Clinical aspects of pituitary disease Flashcards
name 3 conditions caused by a hypersecreting pituitary tumour.
acromegaly (GH)
cushings (ACTH)
hyperprolactinaemia (Prolactin)
what are the clinical features of acromegaly?
oft tissue overgrowth;
- large hands
- large/wide feet
- coarse facial features
- thick lips/ tongue
- carpal tunnel syndrome
- sweating
what are the complications from acromegaly?
headache chiasmal compression diabetes mellitus cardiomyopathy hypertension sleep apnoea accelerated osteoarthritis colonic polpys & CA
what test would you carry out if you suspected acromegaly?
MRI (to investigate if there is a pituitary tumour)
GH levels
if someone has acromegaly would tests would you carry out to investigate any complications?
blood glucose (diabetes?)
test their vision
colonoscopy
what condition is caused by an ACTH secreting pituitary tumour?
cushings disease
what condiitons is caused by over medication with corticosteroids?
cushings syndorme
what are the causes of cushings syndrome which are independant of ACTH production?
adrenal tumour
corticosteorid therapy
what are the causes of cushings syndrome which are dependant on ACTH overproduction?
pituitary tumour
extopic ACTH secretion i.e. from lung carcinoid
what are the high value diagnostuc symptoms and signs of cushings syndrome?
skin atrophy spontaneous purport proximal myopathy osteoporosis growth arrest in children
what are the intermediate value diagnostic symptoms and signs of cushings syndrome?
pink striae
facial mooning and hirsutism
oedema
what are the nonspecific diagnostic signs and symptoms of cushings syndrome?
hypertension
central obesity
what are the clinical manifestations of hyperprolactinaemia in women?
galactorrhoea
mentrual irregularity
infertillity
what are the clinical manifestations of hyperprolactinaemia in men?
galactorrhoea impotence visual field abnormalities headache extraocular muscle weakness anterior pituitary malfunction
what are the causes of hyperprolactinaemia?
pregnancy lactation stress DA depleting and DA antagonist drugs primary hypothyroidism pituitary lesion (prolactinoma or pituitary stalk pressure)
what drugs may cause hyperprolactinaemia?
dopamine antagonists i.e. - DA depleting agents oestrogens antidepressants anti-emetics (metoclproamide) neuroleptics (chlorpromazine)
what is the treatment for acromegaly?
somatostatin analogues
- monthly injections of slow release Octreotide & Lanreotide
what are the adverse effects from somatostatin analogues?
nausea cramps diarrhoea flatulence cholesterole gallstones
what is down side to pituitary radiotherapy for treating tumours?
acts slowly
causes hypopituitarism
what size is the tumour for it to be classed as either microprolactinoma or macroprolactinoma?
micro < 10mm
macro > 10mm
what is the treatment for prolactinomas?
dopamine agonists
i.e. Cabergoline & bromocriptine
what is test is diagnostic of prolactinomas ?
serum PRL (elevated)
what condition occurs if there is hyposecretion of vasopressin from the hypothalamus or pituitary?
diabetes insipidus
what test can be carried out to diagnose diabetes insipid?
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
what causes diabetes inspipidus?
damage to the pituitary or hypothalamus due to;
- tumour
- infection (meningitis)
- inflammation
- head trauma
- surgery
