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ENDOCRINOLOGY > 1b Hypopituitarism & Anterior Pituitary dysfunction > Flashcards

1b Hypopituitarism & Anterior Pituitary dysfunction Flashcards

1
Q

what are the anterior pituitary hormones

A 
Growth Hormone
Prolactin
Thyroid stimulating hormone
Lutenising hormone/Follicle stimulating hormone
Adrenocorticotrophic hormone
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2
Q

What does FSH and LH do in men?

A

FSH: spermatogenesis
LH: testosterone production

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3
Q

where does the pituitary sit

A

sella turcica of sphenoid bone

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4
Q

what does the anterior pituitary rely on?

A

the hypothalamus (to regulate function by releasing or inhibiting factors)

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5
Q

what factors are released by the hypothalamus for the AP

A 
growth hormone releasing hormone
somatostatin
thyrotrophin releasing hormone
dopamine
gonadotrophin releasing hormone
corticotrophin releasing hormone
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6
Q

what is a primary endocrine disease

A

disease where the pathology originates in the gland itself e.g ovaries

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7
Q

what is a secondary endocrine disease

A

disease where the pathology originates in the signals from the hypothalamus/anterior pituitary

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8
Q

what is primary hypothyroidism

A

thyroid doesn’t produce thyroxine
Hashimotos - autoimmune
T3&4 fall TSH high

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9
Q

what is secondary hypothyroidism

A

thyroid functioning, no releasing signals

TSH falls, T3/4 fall

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10
Q

Why can’t we measure TSH or CRH

A

located only in hypothalamic pituitary portal system

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11
Q

what is primary hypoadrenalism

A

Addisons disease
adrenal cortex damaged/destroyed by autoimmune eg TB
ACTH high, cortisol low

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12
Q

How do we measure fT4?

A

Measure for 6 days

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13
Q

what is secondary hypoadrenalism

A

adrenal cortex functioning,
but can’t make ACTH
ACTH falls, cortisol low

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14
Q

When do we take cortisol measurements?

A

suspected hypo: 9am cortisol (when it should be at its highest)
suspected hyper: midnight cortisol (when it should be at its lowest)

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15
Q

what is primary hypogonadism

A

gonads not functional

LH and FSH high, test/oest low

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16
Q

Another test to measure ACTH and GH

A

Insulin tolerance test, give them hypoglycaemia to see if release of these hormones (GH and ACTH) are normal and then measure Cortisol to see if its primary or secondary.

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17
Q

what is secondary hypogonadism

A

gonadotrophs (pituitary) damaged/hypothalamus damage

LH/FSH fall, test/oest fall

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18
Q

congenital causes of hypopituitarism

A

mutations for anterior pituitary transcription e.g PROP1

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19
Q

pattern of cortisol hormones

A

diurnal

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20
Q

what are the signs of congenital hypopituitarism

A

deficient in GH (main one) & at least one more hormone since birth

hypoplastic (underdeveloped) anterior pituitary

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21
Q

acquired causes of hypopituitarism

A

Tumours
infection eg meningitis
traumatic brain injury
pituitary surgery
pituitary apoplexy/ haemorrhage
peri-partum infarction (sheehan’s syndrome)

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22
Q

what is hypophysitis

A

inflammation of the pituitary or infundibulum

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23
Q

What does hypopituitarism usually describe?

A

Anterior pituitary dysfunction

24
Q

what is pituitary apoplexy

A

bleeding into a pituitary adenoma (causing sudden enlargement and damaging the pituitary)

25
Q

What is panhypopituitarism?

A

Total loss of anterior and posterior pituitary function

26
Q

what is the name for complete loss of pituitary function (post. and ant.)

A

panhypopituitarism

27
Q

what are the causes of pituitary apoplexy

A

haemorrhage

less commonly infarction

28
Q

what procedures may cause radiotherapy-induced hypopituitarism

A 
acromegaly treatment (radio right to pit.)
nasopharyngeal carcinoma treatment (indirect)
29
Q

what hormones are most sensitive to radioactivity

A

Growth hormone and gonadotrophins and prolactin

Prolactin

30
Q

how long does the risk of radiotherapy persist for?

