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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)?

A

Lower QoL

24
Q

What are the presentations of hypopituitarism (PRL)?

A

no breastfeeding

25
Q

What is Sheehan’s syndrome?

A

Post partum hypopituitarism secondary to hypotension (PPH - Post Partum Haemorrhage)

26
Q

What happens to the anterior pituitary in pregnancy?

A

Enlarges - lactotroph hyperplasia

27
Q

How does a post partum haemorrhage lead to a pituitary infarction?

A

Haemorrhage = blood pressure drops, as not enough blood to the enlarged pituitary = infarction as the pituitary is deprived

28
Q

Why does the anterior pituitary enlarge in pregnancy?

A

enlarge as they prepare to lactate

29
Q

Four key symptoms of sheehans?

A

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
Q

Why is the posterior pituitary usually not affected by Sheehan’s syndrome?

A

posterior pituitary is a downward extension from the hypothalamus and therefore is neuronal tissue

31
Q

What is a pituitary apoplexy?

A

Bleeding (Haemorrhage) into the pituitary or loss of blood flow (infarction) to the pituitary

32
Q

What might be the first presentation of a pituitary adenoma?

A

Pituitary apoplexy

33
Q

What can help precipitate a pituitary apoplexy?

A

Anti-coagulants

34
Q

What are the key symptoms of a pituitary apoplexy?

A
  • Severe sudden onset headache
  • Visual field defect – compressed optic chiasm,
    bitemporal hemianopia
35
Q

Why must you exercise caution when interpreting basal plasma hormone concentrations?

A

Cortisol – what time of day?
* T4 – circulating t1/2 6 days
* FSH/LH – cyclical in women
* GH/ACTH - pulsatile

36
Q

How is the “stressed” state induced when performing a dynamic pituitary function test?

A

Giving the patient insulin in order to replicate the hypoglycaemic state

37
Q

What are the two “stress” hormones?

A

GH and ACTH Release

38
Q

What does the insulin-induced hypoglycaemia stimulate?

A

GH release and ACTH Release

39
Q

Why are MRI’s used to diagnose hypopituitarism?

A

Highest resolution - CT not good

40
Q

What radiological landmark is looked for on an MRI of the pituitary?

A

Posterior pituitary bright spot

41
Q

What is the treatment for GH deficiency?

A
  • confirm GH deficiency on dynamic function test and assess QoL
  • give daily injection
42
Q

How is the effect of GH treatment measured?

A

Improvement in QoL and plasma IGF-1

43
Q

What is the treatment for TSH deficiency?

A

Levothyroxine

44
Q

What must you aim for when treating a TSH deficiency and why?

A

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
Q

What challenge is faced when treating ACTH deficiency?

A

Difficult to mimic diurnal variation of
cortisol

46
Q

What are the two main treatment options for ACTH deficiency?

A

Prednisolone and hydrocortisone

47
Q

What is important to mention to patients who are on steroid replacement?

A

Sick Day Rules - must have a steroid alert bracelet

48
Q

What happens to the dose of steroid if a patient with ACTH deficiency falls sick?

A

double steroid dose if they have a fever / intercurrent illness

49
Q

What is the treatment for FSH/LH deficiency in men if fertility is and isnt required?

A

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
Q

What is the treatment for FSH/LH deficiency in women if fertility is and isnt required?

A

No fertility = replace oestrogen (oral/topical)

Fertility = induce ovulation. by carefully timed gonadotropin injections

51
Q

What will women need if they are receiving additional oestrogen?

A

Additional progesterone if intact uterus to prevent endometrial hyperplasia

52
Q

Which hormone increases its levels after radiotherapy?

A

Prolactin

53
Q

Sudden onset headache and bitemporal hemaniopia…what is the diagnosis?

A

Pituitary apoplexy

54
Q

What are the signs of an adrenal crisis?

A

Dizziness, hypotension, vomiting, weakness and can result in collapse and death

55
Q

Which patients should be told sick day rules?

A

Patients who take replacement steroids like prednisolone, hydrocortisone

BRS ENDOCRINOLOGY (20 decks)

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