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BRS ENDOCRINOLOGY > 1b Hypopituitarism > Flashcards

1b Hypopituitarism Flashcards

1
Q

What are the five anterior pituitary hormones?

A

growth hormones, prolactin, thyroid stimulating hormone (TSH), luteinising hormone, follicle stimulating hormones (FSH), ACTH

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2
Q

What is the purpose of hypothalamic releasing factors?

A

travel in the portal circulation to the anterior pituitary to regulate anterior pituitary hormone production

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3
Q

What is primary disease in relation to the pituitary?

A

When the gland itself fails

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4
Q

What is secondary disease in relation to pituitary function?

A

when no signal are received from the hypothalamus or anterior pituitary

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5
Q

What happens to TSH and T3 and T4 when a patient has primary hypothyroidism? Why?

A

T3 and T4 fall and TSH increases - Primary = problem with the gland itself therefore thyroxine levels are lowered, and due to the negative feedback of TSH, this causes the levels to rise

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6
Q

What happens to T3 and T4 and TSH levels when a patient has secondary hypothyroidism?

A

TSH Falls as the patient cant make it from the pituitary, and because of this T3 and T4 also lower

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7
Q

Why is only cortisol impacted with disorders of the adrenal gland?

A

Cortisol is regulated by ACTH, aldosterone is through the renin-angiotensin system

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8
Q

What happens to cortisol and ACTH levels during primary hypoadrenalism?

A

Cortisol falls, ACTH Increases - this is due to destruction of the adrenal cortex

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9
Q

What happens to cortisol and ACTH levels during secondary hypoadrenalism?

A

pituitary tumour damaging corticotrophs
Can’t make ACTH
ACTH falls, cortisol falls

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10
Q

What happens to TESTOSTERONE/OESTROGEN and FSH/LH levels during secondary hypogonadism?

A

Can’t make LH/FSH
LH/FSH fall, and therefore Testosterone/oestrogen fall

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11
Q

What happens to Testosterone/Oestrogen and LH and FSH levels during primary hypogonadism?

A

Testosterone (men) or oestrogen (women) fall, LH
& FSH increase

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12
Q

Patients with congenital hypopituitarism?

A

Usually due to mutations of
transcription factor genes needed
for normal anterior pituitary
developmente.g. PROP1
* Deficient in GH and at least 1
more anterior pituitary hormone
* Short stature
* Hypoplastic (underdeveloped)
anterior pituitary gland on MRI

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13
Q

What are some acquired causes of hypopituitarism?

A
  • tumours, radiation, infection,
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14
Q

What is hypophysitis?

A

Inflammation of the pituitary

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15
Q

What is panhypopituitarism?

A

Total loss of anterior and posterior pituitary function

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16
Q

Describe the relationship between the dosage of radiotherapy and the risk of HPA Axis damage?

A

higher total dose = higher risk

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17
Q

Which hormones are most sensitive to Radiotherapy?

A

GH and gonadotrophins

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18
Q

Which endocrine organs are highly sensitive to radiation?

A

Pituitary and hypothalamus

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19
Q

Why is continual assessment required for patients with radiotherapy induced hypopituitarism?

A

Risk persists up to 10y after
radiotherapy, so annual assessment

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20
Q

What are the presentations of hypopituitarism (FSH/LH)?

A

Reduced libido
Secondary amenorrhoea
Erectile dysfunction
Reduced pubic hair

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21
Q

What are the presentations of hypopituitarism (ACTH)?

A

Fatigue

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22
Q

What are the presentations of hypopituitarism (TSH)?

A

Fatigue

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23
Q

What are the presentations of hypopituitarism (GH)?

24
Q

What are the presentations of hypopituitarism (PRL)?

