Pituitary gland

Question 1

CRH stimulates what production

from where

Answer 1

ACTH

anterior pituitary

Question 2

TRH form hypothalamus stimulates what production

from where

Answer 2

TSH

anterior pituitary

Question 3

GnRH from hypothalamus stimulates what production

from where

Answer 3

LH and FSH

anterior pituitary

Question 4

dopamine (DA) from hypothalamus stimulates what production

from where

Answer 4

nothing - it INHIBITS prolactin production

anterior pituitary

Question 5

somatostatin from hypothalamus stimulates what production

from where

Answer 5

nothing - it INHIBITS GH production

anterior pituitary

Question 6

what 2 things are released from the posterior pituitary

Answer 6

ADH/vasopressin

oxytocin

Question 7

ACTH from anterior pituitary stimulates production of what

from where

Answer 7

cortisol

adrenal glands

Question 8

TSH from anterior pituitary stimulate production of what

from where

Answer 8

thyroxine

thyroid gland

Question 9

LH and FSH from the anterior pituitary stimulate production of what

Answer 9

testosterone/estradiol

Question 10

when somatostatin is low = GH release from the anterior pituitary, what does this stimulation production of

from where

Answer 10

IFG1

liver

Question 11

generally with pituitary problems, what biochemical test do you do if you suspect too much hormone

example (1)

Answer 11

suppression test (see if you are able to suppress the hormone from somewhere further back in the axis)

eg dexamethasone suppression test

Question 12

generally with pituitary problems, what biochemical test do you do if you expect too little hormone

examples (3)

Answer 12

stimulation test

eg water deprivation test, insulin stress test, synacthen test

Question 13

generally with pituitary problems, after youve done a biochemical test what would you do

Answer 13

pituitary MRI

Question 14

how big is a pituitary macroadenoma

Answer 14

> 1cm

Question 15

which structure is most commonly compressed in pituitary tumours

Answer 15

optic chiasm

Question 16

what does optic chiasm compression present as (medical name and explanation)

Answer 16

bitemporal hemianopia

tunnel vision, cant see things in the peripheries

Question 17

are most pituitary tumours adenomas (benign) or caricnomas (malignant)

Answer 17

adenomas (benign)

Question 18

are pituitary adenomas common

Answer 18

yes

Question 19

if someone presents with bitemporal hemianopia but all hormone levels are low (basically), what type of tumour do they have

why are the hormone levels low and not just normal

Answer 19

non functioning pituitary adenoma (doesnt produce any hormones)

pituitary is squeezed = doesnt work properly

Question 20

how does a pituitary prolactinoma cause high prolactin

Answer 20

dopamine inhibition

Question 21

apart from a prolactinoma, what else can cause hyperprolactinaemia (3)

Answer 21

dopamine antagonists
genetics
pituitary stalk lesion

Question 22

presentation of prolactinoma in females (3)

Answer 22

galactorrhoea (milk secretion from breasts)
oligomenorrhoea (menstrual irregularity)
infertility

Question 23

presentation of prolactinoma in males (2)

Answer 23

impotence

visual field defect (bitemporal hemianopia)

Question 24

are women or men more likely to present with prolactinoma early

why

what symptom is indicative of this

Answer 24

women

more obvious/worrying symptoms

men are more likely to present with bitemporal hemianopia bc the tumour is more late stage

Question 25

investigations for prolactinoma (2)

Answer 25

biochem - high prolactin (>3000) | pituitary MRI

Question 26

prolactinoma treatment how does this work

Answer 26

dopamine agonists (cabergoline) increases dopamine = reduces tumour size (reduces prolactin secretion)

Question 27

apart from GH secreting pituitary tumour, what else can cause acromegaly (increased growth hormone)

Answer 27

ectopic GH production from carcinoid tumour

Question 28

investigations for acromegaly (to rule out ectopic GH secretion as aetiology)

Answer 28

pituitary MRI

Question 29

increased GH causes increased ... in acromegaly

Answer 29

IFG1 (insulin like growth factors)

Question 30

presentation of acromegaly in hands (2)

Answer 30

wedding ring doesnt fit | spade like hands

Question 31

presentation of acromegaly in feet

Answer 31

increased shoe size

Question 32

presentation of acromegaly in everyday life why does this happen

Answer 32

fatigue protruding jaw = sleep apnoea = tired

Question 33

how does acromegaly present to the GP

Answer 33

headaches

Question 34

presentation of acromegaly in limbs (2)

Answer 34

proximal weakness | joint pain

Question 35

presentation of acromegaly in vision

Answer 35

bitemporal hemianopia

Question 36

presentation of acromegaly in hands

Answer 36

carpal tunnel syndrome

Question 37

complication of acromegaly in heart

Answer 37

ventricular hypertrophy = heart failure

Question 38

most common cause of death in acromegaly

Answer 38

heart failure

Question 39

diagnostic test in acromegaly explanation

Answer 39

oGTT (oral glucose tolerance testing) suppression test - give glucose and measure GH 2 hours later (in normal people GH lowers, in acromegaly it stays high)

