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2a- Endocrinology > Acromegaly and Prolactinoma > Flashcards

Acromegaly and Prolactinoma Flashcards

1
Q

Define acromegaly

A

abnormal growth of hands, feet and face due to overproduction of GH

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2
Q

Name the co-morbidities of acromegaly

A
  • Hypertension and heart disease
  • Cerebrovascular events and headache
  • Arthritis
  • Sleep apnea
  • Insulin – resistant diabetes
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3
Q

What is the diagnosis of acromegaly dependent on?

A
  • Clinical Features
  • GH
  • IGF-I
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4
Q

What are the presenting features of acromegaly?

A
  • Acral (hands + feet) enlargement
  • Arthralgias (joint stiffness)
  • Maxillofacial changes
  • Excessive sweating
  • Headache
  • Hypogonadal symptoms
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5
Q

In the criteria for diagnosing acromegaly, what result shows no acromegaly?

A

random GH <0.4 ng/ml and normal IGF-I

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6
Q

When would you do a glucose tolerance test (GTT) in diagnosing acromegaly?

A

If either GH>0.4 ng/ml or high IGF-I

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7
Q

How much glucose is given in a GTT?

A

75g

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8
Q

What result would exclude acromegaly after a GTT?

A

IGF-I normal and GTT nadir GH <1 ng/ml

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9
Q

What are the objectives of therapy in acromegaly?

A
  • restoration of basal GH and IGF-I to normal levels
  • relief of symptoms
  • reversal of visual and soft tissue changes
  • prevention of further skeletal deformity
  • normalization of pituitary function
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10
Q

What are some options for acromegaly treatment?

A
  • Pituitary surgery
  • Medical therapy
  • Radiotherapy
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11
Q

What is the primary treatment for all types of pituitary adenoma (except prolactinoma)?

A

Transsphenoidal pituitary surgery

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12
Q

What makes transsphenoidal pituitary surgery harder?

A
  • Large size
  • Invasiveness
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13
Q

What are 2 important determinants of success of surgery?

A
  • size of tumour
  • the surgeon
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14
Q

What are some examples of medical therapy?

A
  • Dopamine agonists e.g. cabergoline
  • Somatostatin analogues
  • Growth Hormomne receptor antagonist
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15
Q

What are problems with radiotherapy?

A
  • Loss of pituitary function in the long-term
  • Potential damage to local structures – e.g. eye nerves
  • Control of tumour growth / excess hormone secretion not always achieved
  • Life-long monitoring needed for all patients
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16
Q

What are disadvantages of conventional radiotherapy?

A
  • delayed response
  • hypopituitarism
  • rare secondary tumors
  • rare visual defects
17
Q

Define prolactinoma

A

lactotroph cell tumour of the pituitary

18
Q

Do prolactinomas affect men or women more?

A

Women

19
Q

How does hyperprolactinemia occur?

A
  • Dopamine inhibits prolactin
  • If you lose inhibition then it occurs
20
Q

How does amenorrhea occur?

A
  • Hyperprolactinemia occurs
  • Inhibits LH and FSH, no oestrogen → secondary amenorrhea
21
Q

What are clinical features of prolactinomas?

A
  • Local effect of tumour – macroadenoma
    • Headache
    • Visual field defect (bi-temporal hemianopia)
    • CSF leak (rare)
22
Q

What are the effects of prolactin?

A
  • Menstrual irregularity/ amenorrhoea
  • Infertility
  • Galactorrhoea
  • Low libido
  • Low testosterone in men
23
Q

Define a microadenoma

A

tumour <1cm

24
Q

Define a macroadenoma

A

tumour >1cm

25
Q

What does a microprolactinoma do?

A

virtually always stays small

26
Q

What does a macroprolactinoma do?

A

can be massive

27
Q

What does a non functional pituitary tumour do?

A

compresses pituitary stalk – prolactin <4000 mIU/L

28
Q

What group of drugs needs a drug history for hyperprolactinaemia?

A

Antidopaminergic drugs

29
Q

What are other causes of hyperprolactinaemia?

A

stress, hypothyroidism, PCOS, drugs, renal failure, chest wall injury

30
Q

Describe the management of prolactinoma

A
  • Unlike other pituitary tumours management is medical rather than surgery
  • Dopamine agonists – cabergoline, bromocriptine, quinagolide
  • Remarkable shrinkage usual with macroadenoma – sight saving
  • Microadenoma - usually respond to small doses of cabergoline just once or twice per week
31
Q

What can prolactinomas lead to?

A

infertility and hypogonadism

2a- Endocrinology (17 decks)

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