adenomas, prolactinomas and acromegaly Flashcards
what is the difference between a micro and a macro adenoma?
≤ 1cm: Microadenoma
> 1cm: Macroadenoma
what happens if an adenoma is too big?
Compression on optic chiasma
Compression on other structures
eg cranial nerve 3,4,6
what happens if an adenoma is too little?
Hypoadrenalism
Hypothyroidism
Hypogonadism
(Diabetes Insipidus)
GH deficiency
what is the management of a pituitary adenoma?
transphenoidal surgery
replace hormones
which hormone inhibits prolactin?
dopamine
what are the physiological causes of raised prolactin?
breast feeding - pregnancy - stress/anxiety
sleep
what are the pharmacological causes of raised prolactin?
Dopamine antagonists eg metoclopramide Antipsychotics eg phenothiazines antidepressants eg TCA, SSRIs other- oestrogens, cocaine
what are the pathological causes of raised prolactin?
Hypothyroidism
Stalk lesions
iatrogenic
road accident
Prolactinoma
what are the clinical signs of this in females?
EARLY presentation
Galactorrhoea
(30-80%)
Menstrual irregularity
Ammenorrhoea
Infertility
what are the clinical signs of this in males?
LATE Presentation
Impotence
Visual field abnormal
Ant pit malfunction
what is the drug treatment for prolactinoma?
dopamine agonists
what are some examples of dopamine agonists?
bromocriptine
quinagolide (norprolac)
cabergoline (dostinex)- most commonly used
what are the side effects of dopamine agonists?
Nausea / Vomiting
Low Mood
Obsessive compulsive behaviour (gambling, spending spree, hypersexualisation)
Fibrosis (heart valves/retroperitoneal)?
what causes acromegaly?
GH excess
what are the symptoms and signs of acromegaly?
Giant (before epiphyseal fusion)
Thickened soft tissues -
-skin, large jaw, sweaty, large hands
Snoring/Sleep apnoea (thicked naasopharynx)
Hypertension (heart), cardiac failure
Headaches (vascular)
Diabetes mellitus
Local pituitary effects -
-visual fields, hypopituitarism
Early CV Death
Colonic polyps and colon cancer
