2. Hypersecretion of AP

Question 1

Hyperprolactinaemia

Answer 1

Normal in breastfeeding women
Pathological if caused by prolactinoma

Causes secondary hypogonadism (since high prolactin suppresses GnRH pulsatility)

Question 2

Treatment for hyperprolactinaemia

Answer 2

D2 agonist (Cabergoline)

Binds to D2 receptor on lactotrophs in AP and suppresses prolactin

Question 3

What is acromegaly? Symptoms?

Answer 3

Excess GH in adults
Caused by benign GH secreting pituitary adenoma
Tumour also secretes high prolactin -> secondary hypogonadism

Course features (big hands/feet/nose/tongue/protruding lower jaw)
Carpal Tunnel syndrome
Excessive sweating + headache

Question 4

Complications of acromegaly

Answer 4

Obstructive sleep apnoea (narrowing of upper airways)
Hypertension (renal Na reabsorption due to GH)
Cardiomyopathy (direct toxic effects of GH on heart)

Question 5

Diagnosis of acromegaly

Answer 5

PARADOXICAL RISE in GH after 75g oral glucose admin

Also check elevated serum IGF1

Question 6

Treatment of acromegaly

Answer 6

1. SURGERY (trans-sphenoidal surgery, remove adenoma)

2. Somatostatin analogue (octreotide) or D2 agonist (cabergoline)

Question 7

Side effects of somatostatin analogues?

Answer 7

GI side effects (turns off many gut hormones)