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lcrs y2: endocrinology > Anterior pituitary - Hyposecretion > Flashcards

Anterior pituitary - Hyposecretion Flashcards

1
Q

Distinguish between primary and secondary disease states relating to pituitary function

A

Primary disease - malfunction of gland itself

Secondary disease - signalling malfunction between brain and gland

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2
Q

Define the term panhypopituitarism

A

Decreased production of all anterior pituitary hormones

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3
Q

What is the most common mutation in congenital panhypopituitarism?

A

Mutation in TF genes for normal pit. development

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4
Q

Recall 4 possible tumours that could cause panhypopituitarism

A
  1. Hypothalamic tumour (craniopharyngoma)
  2. Pituitary adenoma
  3. Pituitary cyst
  4. Secondary tumour, metastatic from elsewhere (eg. breast)
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5
Q

Explain the potential damage of radiotherapy on pituitary function

A

Can cause panhypopituitarism:
GH most vulnerable
TSH is relatively resistant

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6
Q

List 9 possible causes of panhypopitiutarism

A
  1. Congenital
  2. Tumour
  3. Radiotherapy
  4. Traumatic brain injury
  5. Infection (meningitis)
  6. Infiltrative disease (sarcoidosis)
  7. AI inflammation
  8. Pituitary apoplexy
  9. Sheehan’s syndrome
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7
Q

What is hypophysitis?

A

AI inflammation of pituitary

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8
Q

Explain the onset of Sheehan’s syndrome

A

Common in post-partum women
Peri-partum infarction following post-partum haemorrhage
Lactotrophic hyperplasia in pregnancy, then starved of blood –> irreversible damage

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9
Q

What is a pituitary apoplexy?

A

Bleed into the pituitary (usually haemorrhage, can be infarct)

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10
Q

Recall 5 symptoms of FSH/LH deficiency

A
  1. Reduced libido
  2. Secondary amenorrhea
  3. Erectile dysfunction
  4. Failure of lactation
  5. Failure to resume menses post-delivery
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11
Q

Recall 3 signs of congenital panhypopituitarism

A
  1. Deficient in GH and at least 1 other AP hormone
  2. Short stature
  3. Hypoplastic AP on MRI
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12
Q

Recall 3 symptoms of Sheehan’s syndrome

A
  1. Lethargy
  2. Anorexia and weight loss
  3. Deficiency in LH and FSH
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13
Q

What is a common first-presentation of a pituitary adenoma?

A

Pituitary apoplexy

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14
Q

Describe the effect of anti-coagulants on pituitary adenoma

A

Can precipitate pituitary apoplexy

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15
Q

Recall 2 general symptoms of pituitary apoplexy

A
  1. Severe, sudden onset headache

2. Visual field defects

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16
Q

Recall 3 visual field defects that may present in pituitary apoplexy and their causes

A
  1. Compression of optic chiasm –> bitemporal hemianopia
  2. Cavernous sinus involvement–> diplopia
  3. Cavernous sinus involvement–> ptosis
17
Q

Why do pituitary tumours cause loss of peripheral vision?

A

At optic chiasm, fibres from nasal retina (that receive peripheral light) cross

18
Q

Recall 3 dynamic tests of pituitary function

A
  1. Insulin-dosage to induce hypoglycaemia - should see increase in GH and cortisol
  2. TRH dosage and look for TSH response
  3. GnRH dosage and look for FSH/LH production
19
Q

Recall 3 genetic causes of GH deficiency

A

Down’s, Turner’s, PWS

20
Q

What 2 types of skeletal dysplasia might leas to short stature?

A

OI

Achondroplasia

21
Q

How is GH deficiency tested?

A

Provocative challenge

22
Q

Recall 4 ways of testing for GH deficiency

A
  1. GnRH and arginine
  2. Insulin
  3. Glucagon (vomiting induced)
  4. Exercise
23
Q

How is GH deficiency treated?

A

Daily, subcutaneous somatotropin injection

24
Q

What is the main drawback of GH therapy?

A

Price

25
Q

Recall 6 non-endocrine causes of short stature, giving examples

A
  1. Genetic (Down’s, Turners, PWS)
  2. Emotional deprivation
  3. Systemic disease (CF, rheumatoid arthritis)
  4. Malnutrition
  5. Malabsorption (Coeliac)
  6. Skeletal dysplasia (OI/ achondroplasia)
26
Q

Recall 4 possible endocrine causes of short stature

A

Cushing’s
Hypothyroidism
GH deficiency
Type 1 DM

27
Q

Recall 4 causes of GH deficiency in adults

A

Trauma
Pituitary tumour
Pituitary surgery
Cranial radiotherapy

28
Q

Recall 4 symptoms of GH deficiency

A
  1. Decreased psychological wellbeing
  2. Raised LDL
  3. Increased central adiposity
  4. Reduced muscle bulk

lcrs y2: endocrinology (18 decks)

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