Clinical Aspects of Pituitary Disease Flashcards
When they grow where can pituitary tumours press on?
Optic chiasma
What causes acromegaly?
Hypersecretion of GH
What causes Cushing’s Disease?
Hypersecretion of ACTH
What causes hyperprolactinaemia?
Hypersecretion of prolactin
What can there be hyposecretion of from the pituitary?
Anterior - (FSH/LH, GH, ACTH, TSH)
Posterior (vasopressin_
What are some clinical features of acromegaly?
Spade like hands Wide feet Coarse facial features Thick lips and tongue Widening of interdontal spaces Carpal tunnel syndrome Headaches Sweating
What are some complications of acromegaly?
Headache Chiasmal compression DM Hypertension Cardiomyopathy Sleep apnoea (breathing difficulty when sleeping) Accelerated osteoarthritis Colonic polyps and colonic carcinoma
Why is there accelerated osteoarthritis in acromegaly?
Due to the increase in soft tissue there is more pressure on the joints
What are the 2 key blood tests for acromegaly?
OGTT
Insulin growth like factor -1 (IGFR-1)
What are the further investigations for acromegaly?
CT
MRI
to see if there is any tumour present
What is Cushing’s disease?
Excess cortisol from the PG
What is Cushing’s syndrome?
Excess cortisol from the adrenal cortex
What are high value symptoms of cushing’s syndrome?
Skin atrophy Spontaneous purpura Proximal myopathy Osteoporosis Growth arrest in children
What are intermediate symptoms of cushing’s disease?
Pink striae
Facial mooning & hirsutism
Oedema
Are all cases of cushing’s syndrome due to a pituitary tumour?
No
What is meant by ACTH dependent cushing’s?
The excess cortisol release is driven by excess ACTH release
What is meant by ACTH independent cushing’s?
ACTH is normal
But cortisol is high
What can cause excess ACTH?
Pituitary tumour (Cushing's disease) Ectopic ACTH secretion
Give an example of something that can cause ectopic ACTH secretion?
Lung carcinoid
What can cause ACTH independent Cushing’s disease?
Adrenal tumour Corticosteroid therapy (using high dosage of steroid for long periods of time)
What are the investigations for Cushing’s?
24hr urinary cortisol
Dexamethasone suppression test
MRI - tumours PG?
What should DEX suppression test do in normal people?
Lowers the level of cortisol in the body
What are clinical manifestations of hyperprolactinaemia in women?
Menstrual irregularity
Infertility
Galactorrhoea (milky nipple discharge)
What are the clinical features of hyperprolactinaemia in men?
Galactorrhoea Impotence (inability to achieve an erection) Visual field abnormalities Headache Extraocular muscle weakness Anterior pituitary malfunction
What are physiological causes of prolactinaemia?
Pregnancy
Lactation
Stress
What are some pharmacological causes of prolactinaemia?
DA deplteting
DA antagonist
What are some pathological causes of prolactinaemia?
Primary hyperthyroidism
Pituitary lesions
Which drugs may cause prolactinaemia?
DA antagonists
DA depleting durgs
Oestrogens
Some anti-depressants
What are clinical features of pituitary hypofunction in adults?
Tiredness Weight gain Depression Reduced libido Impotence Menstrual problems Skin pallor Reduced body hair
What are clinical features of pituitary hypofunction in children?
Reduced linear growth
Delayed puberty
What causes cranial diabetes insipidus?
Lack of vasporessin
What can cause Diabetes insipidus?
Idiopathic Post trauma Metastatic carcinoma Other brain tumours Rare causes e.g sarcoidosis
What type of visual loss can a pituitary tumour cause?
Bitemporal hemianopia?
If there is a pituitary tumour what is the preferred Rx?
Surgery
Transsphenoidal
Radiation if surgery is not possible
What is the drug treatment for hypersecreting pituitary tumours?
DA agonists
Somatostain analogues
GH receptor antagonist
What is the drug treatment for hyposecreting pituitary tumours?
Cortisol T4 Sex steroids GH Desmopressin
What are the beneficial effects of somatostatin analogues in acromegaly?
Improves soft tissue overgrowth, sweating, headaches, sleep apnoea
Normalise GH and IGF-1 in 50%
Induce tumours shrinkage in majority
What are the side effects of somatostatin analogues in acromegaly?
Nausea Cramps Diarrhoea Flatulence Cholesterol gallstones High cost
What is prolactinoma?
Tumour of the PG secreting Prolactin
What is a microprolactinoma?
When prolactinoma is <10mm
How is microprolactinoma treated?
Dopamin agonists
What are symptoms of microprolactinoma?
Galactorrhoea, Amenorrhoea, infertility &
Serum PRL <5000 mU/l (N<500)
What is a macroprolactinoma?
Prolactinoma >10mm
What do macroprolactinomas typically respond to?
Dopamine agonists
