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J Endocrine > Pituitary gland > Flashcards

Pituitary gland Flashcards

1
Q

CRH stimulates what production

from where

A

ACTH

anterior pituitary

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2
Q

TRH form hypothalamus stimulates what production

from where

A

TSH

anterior pituitary

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3
Q

GnRH from hypothalamus stimulates what production

from where

A

LH and FSH

anterior pituitary

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4
Q

dopamine (DA) from hypothalamus stimulates what production

from where

A

nothing - it INHIBITS prolactin production

anterior pituitary

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5
Q

somatostatin from hypothalamus stimulates what production

from where

A

nothing - it INHIBITS GH production

anterior pituitary

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6
Q

what 2 things are released from the posterior pituitary

A

ADH/vasopressin

oxytocin

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7
Q

ACTH from anterior pituitary stimulates production of what

from where

A

cortisol

adrenal glands

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8
Q

TSH from anterior pituitary stimulate production of what

from where

A

thyroxine

thyroid gland

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9
Q

LH and FSH from the anterior pituitary stimulate production of what

A

testosterone/estradiol

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10
Q

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

from where

A

IFG1

liver

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11
Q

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

example (1)

A

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

eg dexamethasone suppression test

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12
Q

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

examples (3)

A

stimulation test

eg water deprivation test, insulin stress test, synacthen test

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13
Q

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

A

pituitary MRI

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14
Q

how big is a pituitary macroadenoma

A

> 1cm

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15
Q

which structure is most commonly compressed in pituitary tumours

A

optic chiasm

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16
Q

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

A

bitemporal hemianopia

tunnel vision, cant see things in the peripheries

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17
Q

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

A

adenomas (benign)

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18
Q

are pituitary adenomas common

A

yes

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19
Q

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

A

non functioning pituitary adenoma (doesnt produce any hormones)

pituitary is squeezed = doesnt work properly

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20
Q

how does a pituitary prolactinoma cause high prolactin

A

dopamine inhibition

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21
Q

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

A

dopamine antagonists
genetics
pituitary stalk lesion

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22
Q

presentation of prolactinoma in females (3)

A

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

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23
Q

presentation of prolactinoma in males (2)

A

impotence

visual field defect (bitemporal hemianopia)

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24
Q

are women or men more likely to present with prolactinoma early

why

what symptom is indicative of this

A

women

more obvious/worrying symptoms

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

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25
Q

investigations for prolactinoma (2)

A

biochem - high prolactin (>3000)

pituitary MRI

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26
Q

prolactinoma treatment

how does this work

A

dopamine agonists (cabergoline)

increases dopamine = reduces tumour size (reduces prolactin secretion)

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27
Q

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

A

ectopic GH production from carcinoid tumour

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28
Q

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

A

pituitary MRI

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29
Q

increased GH causes increased … in acromegaly

A

IFG1 (insulin like growth factors)

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30
Q

presentation of acromegaly in hands (2)

A

wedding ring doesnt fit

spade like hands

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31
Q

presentation of acromegaly in feet

A

increased shoe size

32
Q

presentation of acromegaly in everyday life

why does this happen

A

fatigue

protruding jaw = sleep apnoea = tired

33
Q

how does acromegaly present to the GP

A

headaches

34
Q

presentation of acromegaly in limbs (2)

A

proximal weakness

joint pain

35
Q

presentation of acromegaly in vision

A

bitemporal hemianopia

36
Q

presentation of acromegaly in hands

A

carpal tunnel syndrome

37
Q

complication of acromegaly in heart

A

ventricular hypertrophy = heart failure

38
Q

most common cause of death in acromegaly

A

heart failure

39
Q

diagnostic test in acromegaly

explanation

A

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)

40
Q

basic biochem test for acromegaly

A

serum IGF1

41
Q

investigation to confirm pituitary tumour cause of acromegaly

A

pituitary MRI

42
Q

investigation for visual defects in acromegaly

A

visual field examination

43
Q

investigation for heart involvement in acromegaly (2)

A

ECHO

ECG

44
Q

treatment of acromegaly (first line)

A

transsphenoidal surgery

45
Q

what is increased GH called in kids

A

giantism

46
Q

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

A 
radiotherapy 
somatostatin analogue (increases somatostatin = decreases GH secretion = decreases tumour size)
47
Q

complication of acromegaly in abdomen

A

increased risk of colorectal cancer

48
Q

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

A

cushings disease

see adrenal gland notes for more info

49
Q

pituitary tumour in rathkes pouch (sella turcica)

A

craniopharyngioma

50
Q

how does craniopharyngioma present on xray

A

calcification

51
Q

treatment of craniopharyngioma

A

surgical excision

52
Q

what is pan hypopituitarism

A

pituitary failure

53
Q

most common cause of pan hypopituitarism

A

non functioning pituitary adenoma

54
Q

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

A

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

55
Q

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

A

sheenans syndrome

56
Q

what are hormone levels like in pan hypopituitarism

A

all low

57
Q

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

A

short stature
obesity
menstrual irregularities/erectile dysfunction

58
Q

biochem tests for pan hypopituitarism (3)

A

all hormone levels
synacthen test
insulin tolerance test

59
Q

treatment for pan hypopituitarism (5)

think about it

A 
hormone replacement;
hydrocortisone 10-25mg/day
thyroxine 100-150mcg/day
GH 
synthetic ADH (desmospray)
testosterone/oestrogen
60
Q

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

why

A

if the have prostate cancer

can make it grow

61
Q

is diabetes insipidus common

A

no

62
Q

what is wolframs syndrome (DIDMOAD)

A

diabetes insipidus
diabetes mellitus
optic atrophy
deafness

63
Q

aetiology of diabetes insipidus (4)

A

head trauma
pituitary haemorrhage
drugs that decrease ADH action
meningitis

64
Q

cranial/neurogenic diabetes insipidus definition

A

ADH/vasopressin isnt produced form posterior pituitary

65
Q

nephrogenic diabetes insipidus

A

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

66
Q

what happens to water in diabetes insipidus

A

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

67
Q

Na conc in diabetes insipidus

A

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

68
Q

presentation of diabetes insipidus (3)

A

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

excessive thirst

69
Q

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

A

diabetes mellitus

70
Q

diagnostic investigation for diabetes insipidus

how does it work

A

water deprivation test

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

71
Q

treatment of diabetes insipidus (2)

A 
synthetic ADH (desmospray or desmopressin PO/IM)
fluids - to keep them hydrated bc theyre peeing so much!
72
Q

complication/cause of death in diabetes insipidus

A

life threatening dehydration

73
Q

aetiology of SIADH (2)

A

pituitary tumour

ectopic secretion of ASH from tumour (eg lung)

74
Q

in SIADH what does increased ADH do to water

what does this do to your pee

what does this do to serum sodium levels

A

lots of water reabsorption

v concentrated urine

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

75
Q

treatment of SIADH (1)

how does it work

A

tolvaptan

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

76
Q

what type of drug is tolvaptan

A

vasopressin receptor antagonist

77
Q

what does tolvaptan do to Na levels

A

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

J Endocrine (12 decks)

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