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Endocrine > Clinical Aspects of 
Pituitary Disease > Flashcards

Clinical Aspects of 
Pituitary Disease Flashcards

1
Q

What are the hypersecretion tumours of the pituitary?

A

Growth hormone - acromegaly or gigantism

ACTH - cushing’s disease

Prolactin - hyperprolactinaemia

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2
Q

What are the hyposecretion conditions of the pituitary?

A

Anterior (FSH/LH, GH, ACTH, TSH)

Posterior (vasopressin)

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3
Q

What are the space occupying conditions caused by the piuitary?

A

Optic chiasmal compression

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4
Q

What are the clinical features of acromegaly?

A

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

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5
Q

What is the treatment of acromegaly?

A

Somatostatin anologue

Surgery

Radiation therapy

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6
Q

What causes cushings syndrome?

A

Excess corticosteroids

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7
Q

What is the effect of cortisol on tissue, sodium and insulin?

A

Causes tissue breakdown - weakness of the skin, muscle and bone

Sodium retention - may cause hypertension and heart failure

Insulin antagonism - may cause diabetes mellitus

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8
Q

What are the high value symptoms and signs of cushing’s syndrome?

A

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

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9
Q

What are the two types of cushing’s syndrome?

A

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)

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10
Q

What is the clinical manifestation of hyperprolactinaemia?

A

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

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11
Q

What are the physiological causes of hyperprolactinaemia?

A

Pregnancy

Lactation

Stress

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12
Q

What are the pharmacological causes of hyperprolactinaemia?

A

Dopamine depleting drugs

Dopamine antagonist drugs

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13
Q

What are the pathological causes of hyperprolactinaemia?

A

Primary hypothyroidism

Pituitary lesions (prolactinoma or ‘pituitary stalk pressure’)

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14
Q

What are the drugs which may cause hyperprolactinaemia?

A

Dopamine antagonists

Neuroleptics (chlorpromazine)

Anti-emitics (metoclopramide)

DA-depleting agents

Oestrogens

Some antidepresants

Homeopathic and herbal remedies

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15
Q

What are the clinical features of hypopituitarism in adults vs children?

A

Adults:

Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems

Skin pallor

Reduced body hair

Children:

Reduced linear growth

Delayed puberty

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16
Q

Define diabetes insipidus

A

A disease in which the secretion of or response to the pituitary hormone vasopressin is impaired, resulting in the production of very large quantities of dilute urine, often with dehydration and insatiable thirst

17
Q

What are the causes of diabetes insipidus?

A

Idiopathic - autoimmune hypophysitis

Post trauma

Metastatic carcimnoma

Craniopharyngioma

Other brain tumours (germinoma)

Rare causes (sarcoidosis)

18
Q

What can cause bitemporal hemianopia?

A

Space occupying lesion of the pituitary

(pituitary adenoma)

19
Q

How do we manage hypersecretion of pituitary tumours?

A

Dopamine agonists (prolactinoma)

Somatostatin anologues (acromegaly)

GH receptor antagonists (acromegaly)

20
Q

How do we manage hyposecretion of pituitary?

A

Cortisol

T4 (thyroxine)

Sex steroids

GH

Desmopressin

21
Q

What are the beneficial effects of somatostatin anologues in acromegaly?

A
  • Improve soft tissue overgrowth, sweating, headache, sleep apnoea in most patients
  • Normalise GH and IGF-1 levels in over 50% patients
  • Induce tumour shrinkage in the majority
  • Reduce morbidity & mortality from acromegaly
22
Q

Give examples of somatostatin anologues

A

Octreotide

Lanreotide

23
Q

What are the adverse effects of somatostatin anologues?

A
  • Nausea, cramps, diarrhoea, flatulence (often transient)
  • Cholesterol gallstones occur in 20-30% (mostly asymptomatic)
  • Slow-release preparations require monthly IM/SC injections
  • High cost (£6-12,000 annually)
24
Q

Pituitary radiotherapy and surgery?

A

Pituitary radiotherapy:

use declining, acts slowly,

causes hypopituitarism

Pituitary surgery: especially for non-functional pituitary

tumours and Cushing’s disease

25
Q

What hormones control release of prolactin?

A

Thyrotrophin releasing hormone increases release of prolactin

Dopamine (prolactin inhibiting factor) inhibits the release of prolactin and cancels the effects of thyrotrophin releasing hormone

Dopamine is constantly released in anyone that is not pregnant

26
Q

What negative feedback mechanisms are activated as a result of too much prolactin?

A

Dopamine release is triggered

Gonadotrophin releasing hormone levels are reduced

27
Q

What is the definition of a microprolactinoma and a macroprolactinoma?

A
28
Q

What are the features of microprolactinoma?

A

Usually women with galactorrhoea

Amenorrhoea

Infertility

Serum prolactin less than 5000 mU/I

29
Q

What is the treatment of microprolactinoma?

A

Cabergoline (dopamine receptor agonist)

Ovulatory cycles, fertility and normoprolactinaemia is restored in most cases

30
Q

What is the response to dopamine agonist when there is macroprolactinoma?

A
  • Rapid fall in serum PRL (hours)
  • Tumour shrinkage (days/weeks)
  • Visual improvement (often within days)
  • Often recovery of pituitary function

80-90% tumours show these responses & most will shrink by at least one half

Endocrine (25 decks)

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