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Endocrinology > Clinical Aspects of Pituitary Disease > Flashcards

Clinical Aspects of Pituitary Disease Flashcards

1
Q

When they grow where can pituitary tumours press on?

A

Optic chiasma

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2
Q

What causes acromegaly?

A

Hypersecretion of GH

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3
Q

What causes Cushing’s Disease?

A

Hypersecretion of ACTH

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4
Q

What causes hyperprolactinaemia?

A

Hypersecretion of prolactin

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5
Q

What can there be hyposecretion of from the pituitary?

A

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

Posterior (vasopressin_

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6
Q

What are some clinical features of acromegaly?

A 
Spade like hands 
Wide feet 
Coarse facial features
Thick lips and tongue 
Widening of interdontal spaces 
Carpal tunnel syndrome
Headaches 
Sweating
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7
Q

What are some complications of acromegaly?

A 
Headache 
Chiasmal compression 
DM 
Hypertension 
Cardiomyopathy
Sleep apnoea (breathing difficulty when sleeping)
Accelerated osteoarthritis 
Colonic polyps and colonic carcinoma
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8
Q

Why is there accelerated osteoarthritis in acromegaly?

A

Due to the increase in soft tissue there is more pressure on the joints

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9
Q

What are the 2 key blood tests for acromegaly?

A

OGTT

Insulin growth like factor -1 (IGFR-1)

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10
Q

What are the further investigations for acromegaly?

A

CT
MRI
to see if there is any tumour present

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11
Q

What is Cushing’s disease?

A

Excess cortisol from the PG

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12
Q

What is Cushing’s syndrome?

A

Excess cortisol from the adrenal cortex

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13
Q

What are high value symptoms of cushing’s syndrome?

A 
Skin atrophy 
Spontaneous purpura 
Proximal myopathy
Osteoporosis 
Growth arrest in children
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14
Q

What are intermediate symptoms of cushing’s disease?

A

Pink striae
Facial mooning & hirsutism
Oedema

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15
Q

Are all cases of cushing’s syndrome due to a pituitary tumour?

A

No

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16
Q

What is meant by ACTH dependent cushing’s?

A

The excess cortisol release is driven by excess ACTH release

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17
Q

What is meant by ACTH independent cushing’s?

A

ACTH is normal

But cortisol is high

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18
Q

What can cause excess ACTH?

A 
Pituitary tumour (Cushing's disease)
Ectopic ACTH secretion
19
Q

Give an example of something that can cause ectopic ACTH secretion?

A

Lung carcinoid

20
Q

What can cause ACTH independent Cushing’s disease?

A 
Adrenal tumour 
Corticosteroid therapy  (using high dosage of steroid for long periods of time)
21
Q

What are the investigations for Cushing’s?

A

24hr urinary cortisol
Dexamethasone suppression test
MRI - tumours PG?

22
Q

What should DEX suppression test do in normal people?

A

Lowers the level of cortisol in the body

23
Q

What are clinical manifestations of hyperprolactinaemia in women?

A

Menstrual irregularity
Infertility
Galactorrhoea (milky nipple discharge)

24
Q

What are the clinical features of hyperprolactinaemia in men?

A 
Galactorrhoea Impotence (inability to achieve an erection)
Visual field abnormalities 
Headache 
Extraocular muscle weakness 
Anterior pituitary malfunction
25
Q

What are physiological causes of prolactinaemia?

A

Pregnancy
Lactation
Stress

26
Q

What are some pharmacological causes of prolactinaemia?

A

DA deplteting

DA antagonist

27
Q

What are some pathological causes of prolactinaemia?

A

Primary hyperthyroidism

Pituitary lesions

28
Q

Which drugs may cause prolactinaemia?

A

DA antagonists
DA depleting durgs
Oestrogens
Some anti-depressants

29
Q

What are clinical features of pituitary hypofunction in adults?

A 
Tiredness 
Weight gain 
Depression 
Reduced libido 
Impotence 
Menstrual problems 
Skin pallor 
Reduced body hair
30
Q

What are clinical features of pituitary hypofunction in children?

A

Reduced linear growth

Delayed puberty

31
Q

What causes cranial diabetes insipidus?

A

Lack of vasporessin

32
Q

What can cause Diabetes insipidus?

A 
Idiopathic 
Post trauma
Metastatic carcinoma 
Other brain tumours 
Rare causes e.g sarcoidosis
33
Q

What type of visual loss can a pituitary tumour cause?

A

Bitemporal hemianopia?

34
Q

If there is a pituitary tumour what is the preferred Rx?

A

Surgery
Transsphenoidal

Radiation if surgery is not possible

35
Q

What is the drug treatment for hypersecreting pituitary tumours?

A

DA agonists
Somatostain analogues
GH receptor antagonist

36
Q

What is the drug treatment for hyposecreting pituitary tumours?

A 
Cortisol 
T4 
Sex steroids 
GH 
Desmopressin
37
Q

What are the beneficial effects of somatostatin analogues in acromegaly?

A

Improves soft tissue overgrowth, sweating, headaches, sleep apnoea
Normalise GH and IGF-1 in 50%
Induce tumours shrinkage in majority

38
Q

What are the side effects of somatostatin analogues in acromegaly?

A 
Nausea 
Cramps 
Diarrhoea 
Flatulence 
Cholesterol gallstones 
High cost
39
Q

What is prolactinoma?

A

Tumour of the PG secreting Prolactin

40
Q

What is a microprolactinoma?

A

When prolactinoma is <10mm

41
Q

How is microprolactinoma treated?

A

Dopamin agonists

42
Q

What are symptoms of microprolactinoma?

A

Galactorrhoea, Amenorrhoea, infertility &

Serum PRL <5000 mU/l (N<500)

43
Q

What is a macroprolactinoma?

A

Prolactinoma >10mm

44
Q

What do macroprolactinomas typically respond to?

A

Dopamine agonists

Endocrinology (19 decks)

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