Acromegaly, prolactinoma

Question 1

first line teratment for prolactinoma

Answer 1

dopamine agonist
surgery later on

Question 2

treatment for acromegaly

Answer 2

gH receptor antagonists - decreases IGF-1 but tumour size does not decrease - last line as expensive
dopamine agonsits
somatostatin analogs

Question 3

acromegaly

Answer 3

when pituitary makes too much growth hormone

overproduction usually comes from an adenoma in pituitary

leads to increase growth in bones and tissues

Question 4

clinical presentation of acromegaly

Answer 4

• Giant (before epiphyseal fusion)
  
  • Thickened soft tissues - skin, large jaw, sweaty, large hands
  • Snoring/sleep apnoea (thickened nasopharynx)
  • Hypertension, cardiac failure → early CV death
  • Headaches (vascular)
  • Diabetes mellitus
    Local pituitary effects - visual fields, hypopituitarism

Question 5

investigations in acromegaly

Answer 5

• IGF1 - age and sex matched, nearly always raised
  
  • Normal IGF-1 commonly excludes
  • Gold standard - GTT suppression test
    ○ 75g oral glucose: check GH at 0, 30, 60, 90, 120 min
    ○ Normally GH suppresses to <0.4 ug/l after glucose
    Acromegaly indicated if GH unchanged/no suppression or paradoxical rise

Question 6

management of acromegaly

Answer 6

pituitary surgery
transsphenoidal approach first line
- 90% cure if microadenoma
50% if macro

Question 7

when is radiotherapy performed in acromegaly

Answer 7

• Normally used after pituitary surgery fails to normalise GH levels
  Often combined with medium-term treatment using pharmacological management options

Question 8

complications of acromegaly

Answer 8

• GH excess can result in the formation of colon polyps and colon cancer - may be presenting feature
  
  • Increased risk of hypertension and cardiac failure can lead to early CV death
  • Obstructive sleep apnoea
    Cancer surveillance; colon and tubulo villous adenoma

Question 9

prolactinoma features

Answer 9

• Libido reduction
  
  • Erectile dysfunction
  • Gynaecomastia
  • Weigth gain
  • Delayed puberty development
  • Infertility
  • Galactohhorea
  • Osteopenia/ osteoporosis
  • Oligo amenorrhea
  • Vaginal dryness
    Irritability and depression

Question 10

what cells are responsible for producing prolactin

Answer 10

lactotroph cells

Question 11

prolactinoma

Answer 11

benign tumour in pituitary gland that secretes prolactin

Question 12

what is surgery preserved for in prolactinoma

Answer 12

dopamine agonist resistants / intolerance to/ contraindication/ patient preference of long term therapy

Question 13

first lien treatment for reducing prolactin levels

Answer 13

cabergoline - dopamine agonsit
reduces prolactin levels and shrinks tumour

Question 14

side effects of prolactin

Answer 14

fibrosis reactions
impulse control/ psychiatric disturbance

Question 15

causes of raised prolactin

Answer 15

heroin
resperidone - mental health drug

Question 16

microadenoma

Answer 16

<10mm

Question 17

macroadenoma

Answer 17

> 10mm

Question 18

gonadotroph

Answer 18

cell found in anterior pituitary
secretes gonadotropins

Question 19

gonadotropins

Answer 19

hormones that stimulate the gonads to produce sex hormones and support reproductive functions

Question 20

main gonadotropins

Answer 20

lutenizing hromone - triggers ovulation in females and triggers production of testosterone in males

follicle stimulating hormone - promoes development of eggs in females and sperm in males

Question 21

what is the secretion of LH and FSH controlled by

Answer 21

gonadotropin releasign hromone which is released from hypothalamus