A

no breastfeeding

25
What is Sheehan's syndrome?
Post partum hypopituitarism secondary to hypotension (PPH - Post Partum Haemorrhage)
26
What happens to the anterior pituitary in pregnancy?
Enlarges - lactotroph hyperplasia
27
How does a post partum haemorrhage lead to a pituitary infarction?
Haemorrhage = blood pressure drops, as not enough blood to the enlarged pituitary = infarction as the pituitary is deprived
28
Why does the anterior pituitary enlarge in pregnancy?
enlarge as they prepare to lactate
29
Four key symptoms of sheehans?
Lethargy, anorexia, weight loss – TSH/ACTH/(GH) deficiency * Failure of lactation – PRL deficiency * Failure to resume menses post-delivery * Posterior pituitary usually NOT affected
30
Why is the posterior pituitary usually not affected by Sheehan's syndrome?
posterior pituitary is a downward extension from the hypothalamus and therefore is neuronal tissue
31
What is a pituitary apoplexy?
Bleeding (Haemorrhage) into the pituitary or loss of blood flow (infarction) to the pituitary
32
What might be the first presentation of a pituitary adenoma?
Pituitary apoplexy
33
What can help precipitate a pituitary apoplexy?
Anti-coagulants
34
What are the key symptoms of a pituitary apoplexy?
- Severe sudden onset headache * Visual field defect – compressed optic chiasm, bitemporal hemianopia
35
Why must you exercise caution when interpreting basal plasma hormone concentrations?
Cortisol – what time of day? * T4 – circulating t1/2 6 days * FSH/LH – cyclical in women * GH/ACTH - pulsatile
36
How is the "stressed" state induced when performing a dynamic pituitary function test?
Giving the patient insulin in order to replicate the hypoglycaemic state
37
What are the two "stress" hormones?
GH and ACTH Release
38
What does the insulin-induced hypoglycaemia stimulate?
GH release and ACTH Release
39
Why are MRI's used to diagnose hypopituitarism?
Highest resolution - CT not good
40
What radiological landmark is looked for on an MRI of the pituitary?
Posterior pituitary bright spot
41
What is the treatment for GH deficiency?
- confirm GH deficiency on dynamic function test and assess QoL - give daily injection
42
How is the effect of GH treatment measured?
Improvement in QoL and plasma IGF-1
43
What is the treatment for TSH deficiency?
Levothyroxine
44
What must you aim for when treating a TSH deficiency and why?
Aim for fT4 above the middle of the reference range - the TSH will be low therefore you cannot use this to adjust the dose
45
What challenge is faced when treating ACTH deficiency?
Difficult to mimic diurnal variation of cortisol
46
What are the two main treatment options for ACTH deficiency?
Prednisolone and hydrocortisone
47
What is important to mention to patients who are on steroid replacement?
Sick Day Rules - must have a steroid alert bracelet
48
What happens to the dose of steroid if a patient with ACTH deficiency falls sick?
double steroid dose if they have a fever / intercurrent illness
49
What is the treatment for FSH/LH deficiency in men if fertility is and isnt required?
No fertility = replace testosterone (topical or intramuscular) as this does not impact sperm production Fertility = Induction of spermatogenesis by gonadotropin injections * Best response if secondary hypogonadism has developed after puberty * Measure testosterone and semen analysis * Sperm production may take 6-12 months
50
What is the treatment for FSH/LH deficiency in women if fertility is and isnt required?
No fertility = replace oestrogen (oral/topical) Fertility = induce ovulation. by carefully timed gonadotropin injections
51
What will women need if they are receiving additional oestrogen?
Additional progesterone if intact uterus to prevent endometrial hyperplasia
52
Which hormone increases its levels after radiotherapy?
Prolactin
53
Sudden onset headache and bitemporal hemaniopia...what is the diagnosis?
Pituitary apoplexy
54
What are the signs of an adrenal crisis?
Dizziness, hypotension, vomiting, weakness and can result in collapse and death
55
Which patients should be told sick day rules?
Patients who take replacement steroids like prednisolone, hydrocortisone

BRS ENDOCRINOLOGY (20 decks)

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