A

up to 10yrs

requires annual assessment

31
Q

How does radiotherapy cause hypopituitarism?

A

destroys DNA so cell eventually die - brain cell have slow turnover so can take years

32
Q

how does hypopituitarism affecting LH/FSH present?

A

reduced libido
secondary amenorrhoea
erectile dysfunction
reduced pubic hair

33
Q

how does hypopituitarism affecting ACTH present?

A

fatigue

no salt balance issues

34
Q

how does hypopituitarism affecting TSH present?

A

fatigue, weight gain

35
Q

how does hypopituitarism affecting GH present?

A

reduced quality of life, short stature in children

36
Q

how does hypopituitarism affecting Prolactin present?

A

inability to breastfeed

37
Q

what is sheehan’s syndrome?

A

post-partum hypopituitarism secondary to hypotension/post-partum haemorrhage

38
Q

how does sheehans syndrome happen?

A

pituitary swells so anterior pituitary is more likely to be damaged following hypotension during delivery, causing pituitary infarction

39
Q

what are the signs of sheehans syndrome

A

lethargy, anorexia, weight loss, failure of lactation!!, failure to resume menses!!!
!!- most obv

40
Q

what happens to the pituitary during pregnancy

A

enlargement **(lactotroph hyperplasia)

41
Q

why is only the anterior pit affected in sheehans

A

diff portal system

42
Q

what is the onset of pituitary apoplexy?

A

dramatic and sudden

often precipitated by anti-coagulants

43
Q

what are the signs of pituitary apoplexy

A

severe sudden onset headache
visual field defect - bitemporal hemianopia
possible diplopia and ptosis (droopy eyelids)

44
Q

how does apoplexy show up on MRIs and what is it treated by?

A
  • anticoags
  • white ball
45
Q

what methods can be used to diagnose hypopituitarism

A

blood tests, dynamic pituitary function tests (stress test), pituitary MRI

46
Q

what hormone dysfunction cannot be treated

A

prolactin

47
Q

what is the guidance for treating hypopituitarism affecting GH?

A

daily injection of GH

measure response by improvement in quality of life and plasma IGF-1

48
Q

how to confirm GH treatment is working

A

assess quality of life and measure response to this

measure plasma IGF-1

49
Q

what is the guidance for treating hypopituitarism affecting TSH

A

once daily levothyroxine

aim for fT4 above middle of reference range

50
Q

what is the guidance for treating hypopituitarism affecting ACTH?

A

prednisolone once daily AM
or
hydrocortisone 3x daily

51
Q

what is an adrenal crisis

A

dizziness, hypotension, vomiting, weakness triggered by intercurrent illness
can collapse and die

52
Q

what should patients taking replacement steroids be advised to do?

A

keep steroid alert pendant
double steroid dose if fever/intercurrent illness
if unable to take tablets, inject IM or come to A&E

53
Q

what are the guidelines for hypopituitarism affecting LH/FSH in men?

A

replace testosterone topically or IM

if fertility required - gonadotrophin injections, sperm production should resume 6-12 months after

54
Q

when is fertility in men best conserved?

A

if secondary hypogonadism developed after puberty (gonads are right size/development)

55
Q

what are the guidelines for hypopituitarism affecting LH/FSH in women?

A

oral or topical oestrogen
addition of progesterone if uterus is intact to prevent endometrial hyperplasia
if fertility is required, carefully timed IVF and gonadotrophin injections can induce ovulation

56
Q

signs/presentation of pituitary apoplexy

A

sudden onset - blood/haemorrhage in cavernous sinus

cranial III defect as blood compresses this - ptosis

57
Q

radilogical diagonsis of hypopit?

A

empty sella
apoplexy
adenoma

ENDOCRINOLOGY (20 decks)

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