C - Pituitary Flashcards
can pituitary failure cause hypotension
no
name the pituitary hormones
GH
Prolactin
TSH
LH
FSH
ACTH
what does TRH increase
TSH
prolactin
what does dopamine decrease
prolactin
what 2 Sx indicate pituitary dysfunction
galactorrhoea
amenorrhoea
define macroadenoma of pituitary
> 1cm
complication of macroadenoma
bitemporal hemianopia
what is spared in bitemporal hemianopia and what does this mean for Sx
macular spared
fine vision normally
what is a raised prolactin
> 600
what does a prolactin of >600 indicate
pregnant or prolactinoma
what does a prolactin of >6000 indicate
ALWAYS prolactinoma
how is pituitary function tested
LHRH
TRH
stress - hypoglycaemia
what hormonal changes are supposed to occur when hypoglycaemia is induced
increased GH
increased ACTH
what is the risk of inducing hypoglycaemia
MI / epilepsy
what does CPFT stand for
combined pituitary function test
how is a CPFT conducted
fast overnight, IV access
weigh them
give IV insulin 0.15U/kg, TRH 200mcg and LHRH 100mcg
wait 25 mins
take glucose, cortisol, GH, LH, FSH every 30 mins for 1hr
when is a hypo expected to occur in CPFT
30 mins
what is a normal result in CPFT
glucose <2.2
cortisol >450
LH / FSH >10
what medications are given in pituitary failure
stat hydrocortisone and prednisolone
why is fludrocortisone not in the Mx of pituitary failure
fludrocortisone is aldosterone which is from adrenals, which isn’t affected in pituitary failure
what other medications are given to children with pituitary failure
thyroxine
oestrogen
GH
prolactin antagonists & drug type
cabergoline
bromocriptine
(dopamine agonist)
why can high prolactin occur in pituitary failure
non functioning pituitary adenoma can press on stalk and prevent dopamine coming down, therefore unopposed prolactin production
why is prednisolone given with hydrocortisone for pituitary failure
prednisolone is a longer acting hydrocortisone
pituitary failure Sx but normal / xs GH. Dx?
acromegaly
Ix to confirm acromegaly
glucose tolerance test
Tx for acromegaly
cabergoline / octrectide
pituitary surgery
pituitary radio
what is gold standard for Mx of acromegaly
pituitary surgery
