Clinical aspects of pituitary disease Flashcards
What does hypersecretion of GH lead to?
acromegaly
gigantism
What does hypersecretion of ACTH lead to?
Cushings disease
What does hypersecretion of prolactin lead to?
hyperprolactinaemia
Soft tissue overgrowth of acromegaly
hands like spades - rings feet - shoe size coarse facial features thick lips and tongue carpal tunnel syndrome sweating
Complications of acromegaly
headache chiasmal compression hypertension diabetes mellitus cardiomyopathy sleep apnoea colonic polyps osteoarthritis
How is acromegaly diagnosed
GH not suppressed by an OGTT IGF1 elevated MRI for pituitary tumour pituitary function vision
What does sodium do in terms of sodium retention?
cause hypertension and heart failure
Why does cortisol cause diabetes?
insulin antagonist
List some high value signs of cushings disease
skin atrophy proximal myopathy spontaneous purpura growth arrest osteoporosis
List some mid value sings of cushings disease
pink striae
moon face
hirsutism
oedema
List some low value signs of cushings disease
central obesity
hypertension
2 causes of ACTH dependent cushings
pituitary tumour - cushing’s disease
Ectopic ACTH eg lung carcinoma
2 causes of ACTH independent cushings
adrenal tumour - adenoma or carcinoma
CCS therapy eg IBD, asthma
Hirsutism
Excessive hair growth in females which represents a normal male hair growth pattern
How hyperprolactinaemia can present in women
galactorrhoea
infertility
menstrual irregularity
How hyperprolactinaemia can present in men
galactorrhoea headache impotence visual field abnormalities extraocular muscle weakness anterior pituitary malfunction
Physiological causes of hyperprolactinaemia
pregnancy, lactation, stress
Pharmacological causes of hyperprolactinaemia
DA depleting and DA antagonists
Pathological causes of hyperprolactinaemia
Primary hypothyroidism
pituitary lesion eg prolactinoma or pituitary stalk lesion
4 drug types which may cause hyperprolactinaemia
DA antiagonists eg antiemetics
DA depleting drugs
anti-depressants
oestrogens - not OCP
Adult signs of hypopituarism
tired, weight gain, depression
reduced libido, impotence, menstrual problems
skin problems, reduced body hair
Child signs of hypopituarism
stunted linear growth
delayed puberty
How is cranial diabetes investigated and what causes this?
lack of vasopressin
water deprivation test - urine does not concentrate
Differential diagnosis for cranial diabetes insipidus
idiopathic
post trauma
brain tumours
rare eg sarcoidosis
