In what order are anterior pituitary hormones affected by panhypopituitarism?

Answer 44

GH - LH/FSH - prolactin - TSH - ACTH

Question 45

When does Sheehan's syndrome usually present?

Answer 45

After a delivery involving post-partum haemorrhage

Question 46

What effect does Sheehan's syndrome have?

Answer 46

Panhypopituitarism

Question 47

What investigation is used in panhypopituitarism to assess the adrenal axis?

Answer 47

Short Synacthen test

Question 48

What investigation is used in panhypopituitarism to assess the adrenal and growth hormone axes?

Answer 48

Insulin tolerance test

Question 49

What imaging investigation is indicated in an individual with panhypopituitarism?

Answer 49

Pituitary MRI

Question 50

How is panhypopituitarism treated?

Answer 50

Hormone replacement and treatment of the underlying cause