Cushing and hyper prolactinoma
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Questions and Answers

What is the main purpose of the pituitary gland?

  • To regulate body temperature
  • To control blood pressure
  • To control the activity of many other endocrine glands (correct)
  • To produce hormones for the nervous system

    • What percentage of the pituitary gland's total weight is made up of the anterior lobe?

  • 100%
  • 50%
  • 90%
  • 75% (correct)

    • What is the function of the posterior lobe of the pituitary gland?

  • To produce hormones
  • To store and release hormones produced by the hypothalamus (correct)
  • To regulate body growth
  • To control the activity of other endocrine glands

    • Which hormone is produced by the anterior pituitary and stimulates the adrenal cortex?

    <p>ACTH</p> Signup and view all the answers

    What is the term for hormones produced by the anterior pituitary that stimulate other glands to release hormones?

    <p>Trophic hormones</p> Signup and view all the answers

    What is the location of the pituitary gland?

    <p>At the base of the brain, in the sphenoid bone</p> Signup and view all the answers

    What is the result of GH hypersecretion before the closure of the epiphyseal plates?

    <p>Gigantism</p> Signup and view all the answers

    What is the most common hormone produced in excess in hyperpituitarism?

    <p>GH</p> Signup and view all the answers

    What is the age range in which Acromegaly usually develops?

    <p>30-50 years</p> Signup and view all the answers

    What is a common symptom of Acromegaly?

    <p>Excessive sweating</p> Signup and view all the answers

    What is an investigation used to diagnose Acromegaly?

    <p>All of the above</p> Signup and view all the answers

    What is a complication of Acromegaly?

    <p>Hypertension</p> Signup and view all the answers

    What is a question that can be asked during history taking in a suspected case of Acromegaly?

    <p>Has your shoe size changed?</p> Signup and view all the answers

    What is another name for Acromegaly when it occurs in childhood?

    <p>Gigantism</p> Signup and view all the answers

    What is the goal of adrenal-directed inhibition of steroidogenesis in treating Cushing disease?

    <p>Lower cortisol levels</p> Signup and view all the answers

    What is the primary use of mifepristone in treating Cushing syndrome?

    <p>To treat high blood sugar</p> Signup and view all the answers

    What is the normal range for prolactin levels?

    <p>Less than 20 nanograms per milliliter</p> Signup and view all the answers

    What is a common symptom of hyperprolactinemia in women?

    <p>Oligomenorrhoea</p> Signup and view all the answers

    What is a common cause of hyperprolactinemia?

    <p>All of the above</p> Signup and view all the answers

    What is the typical treatment approach for microprolactinomas?

    <p>Medication therapy</p> Signup and view all the answers

    What is the primary reason for performing a pregnancy test in diagnosing hyperprolactinemia?

    <p>To rule out pregnancy in women of childbearing age</p> Signup and view all the answers

    What is the typical diagnosis threshold for hyperprolactinemia?

    <p>Prolactin level &gt; 150-200 ng/mL</p> Signup and view all the answers

    What is measured in the insulin stimulation test?

    <p>Growth hormone levels</p> Signup and view all the answers

    Why may the insulin stimulation test cause discomfort to patients?

    <p>Because it lowers blood sugar</p> Signup and view all the answers

    What is the goal of growth hormone replacement therapy?

    <p>To improve overall well-being</p> Signup and view all the answers

    What is monitored during growth hormone replacement therapy?

    <p>Side effects</p> Signup and view all the answers

    What is SIADH?

    <p>A syndrome</p> Signup and view all the answers

    What is the location of the nuclei that produce ADH in SIADH?

    <p>Supra optic and paraventricular nuclei</p> Signup and view all the answers

    What is the purpose of radiological tests in diagnosing growth hormone deficiency?

    <p>To correlate chronological bone age</p> Signup and view all the answers

    How often is the growth hormone replacement therapy administered?

    <p>Once a day</p> Signup and view all the answers

    What is associated with the disappearance of symptoms and improvement of general wellbeing?

    <p>Reduced growth hormone levels</p> Signup and view all the answers

    What is the primary choice of treatment for Acromegaly?

    <p>Surgery</p> Signup and view all the answers

    What is the purpose of dopamine agonists in treating Acromegaly?

    <p>To inhibit GH release from the tumour</p> Signup and view all the answers

    What is a potential complication of radiation therapy for Acromegaly?

    <p>Visual loss</p> Signup and view all the answers

    What is the mode of action of Pegvisomant in treating Acromegaly?

    <p>It blocks the action of GH</p> Signup and view all the answers

    What is a symptom of Acromegaly?

    <p>Regular and painful headaches</p> Signup and view all the answers

    What is Somatostatin in the context of Acromegaly?

    <p>A growth hormone receptor antagonist</p> Signup and view all the answers

    What is a contraindication for surgery in treating Acromegaly?

    <p>Poor surgical candidate</p> Signup and view all the answers

    Study Notes

    Pituitary Gland Anatomy

    • Located at the base of the brain, in a small depression of the sphenoid bone (sella turcica)
    • Has two lobes: anterior lobe (accounts for 75% of total weight) and posterior lobe
    • Anterior lobe: glandular tissue, controlled by regulating hormones from the hypothalamus
    • Posterior lobe: nerve tissue, stores hormones produced by the neurosecretory cells in the hypothalamus

    Pituitary Gland Hormones

    • Anterior Pituitary hormones:
      • GH: growth hormone
      • ACTH: adrenocorticotropic hormone
      • TSH: thyroid-stimulating hormone
      • PRL: prolactin
      • FSH: follicle-stimulating hormone
      • LH: luteinizing hormone
      • MSH: melanocyte stimulating hormone
    • Posterior Pituitary hormones:
      • ADH: anti-diuretic hormone (vasopressin)
      • OT: oxytocin

    Pituitary Disorders

    • Hyperpituitarism: excessive hormone production, usually only one hormone is produced in excess
    • Hypopituitarism: hormone deficiency
    • Manifestations of the cause, e.g.: local compression of brain tissue by expanding tumor

    Acromegaly and Gigantism

    • Acromegaly: over secretion of GH in adulthood, leading to coarsening of facial features, enlarged hands and feet, and other symptoms
    • Gigantism: GH hypersecretion before the closure of the epiphyseal plates (childhood), resulting in abnormally tall stature
    • Symptoms of acromegaly: coarsening of facial features, enlarged hands and feet, prognathism, carpal tunnel syndrome, excessive sweating, and others

    Diagnosis

    • History and physical exam
    • Investigations: GH analysis, prolactin levels, MRI or CT, and visual field tests

    Treatment

    • Surgery (primary choice)
    • Radiotherapy
    • Drug treatment: dopamine agonists, somatostatin, and pegvisomant
    • Aim of treatment: reduce GH levels to normal, alleviate symptoms, and improve general wellbeing

    Hyperprolactinemia

    • Normal prolactin level: less than 20 nanograms per milliliter
    • Symptoms: galactorrhoea, oligomenorrhoea or amenorrhoea, reduced libido, and pressure effects
    • Causes: prolactinoma, pregnancy, stress, low thyroid function, and certain medications
    • Diagnosis: serum prolactin level, pregnancy test, laboratory tests, and radiological tests
    • Treatment: replacing growth hormone, injection of replacement hormone, and monitoring for side effects

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