264. Disorders of the Pituitary Gland Flashcards
Hypopituitarism is decreased secretion of anterior pituitary hormones. What are its causes?
Hypothalamus: Kallman’s syndrome, tumour, inflammation/infection
Pituitary stalk: trauma, surgery, mass legion, meningioma, carotid artery aneurysm.
Pituitary: tumours, irradiation, inflammation, autoimmunity
What are the features of hypopituitarism?
Very non-specific, tends to effect GH first therefore:
Central obesity, dry wrinkly skin, decreased strength and balance, decreased exercise ability
Will also have the effects of other hormone deficincies e.g. erectile dysfunction, low bp, low glucose, hypothyroid symptoms
What are the tests for hypopituitarism?
All levels of circulating hormones will be low, dynmaic tests include short synatchen to investigate adrenal axis or insulin tolerance test
MRI scan can be useful to look for a lesion
How is hypopituitarism treated?
hormone replacement, hydrocortisone first for adrenal failure
What are the three types of pituitary tumours?
Chromophole (70%)
Acidophil
Basophil
Nearly all tumours are benign adenomas
What are the features of a pituitary tumours?
Headache, visual field defect
Palsy of cranial nerves III,IV and VI
How are pituitary tumours treated?
Once assessed by MRI scan they are typically surgically removed typically trans-sphenoidal
Radiotherapy- used for residual or recurrent adenomas
What is pituitary apoplexy?
Rapid pituitary enlargement caused by bleed into a tumour. Presents with headaches, blurred vision and reduced GCS.
Urgent steroids and a careful fluid balance is needed to prevent cardiovascular collapse
How does hyperprolactinaemia present?
woman- menstrual disturbances, galactorrhoea
men- erectile dysfunction, decreased facial hair galactorrhoea
What are the causes of hyperprolactinaemia?
Phsyiological- pregancy, breastfeeding, stress
Drugs- metoclopramide, haloperidol, methyldopa, eccies, anti-psychotics.
Diseases- prolactinoma, stalk damage, hypothalmic disease
What tests are done to investigate hyperprolactinaemia?
Basal PRL
pregnancy test
How is hyperprolactinaemia managed?
Microprolactinomas <10mm- bromocriptine titrate up. Consider surgery if intolerant
Macroprolactinomas >10mm- treat initially with bromocriptine but consider surgery if pressure symptoms
What is acromegaly?
Increased growth hormone typically from a pituitary tumour and very rarely from a carcinoid tumour
What are the symptoms of acromegaly?
pins and needles in the hands and feet (acroparasthesia)
Reduced libido, increased snorining, headache
“my rings wont fit”, curly hair, was muscle, now fat.
What are the signs of acromegaly?
Growth of hands, jaw and feet
Wide nose, big tongue, widely spaced teeth,
Skin darkening, sleep apnoea, goitre, carpal tunnel signs
