Clinical Aspects of Pituitary Disease Flashcards
What are the hypersecretion tumours of the pituitary?
Growth hormone - acromegaly or gigantism
ACTH - cushing’s disease
Prolactin - hyperprolactinaemia
What are the hyposecretion conditions of the pituitary?
Anterior (FSH/LH, GH, ACTH, TSH)
Posterior (vasopressin)
What are the space occupying conditions caused by the piuitary?
Optic chiasmal compression
What are the clinical features of acromegaly?
Soft tissue overgrowth:
Spade like hands
Wide feet
Coarse facial features
Thick lips and tongue
Carpal tunnel syndrome
Sweating
Complications:
Headache
Chiasmal compression
Diabetes mellitus
Hypertension
Cardiomyopathy
Sleep apnoea
Accelerated OA
Colonic polyps
Headaches and weating are the most common symptoms of acromegaly
What is the treatment of acromegaly?
Somatostatin anologue
Surgery
Radiation therapy
What causes cushings syndrome?
Excess corticosteroids
What is the effect of cortisol on tissue, sodium and insulin?
Causes tissue breakdown - weakness of the skin, muscle and bone
Sodium retention - may cause hypertension and heart failure
Insulin antagonism - may cause diabetes mellitus
What are the high value symptoms and signs of cushing’s syndrome?
High value:
Skin atrophy
Spontaneous purpura
Proximal myopathy
Osteoporosis
Growth arrest in children
Intermediate value:
Pink striae
Facial mooning and hirsutism
Oedema
Non-specific:
Central obesity
Hypertension
What are the two types of cushing’s syndrome?
ACTH - dependant
Pituitary tumour (cushing’s disease)
Ectopic ACTH secretion (e.g lung carcinoid)
ACTH - Independant
Adrenal tumour (adenoma or carcinoma)
Corticosteroid therapy (asthma or IBD)
What is the clinical manifestation of hyperprolactinaemia?
Women:
Galactorrhoea (spontaneous flow of milk from the breast)
Menstrual irregularity
Infertility
Men:
Galactorrhoea
Impotence (unable to achieve erection or orgasm)
Visual field abnormalities
Headache
Extrraocular muscle weakness
Anterior pituitary malfunction
What are the physiological causes of hyperprolactinaemia?
Pregnancy
Lactation
Stress
What are the pharmacological causes of hyperprolactinaemia?
Dopamine depleting drugs
Dopamine antagonist drugs
What are the pathological causes of hyperprolactinaemia?
Primary hypothyroidism
Pituitary lesions (prolactinoma or ‘pituitary stalk pressure’)
What are the drugs which may cause hyperprolactinaemia?
Dopamine antagonists
Neuroleptics (chlorpromazine)
Anti-emitics (metoclopramide)
DA-depleting agents
Oestrogens
Some antidepresants
Homeopathic and herbal remedies
What are the clinical features of hypopituitarism in adults vs children?
Adults:
Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
Skin pallor
Reduced body hair
Children:
Reduced linear growth
Delayed puberty