Question 40

basic biochem test for acromegaly

Answer 40

serum IGF1

Question 41

investigation to confirm pituitary tumour cause of acromegaly

Answer 41

pituitary MRI

Question 42

investigation for visual defects in acromegaly

Answer 42

visual field examination

Question 43

investigation for heart involvement in acromegaly (2)

Answer 43

ECHO | ECG

Question 44

treatment of acromegaly (first line)

Answer 44

transsphenoidal surgery

Question 45

what is increased GH called in kids

Answer 45

giantism

Question 46

treatment options for acromegaly is surgery contraindicated/surgery done and tumour grows back (2)

Answer 46

``` radiotherapy somatostatin analogue (increases somatostatin = decreases GH secretion = decreases tumour size) ```

Question 47

complication of acromegaly in abdomen

Answer 47

increased risk of colorectal cancer

Question 48

disease caused by ACTH secreting pituitary tumour (other causes too)

Answer 48

cushings disease | see adrenal gland notes for more info

Question 49

pituitary tumour in rathkes pouch (sella turcica)

Answer 49

craniopharyngioma

Question 50

how does craniopharyngioma present on xray

Answer 50

calcification

Question 51

treatment of craniopharyngioma

Answer 51

surgical excision

Question 52

what is pan hypopituitarism

Answer 52

pituitary failure

Question 53

most common cause of pan hypopituitarism

Answer 53

non functioning pituitary adenoma

Question 54

other causes of pan hypopituitarism (apart from non functioning adenoma) (4)

Answer 54

sarcoidosis pituitary stalk cut (trauma, iatrogenic in surgery etc) drugs pituitary artery infarction

Question 55

what is pituitary artery infarction (causing bleeding) post partum (after childbirth) called

Answer 55

sheenans syndrome

Question 56

what are hormone levels like in pan hypopituitarism

Answer 56

all low

Question 57

presentation of pan hypopituitarism (give one for GH, TSH, FSH/LH)

Answer 57

short stature obesity menstrual irregularities/erectile dysfunction

Question 58

biochem tests for pan hypopituitarism (3)

Answer 58

all hormone levels synacthen test insulin tolerance test

Question 59

treatment for pan hypopituitarism (5) think about it

Answer 59

``` hormone replacement; hydrocortisone 10-25mg/day thyroxine 100-150mcg/day GH synthetic ADH (desmospray) testosterone/oestrogen ```

Question 60

when wouldnt you give testosterone in a male patient with pan hypopituitarism why

Answer 60

if the have prostate cancer can make it grow

Question 61

is diabetes insipidus common

Answer 61

no

Question 62

what is wolframs syndrome (DIDMOAD)

Answer 62

diabetes insipidus diabetes mellitus optic atrophy deafness

Question 63

aetiology of diabetes insipidus (4)

Answer 63

head trauma pituitary haemorrhage drugs that decrease ADH action meningitis

Question 64

cranial/neurogenic diabetes insipidus definition

Answer 64

ADH/vasopressin isnt produced form posterior pituitary

Question 65

nephrogenic diabetes insipidus

Answer 65

normal ADH/vasopressin production, but doesnt work in the kidneys like it should

Question 66

what happens to water in diabetes insipidus

Answer 66

no water reabsorption (bc no ADH) = lots of water excreted

Question 67

Na conc in diabetes insipidus

Answer 67

high (bc water is low, so normal Na presents as hypernatraemia)

Question 68

presentation of diabetes insipidus (3)

Answer 68

polyuria (large volumes of urine >3 llitres per hour) | excessive thirst

Question 69

what does diabetes insipidus present similar to (but completely different aetiology)

Answer 69

diabetes mellitus

Question 70

diagnostic investigation for diabetes insipidus how does it work

Answer 70

water deprivation test reduce fluid intake and patient should pee less (in diabetes insipidus they still pee lots)

Question 71

treatment of diabetes insipidus (2)

Answer 71

``` synthetic ADH (desmospray or desmopressin PO/IM) fluids - to keep them hydrated bc theyre peeing so much! ```

Question 72

complication/cause of death in diabetes insipidus

Answer 72

life threatening dehydration

Question 73

aetiology of SIADH (2)

Answer 73

pituitary tumour | ectopic secretion of ASH from tumour (eg lung)

Question 74

in SIADH what does increased ADH do to water what does this do to your pee what does this do to serum sodium levels

Answer 74

lots of water reabsorption v concentrated urine hyponatraemia - Na levels normal but lots of water = v dilute

Question 75

treatment of SIADH (1) how does it work

Answer 75

tolvaptan is a vasopressin receptor antagonist = blocks ADH from binding in the kidneys = water secretion into tubules (reduced water reabsorption)

Question 76

what type of drug is tolvaptan

Answer 76

vasopressin receptor antagonist

Question 77

what does tolvaptan do to Na levels

Answer 77

increase them back to normal (used in SIADH where there is hyponatraemia)