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ZA - Endocrine System > Clinical Aspects of Pituitary Disease > Flashcards

Clinical Aspects of Pituitary Disease Flashcards

1
Q

What disease come from hypersecretion of the pit.gland? Causes?

A

Acromegaly - GH
Cushing’s - ACTH
Hyperprolactinaemia - Prolactin

Tumours

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2
Q

Hormones affected by hyposecretion? Cause?

A

AG - FSH/LH, GH, ACTH and TSH

PG - vasopressin

Mostly due to tumours too

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3
Q

What is FSH and LH?

A

Follicle stimulating hormone

Luteinizing hormone

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4
Q

What is another common presentation of a pit. tumour?

A

Bitemporal hemianopsia due to optic chiasmal compression

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5
Q

Clinical features of acromegaly?

A

Soft tissue like overgrowth =

Spade like hands
Wide feet
Thick lips and tounge
Space between teeth
Sweating
Carpal tunnel syndrome
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6
Q

Complications form acromegaly?

A 
Diabetes 
Hypertension 
Cardiomyopathy
Sleep apnoea
Headaches
Chaismal compression = bitemporal hemianopsia
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7
Q

Diagnosis of acromegaly?

A

Test to see if GH can be supressed via a OGTT

Is IGF-1 elevated?

Glucose will also be elevated

Is the rest of pit. gland function normal?

Is vision normal?

tumour on MRI?

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8
Q

What is cushings?

A

Excess cortisol

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9
Q

What does cortisol do?

A

A catabolic hormone

Tissue breakdown causing weakening of skin, muscle and bone

Na retention - causing hypertension and heart failure

Insulin antagonism - causing DM

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10
Q

Symptoms that give high suspicion of cushings?

A 
Moon face with central adiposity but skinny arms and legs, also pink striae 
Oedema
Skin atrophy
Spontaneous purpura
Proximal myopathy
Osteoporosis
Growth arrest in kids
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11
Q

Other causes of cushing’s besides a pit. tumour?

A

ACTH dependant = Ectopic ACTH secretion like a lung carcinoid

ACTH independent = Adrenal tumour - adenoma/carcinoma

Corticosteropid therapy

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12
Q

Cushings disease vs syndrome?

A

Cushing’s disease is a medical cause of Cushing’s syndrome. Cushing’s disease occurs when a tumor on the pituitary gland causes the gland to produce too much ACTH

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13
Q

What are the clinical manifestations of hyperprolactinaemia in women?

A

Galactorrhoea in 30-80%
Menstual irregularity
Infertility

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14
Q

What are the clinical manifestations of hyperprolactinaemia in men?

A 
Galactorrhoea - 5%
Impotence
Visual field abnormalities
Heachache
Extraocular muscle weakness
Anterior pituitary malfunction
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15
Q

What is purpura ?

A

a condition of red or purple discolored spots on the skin that do not blanch on applying pressure

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16
Q

What is galactorrhoea?

A

Production of milk when you shouldn’t be making milk

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17
Q

Causes of hyperprolactinaemia?

A

Physiological - pregnancy, stress, lactation

Pharmacological - Dopamine depleting and dopamine antagonistic drugs

Pathological - 1y hypothyroidism, pit. lesions like prolactinoma or pit. stalk pressure

18
Q

Drugs that may cause hyperprolactinaemia?

A 
Dopamine antagonists - neuroleptics, anti-emetics
Dopamine depleting drugs
Oestrogens
Some antidepressants
Homeopathic or herbal remedies
19
Q

Clinical features of hypo-pituitarism in adults?

A 
Tiredness
Weight gain
Depression
Reduced libido and impotence
Menstrual problems
Skin pallor
Reduced body hair
20
Q

Clinical features of hypopituitarism in kids?

A

Reduced linear growth

Delayed puberty

21
Q

What is cranial diabetes insipidus?

A

The hypothalamus/pit gland does not produce enough anti-diuretic hormone/vasopressin

22
Q

Symptoms of DI?

A

Polyuria/nocturia

Extreme thirst

23
Q

DI differentials/causes?

A 
Idiopthic
Post-trauma
Carcinoma mets
Cranio-pharyngioma
Other brain tumours
Rarer causes like Sarcoidosis
24
Q

Management of prolactinoma?

A

Dopamine agonists for

25
Q

Management for acromegaly?

A

Somatostatin analogues

GH receptor antagonist

26
Q

Management for hyposecretion of normal pit. gland?

A 
Cortisol
T4
Sex steroids
GH
Desmopressin
27
Q

Management for pituitary tumours?

A

Trans-sphenoidal surgery most common

Radiotherapy

28
Q

What are the beneficial effects of somatostatin analogues in acromegaly?

A

Improves soft tissue overgrowth, sweating, headache and sleep apnoea symptoms

Normalise GH and IGF-1 in over 50% of patients

Induce tumour to shrink in the majority

Reduces morbidity and mortality

29
Q

Name somatostatin analogues?

A

Octreotide LAR

Lanreotide autogel

30
Q

Adverse side effects of somatostatin analogues?

A

Nausea
Cramps
Diarrhoea
Flatulence

Cholesterol gallstones - often asymptomatic

31
Q

Disadvantages of SS analogues?

A

Expensive

Slow release preparations need monlthy IM or s/c injections

32
Q

Is pituitary radiotherapy used often?

A

No, use is declining as it acts slowly and causes hypopituitarism

33
Q

When is pituitary surgery carried out?

A

Mainly for non-functioning pit. tumours and cushing’s

34
Q

What hormones control the 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 to stop the effects

35
Q

Neg. feedback loops that stop high levels of prolactin?

A

Dopamine released to inhibit it

Gonadotrophin releasing hormone levels are reduced

36
Q

What is a prolactinoma and what makes it micro/macro?

A

A functional tumour that divides uncontrollably and makes prolactin
Can compress optic chiasm

Over 10mm is macro and under is micro

37
Q

Features of micro-prolactinoma

A

Usually women with galactorrhoea

Amenorrhoea

Infertility

Serum prolactin less than 5000 mU/I

38
Q

What is amenorrhoea?

A

Absence of a menstrual period

39
Q

Treatment of microprolactinoma?

A

Cabergoline (dopamine receptor agonist)

Ovulatory cycles, fertility and normoprolactinaemia is restored in 70-90%

40
Q

Dopamine agonist effects on 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

ZA - Endocrine System (21 decks)

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