Clinical Aspects of Pituitary Disease

Question 1

What are the endocrine orgons?

Answer 1

Hypothalamus

Pituitary gland

Thyroid gland

Parathyroid gland

Ovaries

Pancreas

Adrenal glands

Testis

Question 2

What are the different classifications of pituitary disease?

Answer 2

Hypersecretion (tumours)

Hyposecretion (mostly tumours, other causes)

Space occupation

Question 3

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

Answer 3

Acromegaly (GH)

Cushing’s disease (ACTH)

Hyperprolactinaemia (prolactin)

Question 4

What is hypersecretion of the pituitary gland usually caused by?

Answer 4

Tumours

Question 5

What is hyposecretion of the pituitary gland usually caused by?

Answer 5

Mostly tumours, other causes

Question 6

What is an example of a space occupation complication of the pituitary gland?

Answer 6

Optic chiasmal compression

Question 7

What are some clinical features of acromegaly?

Answer 7

Spade like hands

Wide feet

Coarse facial features

Thick lips and tongue

Carpal tunnel syndrome

Sweating

Question 8

What are some complications of acromegaly?

Answer 8

Headache

Chiasmal compression

Diabetes mellitus

Hypertension

Cardiomyopathy

Sleep apnoea

Question 9

What disease is this?

Answer 9

Question 10

What investigations are used to diagnose acromegaly?

Answer 10

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

MRI (look for pituitary tumour)

Question 11

What is Cushing’s syndrome caused by?

Answer 11

Excess corticosteroids

Question 12

Is cortisol a catabolic or anabolic hormone?

Answer 12

Catabolic

Question 13

What effects does cortisol have that leads to Cushing’s syndrome?

Answer 13

Tissue breakdown (causing weakness of skin, muscle and bone)

Sodium retention (cause hypertension and heart failure)

Insulin antagonism (may cause diabetes)

Question 14

What is the clinical presentation of Cushing’s syndrome?

Answer 14

Question 15

Is cushing’s syndrome due to hyper or hyposecretion of the pituitary gland?

Answer 15

Hypersecretion

Question 16

Is acromegaly due to hyper or hyposecretion of the pituitary gland?

Answer 16

Hypersecretion

Question 17

What are some examples of ACTH dependent causes of Cushing’s syndrome?

Answer 17

Pituitary tumour (Cushing’s disease)

Ectopic ACTH secretion (such as lung carinoid)

Question 18

What are some ACTH independent causes of Cushing’s syndrome?

Answer 18

Adrenal tumour (adenoma or carcinoma)

Corticosteroid therapy (such as for asthma or IBD)

Question 19

What disease is this?

Answer 19

Cushing’s syndrome

Question 20

What is the clinical manifestation of hyperprolactinaemia?

Answer 20

Question 21

Is hyperprolactinaemia due to hyper or hyposecretion of the pituitary gland?

Answer 21

Hypersecretion

Question 22

What is the aetiology of hyperlacticaemia?

Answer 22

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

Question 23

What are some examples of drugs that may cause hyperprolactinaemia?

Answer 23

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

Question 24

What are some clinical features of pituitary hypofunction?

Answer 24

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

Question 25

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

Answer 25

Cranial diabetes insipidus

Question 26

What causes cranial diabetes insipidus?

Answer 26

Hypothalamus does not produce enough vasopressin hormone

Question 27

What investigation is done for cranial diabetes insipidus?

Answer 27

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

Question 28

What is the differential diagnosis for cranial diabetes insipidus?

Answer 28

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

Question 29

What investigation is used to see if there is space occupation due to the pituitary gland?

Answer 29

MRI

Question 30

What visual field defect is caused by a pituitary tumour?

Answer 30

Bitemporal hemianopia

Question 31

What is the management of prolactinoma?

Answer 31

Dopamine agonist

Question 32

What is the management of acromegaly due to pituitary tumour?

Answer 32

Somatostatin analogues

GH receptor antagonist

Question 33

What is the management of hyposecretion due to pituitary tumour?

Answer 33

Cortisol, T4, sex steroids, GH

Desmopressin

Question 34

What is the treatment of pituitary tumours?

Answer 34

Surgery (mostly transphenoidal)

Radiotherapy

Question 35

What approach is used for surgery for pituitary tumours?

Answer 35

Transsphenoidal

Question 36

What are some of the beneficial effects of somatostatin analogues in acromegaly?

Answer 36

• Improve soft tissue overgrowth, sweating, headache, sleep apnoea in most patients
• Normalise GH and IGF-1 levels in over 50% of patients
• Induce tumour shrinkage in majority
• Reduce morbidity and mortality from acromegaly

Question 37

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

Answer 37

Slow release octreotide and lanreotide

Question 38

What are some adverse effects of somatostatin analogues?

Answer 38

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

Question 39

What is prolactinoma treated with?

Answer 39

Dopamine agonist