Clinical Aspects of Pituitary Disease

Question 1

What are examples of diseases caused by hypersecretion of the pituitary gland?

Answer 1

Acromegaly (GH)

Cushing’s disease (ACTH)

Hyperprolactinaemia (prolactin)

Question 2

What are some clinical features of acromegaly?

Answer 2

Spade like hands

Wide feet

Coarse facial features

Thick lips and tongue

Carpal tunnel syndrome

Sweating

Question 3

What are some complications of acromegaly?

Answer 3

Headache

Chiasmal compression

Diabetes mellitus

Hypertension

Cardiomyopathy

Sleep apnoea

Question 4

What disease is this?

Answer 4

Question 5

What investigations are used to diagnose acromegaly?

Answer 5

OGTT (give carbohydrates and see if GH and IGF-1 is suppressed like it should be)

Random Serum GH

GHRH

MRI (look for pituitary tumour)

Question 6

What disease is this?

Answer 6

Cushing’s syndrome

Question 7

What is the clinical manifestation of hyperprolactinaemia?

Answer 7

Question 8

What is the aetiology of hyperprolacticaemia?

Answer 8

• Physiological
  
  • Pregnancy, lactation, stress
• Pharmacological
  
  • DA depleting and DA antagonist drugs
• Pathological
  
  • Primary hypothyroidism
  • Pituitary lesions (prolactinoma or pituitary stalk pressure)

Question 9

What are some examples of drugs that may cause hyperprolactinaemia?

Answer 9

• Dopamine antagonists
  
  • Neuroleptics
  • Anti-emetics
• DA depleting agents
• Oestrogens
• Some antidepressents

Question 10

What are some clinical features of pituitary hypofunction?

Answer 10

• Adults
  
  • Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
  • Skin pallor
  • Reduced body hair
• Children
  
  • Reduced linear growth
  • Delayed puberty

Question 11

What is an example of a condition that is caused by pituitary hypofunction?

Answer 11

Cranial diabetes insipidus

Question 12

What causes cranial diabetes insipidus?

Answer 12

Hypothalamus does not produce enough vasopressin hormone

Question 13

What investigation is done for cranial diabetes insipidus?

Answer 13

Fluid deprivation test assess ability of kidneys to concentrate urine under the influence of ADH

Question 14

What is the differential diagnosis for cranial diabetes insipidus?

Answer 14

• Idiopathic
• Post-trauma
• Metastatic carcinoma
• Craniopharyngioma
• Other brain tumours such as germinoma
• Rare causes like sarcoidosis

Question 15

What visual field defect is caused by a pituitary tumour?

Answer 15

Bitemporal hemianopia

Question 16

What is the management of acromegaly due to pituitary tumour?

Answer 16

Somatostatin analogues

GH receptor antagonist

Question 17

What is the management of hyposecretion due to pituitary tumour?

Answer 17

Cortisol, T4, sex steroids, GH

Desmopressin

Question 18

What is the treatment of pituitary tumours?

Answer 18

Surgery (mostly transphenoidal)

Radiotherapy

Question 19

What monthly injections can be given for the management of acromegaly?

Answer 19

Slow release octreotide and lanreotide

Question 20

What are some adverse effects of somatostatin analogues in treatment of acromegaly?

Answer 20

• Nausea, cramps, diarrhoea, flatulence
• Cholesterol gallstones
• Slow release preparations required monthly injections
• High cost

Question 21

Management of Hyperprolactinaemia

Answer 21

Dopamine agonist

Surgery

Stop drugs which reduce dopamine:

Anti-emtetics

Oestrogen (not the OCP)

Antipsychotics and antidepressants

Question 22

Iatrogenic causes of diabetes insipidus

Answer 22

Litium (biploar drug)