Clinical aspects of pituitary disease

Question 1

name 3 conditions caused by a hypersecreting pituitary tumour.

Answer 1

acromegaly (GH)
cushings (ACTH)
hyperprolactinaemia (Prolactin)

Question 2

what are the clinical features of acromegaly?

Answer 2

oft tissue overgrowth;

• large hands
• large/wide feet
• coarse facial features
• thick lips/ tongue
• carpal tunnel syndrome
• sweating

Question 3

what are the complications from acromegaly?

Answer 3

headache
chiasmal compression
diabetes mellitus
cardiomyopathy
hypertension
sleep apnoea 
accelerated osteoarthritis 
colonic polpys & CA

Question 4

what test would you carry out if you suspected acromegaly?

Answer 4

MRI (to investigate if there is a pituitary tumour)

GH levels

Question 5

if someone has acromegaly would tests would you carry out to investigate any complications?

Answer 5

blood glucose (diabetes?)
test their vision
colonoscopy

Question 6

what condition is caused by an ACTH secreting pituitary tumour?

Answer 6

cushings disease

Question 7

what condiitons is caused by over medication with corticosteroids?

Answer 7

cushings syndorme

Question 8

what are the causes of cushings syndrome which are independant of ACTH production?

Answer 8

adrenal tumour

corticosteorid therapy

Question 9

what are the causes of cushings syndrome which are dependant on ACTH overproduction?

Answer 9

pituitary tumour

extopic ACTH secretion i.e. from lung carcinoid

Question 10

what are the high value diagnostuc symptoms and signs of cushings syndrome?

Answer 10

skin atrophy
spontaneous purport 
proximal myopathy
osteoporosis 
growth arrest in children

Question 11

what are the intermediate value diagnostic symptoms and signs of cushings syndrome?

Answer 11

pink striae
facial mooning and hirsutism
oedema

Question 12

what are the nonspecific diagnostic signs and symptoms of cushings syndrome?

Answer 12

hypertension

central obesity

Question 13

what are the clinical manifestations of hyperprolactinaemia in women?

Answer 13

galactorrhoea
mentrual irregularity
infertillity

Question 14

what are the clinical manifestations of hyperprolactinaemia in men?

Answer 14

galactorrhoea 
impotence 
visual field abnormalities
headache
extraocular muscle weakness
anterior pituitary malfunction

Question 15

what are the causes of hyperprolactinaemia?

Answer 15

pregnancy
lactation
stress
DA depleting and DA antagonist drugs 
primary hypothyroidism
pituitary lesion (prolactinoma or pituitary stalk pressure)

Question 16

what drugs may cause hyperprolactinaemia?

Answer 16

dopamine antagonists i.e.
- DA depleting agents 
oestrogens 
antidepressants
anti-emetics (metoclproamide)
neuroleptics (chlorpromazine)

Question 17

what is the treatment for acromegaly?

Answer 17

somatostatin analogues

- monthly injections of slow release Octreotide & Lanreotide

Question 18

what are the adverse effects from somatostatin analogues?

Answer 18

nausea
cramps
diarrhoea
flatulence 
cholesterole gallstones

Question 19

what is down side to pituitary radiotherapy for treating tumours?

Answer 19

acts slowly

causes hypopituitarism

Question 20

what size is the tumour for it to be classed as either microprolactinoma or macroprolactinoma?

Answer 20

micro < 10mm

macro > 10mm

Question 21

what is the treatment for prolactinomas?

Answer 21

dopamine agonists

i.e. Cabergoline & bromocriptine

Question 22

what is test is diagnostic of prolactinomas ?

Answer 22

serum PRL (elevated)

Question 23

what condition occurs if there is hyposecretion of vasopressin from the hypothalamus or pituitary?

Answer 23

diabetes insipidus

Question 24

what test can be carried out to diagnose diabetes insipid?

Answer 24

water depravation test
as the patient is deprived of water, the urine should be concentrated to preserve water in the body but with DI, it isn’t concentrated due to lack of ADH therefore resulting in too much excretion of water = dehydration

Question 25

what causes diabetes inspipidus?

Answer 25

damage to the pituitary or hypothalamus due to;

• tumour
• infection (meningitis)
• inflammation
• head trauma
• surgery